Published online Jun 21, 2022. doi: 10.3748/wjg.v28.i23.2625
Peer-review started: December 18, 2021
First decision: January 23, 2022
Revised: January 29, 2022
Accepted: May 5, 2022
Article in press: May 5, 2022
Published online: June 21, 2022
Liposarcoma is one of the most common adult mesenchymal tumors but is uncommon in the gastrointestinal tract and extremely rare in the stomach. Furthermore, the histological subtypes of liposarcoma usually reported in the stomach are well-differentiated or myxoid, and few reports have been issued on small-sized gastric liposarcomas resected endoscopically and followed up. Herein, we report a case of primary gastric dedifferentiated liposarcoma (DL) that was resected endoscopically.
A 67-year-old female Korean patient was referred to our institution for further evaluation of a gastric submucosal tumor (SMT) located in the lesser curvature of the gastric body by esophagogastroduodenoscopy. Endoscopic ultrasound revealed a well-circumscribed, slightly heterogeneous, isoechoic, 17 mm × 10 mm sized mass originating from the third sonographic layer. Computed tomography showed no evidence of significant lymph node enlargement or distant metastasis. Endoscopic resection was undertaken using the snare resection technique after mucosal precutting to provide a definitive histopathologic diagnosis, which proved to be consistent with DL, based on its morphology and the immunoexpressions of MDM2 and CDK4. The patient was planned for surgery because the deep resection margin was positive for malignancy. After declining any invasive procedure or adjuvant treatment, the patient was placed under close follow-up, and at one year after endoscopic resection, remained disease free.
This is the first reported case of a small primary gastric DL resected endoscopically and followed up. This report demonstrates that when diagnosis of a SMT is uncertain, the use of invasive techniques, including endoscopic resection, should be considered.
Core Tip: Liposarcoma is uncommon in the gastrointestinal tract and rarely encountered in the stomach. Furthermore, the dedifferentiated histologic subtype has not been previously reported in the stomach in the English literature. We experienced a case of a small (1.7 cm) primary gastric dedifferentiated liposarcoma, which was resected endoscopically. This report cautions that if a diagnosis of submucosal tumor is uncertain, the use of aggressive techniques, including endoscopic resection, should be considered.