Gastric Leiomyoma Misdiagnosed as a Left Cystic Adrenal Tumor

Gastrointestinal leiomyomas often occur in the esophagus, colon, and rectum, but are very rare in the stomach. The patient was referred to Jeju national university medical center for the treatment of a left adrenal tumor diagnosed 5 years ago. She had a long history of repeated left flank pain, nausea, and abdominal distension for the last few years. Annual follow-up computed tomography scan showed a no changed 5×5.5-cm sized multiloculated left adrenal cystic lesion. Laboratory tests revealed that the basal levels of plasma adrenocorticotropin, cortisol, aldosterone, renin, testosterone, adrenaline, noradrenaline, and dopamine were normal findings. The preoperative diagnosis was a left nonfunctioning adrenal neoplasm with symptom of discomfort. However, the tumor revealed as an exophytic growing leiomyoma with cystic changes of a stomach by surgery. The mass was found at the posterior wall of the fundus and about 5-cm-sized mass. Resection of the tumor was performed using laparoscopy. The pathologic diagnosis revealed a gastrointestinal leiomyoma with a benign cystic lesion lined by respiratory epithelium with an old hemorrhage and chronic gastritis. The patient had no evidence of recurrence during the 12-month follow-up. Gastric leiomyoma is unfamiliar to the usual urologists. It needs to take gastric leiomyoma into account if the left adrenal tumor is close to the stomach. Herein, we report the case of a 44-year-old woman with gastrointestinal leiomyoma misdiagnosing as a nonfunctioning adrenal tumor.

Minimally invasive removal of gastric leiomyoma

Leiomas are more common in men aged 20 to 50 years. In women, they occur at an older age and 3 times less often than in men. An essential point in the disease pathogenesis is rapid growth of leiomyomas and their tendency to ulceration with decay, which leads to the development of formidable complications in the form of bleeding, perforation of the hollow organ, followed by the development of peritonitis. The growth of leiomyomas occurs from the thickness of the muscle layer in the form of a single node, mainly endogastrically in 66.5 % of cases. Exogastric growth was noted in 24.6 %, mixed in 5 % and intramural in 3.9 % of cases. A rare representation of benign stomach tumors of non-epithelial origin is characterized by an extremely wide variety of their types and names. A clinical case of surgical treatment of gastric leiomyoma using minimally invasive technologies in a patient with concomitant pathology is presented. The neoplasm was detected during a screening examination of the respiratory system. The patient underwent laparoscopic removal of the neoplasm. A macro- and micropreparation of gastric leiomyoma is presented. After surgical treatment, a positive result was achieved, the patient was discharged from the clinic in a satisfactory condition. The modern development of medicine and the use of video endoscopic technologies significantly expand the possibilities of surgery for neoplasms of the gastrointestinal tract. This observation demonstrates the features of the clinical picture of benign gastric neoplasms and the possibility of using minimally invasive surgical technologies in their treatment against the background of severe comorbid pathology.

Value of CT Imaging in the Differentiation of Gastric Leiomyoma From Gastric Stromal Tumor

Purpose: To discuss significant computed tomography (CT) findings that differentiate gastric leiomyomas (GLs) from small gastric stromal tumors (GSTs). Methods: One hundred sixty cases with pathologically proven GLs (n = 50) and GSTs (n = 110) with comprehensive CT images were enrolled in this retrospective study. Computed tomography findings (ie, size, location, contour, growth pattern, enhancement degree, necrosis, ulceration, calcification, and lymph nodes) were analyzed through the χ2 or Fisher exact test, independent T test, and multivariate (logistic regression) analysis. Sensitivity and specificity were also calculated. Results: Features of cardia location, endophytic growth, homogeneous gradual enhancement, absent of necrosis, long diameter less than 24 mm, short diameter less than 20 mm, unenhanced CT value larger than 35.2 Hounsfield units (HU), portal venous phase CT value larger than 67.4 HU, and enhancement degree of arterial and venous phase less than 16.2 HU and 32.4 HU were found to be statistically significant between GLs and small GSTs ( P < .05). On multivariate analysis, cardia location, endophytic growth, and homogeneous gradual enhancement were independent predictive factors for GLs and small GSTs. Conclusion: These 10 CT criteria are very helpful to differentiate GLs from small GSTs. Especially cardia location, endophytic growth, and homogeneous gradual enhancement are of high value in differential diagnosis.