ArticleFrontiers in oncology2026
Acute gastrointestinal hemorrhage as the sole initial manifestation of gastric leiomyosarcoma: a case report highlighting the discrepancy between preoperative assessment and final pathology.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Gastric leiomyosarcoma (LMS) is an exceedingly rare mesenchymal malignancy, and its presentation with acute upper gastrointestinal hemorrhage is poorly documented. We present a case of this tumor in a 78-year-old female, whose sole initial manifestation was acute upper gastrointestinal hemorrhage with severe anemia (hemoglobin 70 g/L). Gastroscopy showed a 1.2 × 1.8 cm ulcerated submucosal protrusion; contrast-enhanced computed tomography (CT) revealed a 2.0 cm moderately enhancing gastric wall nodule without regional lymphadenopathy or distant metastasis. Endoscopic biopsy demonstrated a spindle cell neoplasm negative for CD117 and DOG1 but positive for SMA and SMMS-1, with a Ki-67 index of 25%. Laparoscopic wedge resection yielded a 5.0 × 3.0 × 1.5 cm tumor. Final pathology confirmed LMS with an elevated Ki-67 of 50% and a mitotic count of 13/10 high-power fields (HPF). This case underscores that superficial biopsy and preoperative imaging may substantially underestimate the true infiltrative extent and proliferative activity of gastric LMS. Acute hemorrhage may herald this rare malignancy despite seemingly unremarkable endoscopic findings. Accurate diagnosis mandates immunohistochemical exclusion of gastrointestinal stromal tumor (GIST). Close postoperative surveillance is warranted.
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