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 19 June 2018

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GastroenterologyStomach & duodenum

Benign tumors

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Leiomyoma of stomach.

An 86-year old man admitted with acute on chronic gastrointestinal haemorrhage. His haemoglobin on admission was 77 g/L and he had developed angina. This settled after blood transfusion. He then vomited fresh blood.

An endoscopy showed a leiomyoma adjacent to the cardia. There was a bleeding ulcer at the apex.

The operative photograph shows the leiomyoma. The stomach has been opened and the tumour everted. The ulcerated area at the apex can be clearly seen. A local excision of the tumour was performed. The specimen has been cut in half. Areas of necrosis can be seen in the body of the tumour. The arrow points to the apical ulcer.

Leiomyomas (now referred to as 'GIST,' or gastrointestinal stromal tumours) are relatively common. Those that occur in the stomach are usually found incidentally at endoscopy and most never cause symptoms. As the tumour enlarges, it may outgrow its blood supply, infarct and ulcerate at its apex. Bleeding from the mucosal edges may lead to anaemia or profuse haemorrhage. Local therapies (acid suppression or injection of adrenaline) are ineffective and resection is required. Small tumours (<4cm) tend to be benign and local wedge excision is adequate treatment. Larger tumours (>4cm) and those with more than 5-10 mitotic figures per high powered field have increased malignant potential and formal gastric resection should be considered.
Peter Devitt, Adelaide, Australia

Leiomyoma of stomach.

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