Burhan Ahmad Khan, Azhar Mahmood Qureshi, Qasim Mahmood Buttar, Mohammad Amjad Rasool, Asad Ali Khan.
Gastric leiomyoma mimicking a carcinoma.
Rawal Med J Jan ;28(2):72-4.

A 70 year old gentleman was admitted with three days history of anorexia, epigastric pain, vomiting, melena, and one day history of hematemesis. There was history of peptic ulcer disease for the last two years, with anorexia, weight loss, and complaints of melena on and off for the last 6 months, and also bleeding hemorrhoids for the last 6 years. There was no other significant past history; specifically no history of jaundice, fever, abdominal pain, distension, previous blood transfusions, or surgery. He was a non-smoker. On examination, he was a markedly pale elderly ill looking and emaciated gentleman, fully conscious and oriented, afebrile with blood pressure of 130/90, regular pulse of 78 beats/min, and respiratory rate of 24/min. Systemic and external genitalia examination revealed no abnormality. The patient was investigated with a possibility of an underlying malignancy, specifically that of upper gastro-intestinal tract. Laboratory data showed a microcytic hypochromic anemia with hemoglobin of 6.8gm/dl, with normal white cells and platelet count, renal and liver function tests, blood sugar, bleeding profile, and urine examination.. Chest x-ray was normal and ultrasonography of abdomen revealed no abnormal findings. A computerised tomographic (CT) scan was suggestive of carcinoma of the stomach along with inferior vena cava thrombosis below the level of celiac axis. Upper gastrointestinal endoscopy revealed a well-circumscribed mass 3–4 cm in size of which a biopsy was taken; histopathology showed atypical glands and cells suggestive of adenocarcinoma of the stomach. After nine blood transfusions, a laparotomy was performed revealing a non-invasive well-circumscribed mobile mass in the region of fundus and greater curvature. Frozen sections were reported as leiomyoma, and a wide local excision with sufficient normal margin (5 x 4 x 4 cm) was done. Recovery was uneventful and the patient was discharged on the 8th post operative day. Histopathology report confirmed benign smooth muscle leiomyoma. Follow up at six months showed the patient markedly improved with significant weight gain and no GI blood loss.

PakMediNet -Pakistan's largest Database of Pakistani Medical Journals - http://www.pakmedinet.com