Gastric Leiomyosarcoma: A Ten-Year Institutional Overview

Abstract

Gastric leiomyosarcoma is a rare malignant smooth muscle tumor, particularly since its immunohistochemical distinction from gastrointestinal stromal tumors. This study aims to present our institutional experience with this entity and to review the available literature. In this study, two cases of gastric leiomyosarcoma were identified among 638 gastric neoplasms diagnosed at our institution over the past 10 years. Both occurred in 73-year-old women: in the first case, a 6 cm lesion located on the greater curvature of the stomach was diagnosed and treated with elective laparoscopic wedge gastrectomy. Histological examination confirmed a grade 1 leiomyosarcoma with negative surgical margins. In the second case, a 12.5 cm circumferential antral lesion was identified and managed with urgent subtotal gastrectomy and Roux-en-Y reconstruction, confirming a grade 2 leiomyosarcoma with negative margins. In both cases, immunohistochemical analysis demonstrated positivity for smooth muscle markers and negativity for c-KIT, DOG-1, and CD34. No adjuvant therapy was administered. Both patients remain disease-free after more than one year of follow-up. In conclusion, definitive diagnosis relies on histological and immunohistochemical confirmation. Complete surgical resection with negative margins remains the treatment of choice. These cases reinforce the central role of surgery in the management of this rare entity and contribute to the limited body of evidence currently available.