Okamura K, Hayakawa H, Kusakawa M, Takahashi H, Kosaka A, Mizumoto R, Katsuta K
Department of Surgery, Matsusaka City Hospital, Mie, Japan.
Surg Today. 1998;28(10):1056-60. doi: 10.1007/BF02483961.
We describe herein the case of a 73-year-old woman who developed a giant leiomyosarcoma in the remnant stomach 4 years after undergoing a distal gastrectomy for gastric carcinoma. Abdominal ultrasonography and computed tomography revealed a huge tumor, 22 cm in maximum diameter, in the left hypochondrial region. Selective abdominal angiography showed a hypervascular tumor fed by the branches of the splenic artery and left inferior phrenic artery. The tumor arose from the posterior wall of the remnant stomach, and demonstrated marked extragastric growth and direct invasion of the pancreas, transverse colon, and diaphragm on the left side. Total resection of the remnant stomach with en bloc resection of these adjacent organs was subsequently carried out. We reviewed the Japanese literature on this extremely rare tumor and evaluated its clinical profile. In comparison with leiomyosarcoma of the unresected stomach, that of the remnant stomach more frequently showed endogastric-type growth and was accompanied by ulceration of the gastric mucosa. The prognosis of patients with leiomyosarcoma of the remnant stomach appears to be greatly affected by the presence of liver metastases and the tumor diameter, similar to that of patients with leiomyosarcoma of the unresected stomach.
我们在此描述一例73岁女性患者，该患者在因胃癌接受远端胃切除术后4年，残胃发生了巨大平滑肌肉瘤。腹部超声和计算机断层扫描显示左季肋区有一个巨大肿瘤，最大直径达22厘米。选择性腹部血管造影显示该肿瘤血供丰富，由脾动脉分支和左膈下动脉供血。肿瘤起源于残胃后壁，表现为明显的胃外生长，并直接侵犯胰腺、横结肠和左侧膈肌。随后对残胃进行了全切除，并将这些相邻器官整块切除。我们查阅了日本关于这种极其罕见肿瘤的文献，并评估了其临床特征。与未切除胃的平滑肌肉瘤相比，残胃平滑肌肉瘤更常表现为胃内型生长，并伴有胃黏膜溃疡。残胃平滑肌肉瘤患者的预后似乎与未切除胃的平滑肌肉瘤患者一样，受肝转移和肿瘤直径的影响很大。
