LETTERS TO THE EDITOR

 

Endoscopic full-thickness resection for a gastric angioleiomyoma

 

 

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Key words: Angioleiomyoma. Endoscopic full-thickness resection. Submucosal tumor.

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Dear Editor,

Angioleiomyoma (ALM) is a rare benign tumor which usually appears on the extremities, particularly the lower legs, and seldom involves the digestive tract (1,2). It is composed of varied smooth muscle bundles and vascular channels (3). We describe the first case report of gastric ALM.

 

Case report

A 63-year old female presented to our hospital due to a three year history of heartburn and abdominal distension. The physical examination and laboratory results were unremarkable. Esophagogastroduodenoscopy showed a 1.5 cm protrusive lesion in the gastric corpus with a smooth overlying mucosa (Fig. 1A), and endoscopic ultrasonography showed that the tumor originated from the muscularis propria layer (MP) (Fig. 1B). Computerized tomography showed no metastasis or lymph node involvement.

 

 

Endoscopic full-thickness resection (EFTR) without laparoscopic assistance was performed as follows (Fig. 1 C-F): a) a sub-mucosal injection and precutting of the mucosal and sub-mucosal layer around the lesion; b) a circumferential incision as deep as the MP layer around the lesion using the ESD technique; c) incision into the serosal layer around the lesion; d) full-thickness resection of the tumor including the serosal layer; and e) closure of the gastric wall defect with metallic clips. The procedure was completed without complications and the resected specimen measured 1.8 × 1.5 × 1.5 cm (Fig. 1G). Histopathological results revealed that the tumor consisted of intersecting fascicles of spindle cells merged into numerous vascular structures with thick proliferated walls (Fig. 1H). Smooth muscle actin (SMA) and CD34 immunohistochemical staining were positive in the spindle cells, and CD34 was also positive in the vascular walls (Fig. 1I and J). Dog-1, Syn and Ki-67 were focally positive in these spindle cells, which was consistent with stomach ALM.

There was no disease recurrence during the follow-up of one year.

 

Discussion

ALM is a rare benign tumor that most commonly occurs in middle-aged people, especially in females. Paroxysmal pain is the most striking clinical presentation (3). ALM is rarely diagnosed preoperatively; immunohistochemical examination is necessary to differentiate it from other mesenchymal tumors. Three types can be distinguished based on pathological features: capillary or solid, cavernous and venous (3). Local excision, which is curative, is often recommended and tumor recurrence is rare (3,4). EFTR is a minimally invasive technique for the resection of gastric submucosal tumors originating from muscularis propria with a high success rate and low complication rate (5).

In this case, the solid ALM was located in the gastric corpus and there were no specific symptoms. It was successfully managed with EFTR and there was no recurrence during follow-up.

 

Guinan Liu, Yuyong Tan and Jirong Huo
Department of Gastroenterology.
The Second Xiangya Hospital of Central South University.
Changsha, Hunan. China
(huojirong1953@sina.com)

 

References

1. Stout AP. Solitary cutaneous and subcutaneous leiomyoma. Am J Cancer 1937;29:435-69. DOI: 10.1158/ajc.1937.435.         [ Links ]

2. Sadat U, Theivacumar NS, Vat J, et al. Angioleiomyoma of the small intestine - A rare cause of gastrointestinal bleeding. World J Surg Oncol 2007;5:129. DOI:10.1186/1477-7819-5-129.         [ Links ]

3. Hachisuga T, Hashimoto H, Enjoji M. Angioleiomyoma: A clinicopathologic reappraisal of 562 Cases. Cancer 1984;54:126-30. DOI: 10.1002/1097-0142(19840701)54:1126::AID-CNCR2820540125> 3.0.CO;2-F.         [ Links ]

4. Ramesh P, Annapureddy SR, Khan F, et al. Angioleiomyoma: A clinical, pathological and radiological review. Int J Clin Pract 2004;58:587-91.DOI: 10.1111/j.1368-5031.2004.00085.x.         [ Links ]

5. Jain D, Mahmood E, Desai A, et al. Endoscopic full thickness resection for gastric tumors originating from muscularis propria. World J Gastrointest Endosc 2016;8:489-95. DOI:10.4253/wjge.v8.i14.489.         [ Links ]