A Case Report of Leiomyosarcoma Developing at the Esophagogastric Junction

Shinpei Takeda, Wataru Takiyama, Shigemitsu Takashima, Kouichi Mandai*

Department of Surgery and Histology*, Shikoku Cancer Center

A rare case of leiomyosarcoma arising at the esophagogastric junction is reported. A 70-year-old woman presented with dysphagia. A barium examination of the upper gastrointestinal tract showed a large (about 10 cm) submucosal tumor at the esophagogastric junction. An endoscopic examination revealed a submucosal tumor with bridging folds and ulceration extending from the lower esophagus to the cardia. Histological examination of the biopsied specimen showed simple necrotic tissue without malignancy. By CT an irregular-shaped tumor (9×8×7 cm) was found with some low density areas. An esophagogastrectomy was carried out. Macroscopic examination of the surgical specimen revealed a submucosal tumor with pronounced ulcertion and necrosis. Histological examination showed spindle shaped dense proliferation of anaplastic tumor cells with many mitotic figures to form tightly packed tumor cell nests, diagnosed as leiomyosarcoma. Metastatic foci were histologically found in the regional lymph nodes. A follow-up 6 months after the operation disclosed hepatic metastasis and the patient has been treated with chemotherapy. We suggest that dissection of the primary lesion with removal of regional lymph nodes and appropriate chemotherapy would be the best therapeutic modality for advanced leiomyosarcoma of the digestive tract.

Key words
leiomyosarcoma at the esophagogastric junction, lymph node metastasis of leiomyosarcoma, liver metastasis of leiomyosarcoma

Reprint requests
Shinpei Takeda Department of Surgery, Shikoku Cancer Center
13 Horinouchi, Matsuyama, 790 JAPAN

Accepted
July 3, 1991

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