Paredes Oscar, Eom Sang Soo, Park Sin Hye, Kim Young-Woo
Center for Gastric Cancer, National Cancer Center, Goyang, South Korea.
Department of Cancer Control and Population Health, National Cancer Center Graduate School of Cancer Science and Policy, Goyang, South Korea.
Heliyon. 2024 Apr 27;10(9):e30410. doi: 10.1016/j.heliyon.2024.e30410. eCollection 2024 May 15.
Gastric liposarcoma (GL) is extremely rare and radical surgery has been the conventional treatment, even in small tumors. Laparoscopic wedge resection has been reported worldwide for subepithelial tumors of the stomach.
The patient was an asymptomatic 63-year-old man presenting with a subepithelial gastric tumor. The esophagogastroduodenoscopy showed a 3 cm ulcerated soft tumor located in the posterior wall of the antrum just above the pylorus. Two preoperative biopsies were performed with a negative result for malignant neoplasm. Dynamic computerized tomography revealed 35 × 35 mm well-defined pyloric mass with fat density. Despite the difficult location of the tumor, function-preserving surgery was performed. Surgery was initiated by a laparoscopic approach with four trocars. After the dissection of the greater omentum, the greater curvature and the posterior wall of the stomach were exposed. A gastrostomy was performed in the anterior wall of the antrum. Due to the difficulty in identifying the tumor location, a mini-laparotomy was conducted. After assessing the pylorus and section parameters, the tumor was extracted by gastrostomy and resected with a linear stapler. The patient was discharged after five days with no complications. The histological diagnosis was a well-differentiated liposarcoma. Resection margins were clear. The tumor cells tested negative for MDM2. No adjuvant therapy was indicated. The patient is alive without recurrence.
Despite its rarity, gastric liposarcoma should be respected for differential diagnosis in submucosal tumors. The main diagnostic method is histological, and surgery is the conventional treatment without yet having a consensus. Minimally invasive wedge resection might be a suitable treatment even if the location is close to the pylorus. Multicenter studies are required to obtain better results in the management of this pathology.
胃脂肪肉瘤（GL）极为罕见，即使对于小肿瘤，根治性手术一直是传统治疗方法。腹腔镜楔形切除术已在全球范围内报道用于胃的上皮下肿瘤。
该患者是一名63岁无症状男性，患有胃上皮下肿瘤。食管胃十二指肠镜检查显示在幽门上方胃窦后壁有一个3 cm的溃疡性软肿瘤。术前进行了两次活检，结果均为恶性肿瘤阴性。动态计算机断层扫描显示一个35×35 mm边界清晰、具有脂肪密度的幽门肿块。尽管肿瘤位置困难，但仍进行了保留功能的手术。手术采用四孔腹腔镜入路开始。在分离大网膜后，暴露胃大弯和胃后壁。在胃窦前壁进行胃造口术。由于难以确定肿瘤位置，进行了小切口剖腹手术。在评估幽门和切除参数后，通过胃造口术取出肿瘤并用直线缝合器切除。患者术后五天出院，无并发症。组织学诊断为高分化脂肪肉瘤。切缘清晰。肿瘤细胞MDM2检测为阴性。无需辅助治疗。患者存活且无复发。
尽管胃脂肪肉瘤罕见，但在鉴别诊断黏膜下肿瘤时仍应予以重视。主要诊断方法是组织学检查，手术是传统治疗方法，但尚未达成共识。即使肿瘤位置靠近幽门，微创楔形切除术也可能是一种合适的治疗方法。需要多中心研究以在这种疾病的管理中取得更好的结果。
