Post written by Michael Yulong Wu, BMedSt, MD, MSurg, from Port Macquarie Private Hospital, Port Macquarie, and Port Macquarie Gastroenterology, Thrumster, and Stuart Kostalas, MBBS (Hons 1), MM (Clin Epi), MSc (Oxon), MBiostatistics, FRACP, from Port Macquarie Private Hospital, Port Macquarie, Port Macquarie Gastroenterology, Thrumster, and UNSW Rural Clinical Campus, University of New South Wales, Port Macquarie, Australia.

This article discusses the management of a gastric lesion identified incidentally during gastroscopy. EUS revealed a well-defined, hypoechoic 30-mm lesion originating from the muscularis propria, and fine-needle biopsy indicated a benign leiomyoma.

However, because of the lesion’s increasing size, location in the gastric body, surface ulceration, and risk of bleeding and the patient’s strong preference to avoid surgery, endoscopic full-thickness resection was carried out. Histopathological examination of the resected tissue later revised the diagnosis to high-grade gastric leiomyosarcoma.

Gastric leiomyosarcoma is rare, and there are no established treatment guidelines, to our knowledge. Of the few reported cases, only 1 out of 3 involved endoscopic resection based on a preresection diagnosis. This case underscores the feasibility and safety of endoscopic resection using a 2-layer clip closure technique.

Although gastric leiomyomas are generally benign, they can undergo malignant transformation into leiomyosarcoma and might be overlooked if biopsies do not sample the malignant areas (sampling error). Therefore, when lesions exhibit atypical features, biopsy results are inconclusive or inconsistent, or there is a relevant history of malignancy, further assessment or removal should be considered.

Ulcerated subepithelial lesion visualized at the upper part of the greater curvature of the stomach.

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