Gastric leiomyosarcoma manifesting peculiar findings: radiological-pathological correlation.
Reported herein is a gastric leiomyosarcoma, which, nowadays, is extremely rare. Attention was focused not only on pathological findings but also on the histological basis of magnetic resonance imaging (MRI) findings. The patient was a 29-year-old Japanese woman. Preoperative T2-weighted MRI showed a large high-intensity gastric tumor with isointense streaks. The tumor was a broad-based large polypoid lesion and histologically consisted of fascicles of spindled cells having eosinophilic cytoplasm and cigar-shaped nuclei. Immunoreactivity for several smooth muscle markers including desmin on tumor cells, low amplification of both c-kit and PDGFRA cDNA on polymerase chain reaction, and absence of c-kit gene mutation in exons 9 and 11 strongly suggested that the tumor was not a gastrointestinal stromal tumor but a true leiomyosarcoma. In vitro MRI of the fresh tumor was obtained to explain the radiological findings on a morphological basis. In vitro MRI clearly depicted the very high-intensity areas separated by radially extended isointense lines. This radiological finding corresponded best to the most characteristic histological feature, that is, linearly extended fascicles of the tumor cells often with myxedematous change separated by radially elongated thin fibrovascular stroma: in other words, spouting appearance.
Department of Pathology, Otsu Municipal Hospital, Otsu, Japan. nao7038masu@yahoo.co.jp
Naoko
N
Masuzawa
Mitsuo
M
Kishimoto
Ayako
A
Nishimura
Noriatsu
N
Ichiba
Etsuo
E
Aoki
Ken
K
Yanagibashi
Seiichi
S
Hirota
Akio
A
Yanagisawa
D000328:Adult; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D007890:Leiomyosarcoma / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011859:Radiography; D020796:Receptor, Platelet-Derived Growth Factor alpha / Q000235:genetics; D020133:Reverse Transcriptase Polymerase Chain Reaction; D019089:Stem Cell Factor / Q000235:genetics; D013274:Stomach Neoplasms / Q000000981:diagnostic imaging* / Q000235:genetics / Q000473:pathology
D019089:Stem Cell Factor; D020796:Receptor, Platelet-Derived Growth Factor alpha