A Case of Gastric Leiomyosarcoma Removed by Four Resections for Intraperitoneal Recurrence

Masahiro Ohishi, Nobuyuki Onishi, Takehisa Onishi, Tetsuya Onishi, Kazutaka Satomoto, Hiroshi Yamagiwa*

Onishi Hospital and *Department of Clinical Pathology, Mie University School of Medicine

A 37-year-old man was admitted with complaints of a tumor in the left upper abdomen and hematemesis. A gastrointestinal series revealed an extragastric type of leiomyosarcoma of the stomach with ulceration. Subtotal gastrectomy with lymphnode dissection was performed on February 15, 1983. The resected elastic hard encapsulated tumor, 15×15×13 cm in size, was histologically diagnosed as leiomyosarcoma. During nine years and two months after the initial operation, four operations were carried out for intra-peritoneal recurrent tumors. Two of the tumors were located in the perigastric area and the other two were in the mesoileum and at the diaphragma. Two extirpations, a partial resection of the ileum and a partial resection of the diaphragma, were performed. All recurrent tumors were diagnosed as leiomyosarcomas, and the largest tumor was 22×10×10 cm in size. Up to now, the patient has been leading a good life without recurrence. The suspected cause of recurrence was implantation of tumor cells at the initial operation. Accordingly we propose the no touch isolation method as efficient for avoiding recurrence. Better prognosis can be expected by aggresive surgical treatment for resectable intraperitoneal seeding, because leiomyosarcoma is less apt to metastasize to the lymph node than gastric cancer.

Key words
gastric Leiomyosarcoma, recurrence of gastric leiomyosarcoma, resection for recurrence of gastric leiomyosarcoma

Reprint requests
Masahiro Ohishi Onishi Hospital
835 Higashikurobe, Matsuzaki, 515-01 JAPAN

Accepted
July 6, 1992

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