Gastric Metastasis of Uterine Leiomyosarcoma Detected During Surveillance Endoscopy and Resected by Endoscopic Submucosal Dissection After Multiple Metachronous Metastases: A Case Report.
This case report illustrates that incidental gastric metastasis can occur in patients with uterine leiomyosarcoma and that endoscopic submucosal dissection may be a useful minimally invasive treatment option.
Where it sits
this study against the rest of the bpc-157 corpusSummary and findings
A 69-year-old woman with uterine leiomyosarcoma developed metachronous metastases including a 15-mm gastric lesion. Endoscopic submucosal dissection was performed, achieving en bloc resection without adverse events. The study highlights the occurrence of incidental gastric metastasis during prolonged disease courses.
Abstract
Uterine leiomyosarcoma (uLMS) is a rare, aggressive uterine malignancy that usually metastasizes hematogenously, whereas gastrointestinal involvement is uncommon. A 69-year-old woman with uLMS treated by hysterectomy and adjuvant chemotherapy developed metachronous lung, sigmoid colon, gallbladder, and abdominal wall metastases. After treatment of these metastases, periodical surveillance endoscopy revealed a 15-mm subepithelial lesion with a shallow central depression in the lower gastric body. Endoscopic ultrasonography showed a well-defined submucosal lesion without muscularis propria invasion, and biopsy confirmed metastatic leiomyosarcoma. Endoscopic submucosal dissection (ESD) was performed, achieving en bloc resection without adverse events. This rare metachronous combination of gastric, colonic, and gallbladder metastases highlights that incidental gastric metastasis may occur during prolonged disease courses and suggests that ESD may be a useful minimally invasive option for local control of small gastric metastases.
Background
Uterine leiomyosarcoma (uLMS) is a rare and aggressive malignancy that typically metastasizes through the bloodstream, with gastrointestinal involvement being uncommon. Previous literature has documented various metastatic sites, but the occurrence of gastric metastasis is less frequently reported. This case report is significant as it illustrates the potential for incidental gastric metastasis during the surveillance of uLMS, emphasizing the need for vigilance in monitoring patients with this condition.
Methods
This is a case report involving a 69-year-old female patient with a history of uLMS who underwent hysterectomy and adjuvant chemotherapy. After developing multiple metachronous metastases, she underwent periodic surveillance endoscopy. The endoscopic findings led to the identification of a 15-mm subepithelial gastric lesion, which was further evaluated using endoscopic ultrasonography and biopsy prior to endoscopic submucosal dissection (ESD).
Results
The primary endpoint was the successful en bloc resection of the gastric lesion via ESD, which was achieved without any reported adverse events. Specific numeric findings regarding the effectiveness of ESD or patient outcomes post-procedure were not provided in the abstract.
Interpretation
This case contributes to the understanding of uLMS and its potential for gastric metastasis, which is not commonly documented. While the findings are statistically significant in terms of the successful resection, the clinical significance of this case is limited by the lack of broader data on similar cases. The absence of adverse events is promising, but further studies are needed to establish the efficacy and safety of ESD in this context. The findings suggest that ESD may be a viable option for local control of small gastric metastases, but caution is warranted due to the limited nature of the evidence.
Key findings
- 15-mm subepithelial lesion detected in the lower gastric body.
- Endoscopic ultrasonography showed a well-defined submucosal lesion without muscularis propria invasion.
- Biopsy confirmed metastatic leiomyosarcoma.
Limitations
- Not a controlled study, single case report.
- No quantitative outcomes reported.
- Lack of long-term follow-up data.