Rare benign esogastric tumors. Contemporary tactics of diagnosis and treatment

Abstract

Introduction: Leiomyomas are rare benign mesenchymal GI tumors, with low malignity rate that are often asymptomatic, casually discovered, but can suddenly result in massive hemorrhage. Esophageal leiomyomas represent 8% of the total esophageal tumors, gastric leiomyomas account for 2,5% of all gastric neoplasms. On imaging, this tumor is normally characterized as: solitary mass,usually smaller than 3 cm, location: distal body of the stomach or fundus. The main differential diagnosis on imaging is made with a gastric GIST, which is much more common. Complications are rare and may include hemorrhage (hematemesis, melena) obstruction fistulisation / perforation, malignant degeneration (exceptional). Purpose: Analysis of the efficacy of diagnosis and surgical treatment of patients with esogastric leiomyomas. Material and methods: In the Surgical department No 4 between 2010-2020 there have been treated 6 patients with benign esogastric tumors, of which 3 – gastric leiomyomas, 2 esophageal, 1 jejunal, that were histopathologically confirmed. Asymptomatic – 2 cases, with epigastric pain – 1 case, with postprandial regurgitation – 2 cases, and one case complicated with gastrointestinal hemorrhage. We present one of the cases of gastric leiomyoma: Female 59 years old, presented with epigastric discomfort, postprandial fullness and anemia. On CT was discovered a mass at the lesser curvature of 16 mm that grew to 20mm in 6 months. Gastroscopy – it was not informative in this case. The patient underwent laparoscopic surgery - tumor excision was performed. Histopathological examination confirmed encapsulated fibromuscular mesenchymal tumor (fibroleomyoma). Results: On one patient traditional laparotomy was performed, videothoracoscopy- 1 patient, videothoracoscopy + conversion to thoracotomy- 1 patient, laparoscopy- 3 patients. Postoperative evolution for everyone was favorable, with a short stay in hospital for those with laparoscopic approach. Postoperative complications were not detected. Conclusions: Large tumors are more prone to ulcerations, that may result in severe hemorrhage. The surgical approach to each patient is individual. The minimally invasive surgery represents the ˮGold-standardˮ of treatment.