Gastric Leiomyosarcoma: A Case Report and Literature Review.

Gastric leiomyosarcoma is an exceptionally rare malignancy. This case report describes a 57-year-old woman, previously healthy, who presented to the emergency department with signs of upper gastrointestinal bleeding and severe anemia. Urgent upper endoscopy revealed a large ulcerated lesion on the greater curvature of the stomach, raising suspicion for a gastrointestinal stromal tumor (GIST). Biopsies suggested a mesenchymal neoplasm with epithelioid features. Staging imaging excluded metastatic disease. The patient underwent a laparoscopic radical subtotal gastrectomy with Roux-en-Y reconstruction. Histological and immunohistochemical analysis concluded a diagnosis of gastric leimyosarcoma. Surgical margins were negative, and no lymph node metastases were found. This case underscores the importance of immunohistochemistry in differentiating leiomyosarcoma from other mesenchymal tumors such as GIST. Despite surgical resection being the mainstay of treatment, the prognosis remains guarded due to high mitotic activity and the potential for recurrence. This report adds to the limited literature and highlights the need for further studies to establish standardized management protocols.