Endoscopic resection of giant gastric leiomyomas, particularly in the fundus and cardia regions, is infrequently documented and presents a significant challenge for endoscopic surgery.

Herein, a case of a 59-year-old woman with a giant gastric leiomyoma was reported. The patient presented to the department of hepatological surgery with a complaint of right upper abdominal pain for one month and worsening for one week. The patient was diagnosed as gastric submucosal tumor (SMT), gallstone, and cholecystitis combined with computed tomography and gastroendoscopy prior to operation. Upon admission, following a multi-disciplinary treatment discussion, it was determined that the patient would undergo a laparoscopic cholecystectomy and endoscopic resection of gastric SMT. It took 3 hours to completely resect the lesion by Endoscopic submucosal excavation and endoscopic full-thickness resection, and about 3 hours to suture the wound and take out the lesion. The lesion, ginger-shaped and measuring 8 cm × 5 cm, led to transient peritonitis post-surgery. With no cardiac complications, the patient was discharged one week after surgery.

Endoscopic resection of a giant leiomyoma in the cardiac fundus is feasible and suitable for skilled endoscopists.

Gastric leiomyomas are benign, submucosal tumors found incidentally on unrelated imaging or during autopsy. The majority of leiomyomas are asymptomatic; however, patients can develop central ulcerations on the lesions leading to upper gastrointestinal (GI) bleeding. A 75-year-old female, with a past medical history of hypertension, hyperlipidemia, and a cerebrovascular accident, presented with complaints of melena, near-syncope events, lightheadedness, weakness, and hematemesis. A computed tomography (CT) of the abdomen with contrast found a heterogeneous low-attenuation mass of 4×4×3 cm3 within the gastric fundus and near the gastroesophageal (GE) junction. After an open gastrostomy and excisional biopsy, the mass was identified as a leiomyoma. This case report reviews the presentation, diagnostic assessments, and treatment of a gastric leiomyoma in a complex location proximal to the gastroesophageal junction. Gastric leiomyomas should be considered as a differential diagnosis for patients presenting with an upper gastrointestinal bleed.

Most gastric leiomyomas are asymptomatic and benign subepithelial tumors (SETs); however, some may increase in size or become symptomatic. Understanding their natural history is therefore important to their management. We investigated the natural history of histologically proven gastric leiomyomas.

We retrospectively reviewed histologically proven gastric leiomyoma cases at a tertiary center. The baseline characteristics of these cases were analyzed, and those with a follow-up period of at least 12 months without immediate resection were evaluated. The primary outcome was the frequency of size increase of more than 25% during the follow-up period, and the secondary outcome was the histopathologic results in cases that underwent resection.

Among the 231 patients with histologically proven gastric leiomyomas, the most frequent location was the cardia (77.1%), and the median size was 3 cm (IQR 2-4 cm). Eighty-four cases were followed up over a median period of 50.8 months (IQR 27.2-91.3 months). During the follow-up period, tumor size increased in two cases (2.4%). Surgical results showed that one case was leiomyoma, and the other was leiomyosarcoma. Among the remaining cases without change in size, 15 underwent surgical resection (n = 10) or endoscopic resection (n = 5), and all cases were confirmed as leiomyoma.

Most gastric leiomyomas are benign SETs, and an increase in size is not frequent, even in large-sized cases. Close monitoring with routine follow-up without resection may be sufficient in cases of histologically proven gastric leiomyoma. However, in cases of ulceration or size increase, resection may be beneficial.

Leiomyomas are rare, slow-growing submucosal tumors originating from smooth muscle cells. They are typically benign when found in the gastrointestinal tract, and they present no risk for recurrence or metastasis. In this report, we describe the case of a 64-year-old female patient presenting with severe anemia, generalized fatigue, and intermittent dark tarry stools and who was found to have a bleeding gastric cardia mass one centimeter distal to the gastroesophageal junction (GEJ) on abdominal computed tomography and confirmed with an esophagoduodenoscopy. Robotic-assisted laparoscopic wedge resection of the stomach with partial resection of the gastrohepatic ligament was performed to resect the mass. Histopathological examination revealed positivity for smooth muscle actin (SMA) and H caldesmon, consistent with a leiomyoma. In this report, we discuss this patient's clinical presentation, the method of mass resection, the importance of mass location in choosing a surgical approach for resection, and differential diagnoses for this case.

We introduce the case of a 40-year-old male with no medical history of interest who was admitted in the Digestive System unit due to upper gastrointestinal bleeding, and a large protruding lesion located in gastric antrum was detected during oral endoscopy, but biopsies were negative for malignancy. Therefore, endoscopic ultrasound was performed, confirming the submucosal origin of the lesion, puncturing it, and obtaining histological results compatible with leiomyoma. Gastric leiomyomas are rare mesenchymal tumors that are usually asymptomatic and are detected by performing a procedure for another reason. The definitive diagnosis is histological, being sometimes difficult to obtain samples given the submucosal origin of these lesions. The main treatment is surgery, although endoscopic resection is accepted in certain cases.

Endoluminal gastric leiomyoma (GL) of the antrum is a rare benign tumor. In this paper, we report a case of a 72-year-old patient that presented for a 1-month episode of epigastric pain. Imaging found a well-limited tumor in the antrum with extrinsic compression on ulcerated congestive mucosa. A surgical resection based on Finsterer's antrectomy with end-to-side trans-mesocolic gastro-jejunal anastomosis was performed. The histopathological examination in combination with immunohistochemistry diagnosed GL and found a diffuse and marked staining of smooth muscle actin (SMA) and h-caldesmon (h-CD) and negative expression of CD117 and DOG1. The patient was discharged without post-surgical complications and is still alive at the time of this case report writing.

Although the small intestine accounts for over 90% of the surface area of the alimentary tract, tumors of the small intestine represent less than 5% of all gastrointestinal tract neoplasms. Common small bowel tumors typically are well evaluated with cross-sectional imaging modalities such as CT and MR, but accurate identification and differentiation can be challenging. Differentiating normal bowel from abnormal tumor depends on imaging modality and the particular technique. While endoscopic evaluation is typically more sensitive for the detection of intraluminal tumors that can be reached, CT and MR, as well as select nuclear medicine studies, remain superior for evaluating extraluminal neoplasms. Understanding the imaging characteristics of typical benign and malignant small bowel tumors is critical, because of overlapping features and associated secondary complications.