Gastric leiomyoma

　　Gastric leiomyoma is a benign tumor originating from smooth muscle tissue (mainly from the circular muscle or longitudinal muscle of the gastric wall), a few originate from the mucosal muscle layer. It is more common in the gastric fundus and corpus, with more cases on the lesser curvature than on the greater curvature, and more on the posterior wall than on the anterior wall.

　　Gastric leiomyoma is a benign tumor originating from smooth muscle tissue, which is the most common interstitial benign gastric tumor. The clinical symptoms of the disease are non-specific, and early surgical treatment has a good prognosis. Therefore, it is worthy of clinical attention to strive for early detection, achieve early diagnosis and treatment, and what are the complications of this disease? The following will introduce the complications of gastric leiomyoma.

　　1. Anemia

　　Long-term chronic small amount of bleeding can cause iron deficiency anemia.

　　2. Pyloric obstruction

　　Large tumors near the esophagus can cause difficulty in swallowing, and giant smooth muscle tumors in the pyloric region can cause pyloric obstruction symptoms.

　　The above are the complications of gastric leiomyoma patients. Once the disease is diagnosed, it is best to undergo surgical treatment, and the prognosis is generally good after surgery.

　　The clinical manifestations of gastric leiomyoma are often related to the location, size, growth manner, and type of complications of the tumor. Bleeding is the most common symptom, which can cause hematemesis or melena. Other symptoms include upper abdominal pain, fullness, and discomfort. During physical examination, an abdominal mass may be found in the upper abdomen, with moderate hardness, smooth, active, and without tenderness. The progression is slow, and asymptomatic in early stage or without complications, often discovered incidentally during gastroscopy, gastric surgery, or autopsy. The main symptoms and signs are summarized as follows.

　　1. Gastrointestinal bleeding

　　It is the prominent clinical manifestation of gastric leiomyoma, with a reported incidence of up to 58%. It often presents as intermittent small amount of bleeding with varying duration, and occasionally large bleeding leading to shock. The occurrence of bleeding is related to compression of the mass, insufficient blood supply to the central part of the tumor leading to ischemic necrosis and ulcer formation on the surface, etc.

　　2. Abdominal pain

　　Caused by traction and compression of the tumor on adjacent tissues, or due to the imbalance of gastrointestinal peristalsis and functional disorders, etc. It often presents as dull or bloating pain, with an uncertain location, and often appears before gastrointestinal bleeding or the discovery of abdominal mass.

　　3. Abdominal mass

　　The palpation of abdominal mass is related to the size and growth location and manner of the tumor. Those with a diameter greater than 5 cm and an extracavitary type of growth are easy to be palpated.

　　4. Other symptoms

　　Large tumors near the esophagus can cause difficulty in swallowing, and those located at the pylorus can have pyloric obstruction symptoms.

　　Feihua Health Network reminds you:In addition to the clinical symptoms of upper gastrointestinal bleeding, abdominal pain, and abdominal mass in the diagnosis of gastric leiomyoma, it should be suspected that this disease is mainly dependent on X-ray and gastroscopy examination.

　　A reasonable diet can increase the intake of high-fiber foods as well as fresh vegetables and fruits, ensuring a balanced nutrition including proteins, sugars, fats, vitamins, trace elements, and dietary fibers, etc. The combination of meat and vegetables, diversified food varieties, and the complementary effect of nutrients between foods are very helpful in preventing this disease.

　　Gastric leiomyoma is a benign tumor originating from smooth muscle tissue, the most common interstitial benign gastric tumor. The clinical symptoms of this disease are non-specific, and early surgical treatment has a good prognosis. Therefore, it is worthy of clinical attention to strive for early detection, early diagnosis, and treatment. Then, what are the laboratory examination items for gastric leiomyoma? The following introduces the laboratory examination items that need to be performed for patients with gastric leiomyoma.

　　1. Biochemical and pathological examination

　　1. Blood routine examination

　　There may be a decrease in red blood cells and hemoglobin, indicating the presence of anemia.

　　2. Fecal occult blood test

　　The gastrointestinal tract often presents with intermittent small amounts of bleeding, manifested as positive occult blood test in feces or black stools.

　　3. Histopathological examination

　　The tumor boundary is clear, without a capsule, and under the microscope, well-differentiated spindle cells are arranged in bundles, with varying amounts of fibrous connective tissue and fibroblasts.

　　Second, clinical auxiliary examination

　　1. X-ray examination

　　The classic sign of upper gastrointestinal barium meal is a mass protruding into the gastric cavity, with a circular or elliptical filling defect in the gastric cavity, with a regular shape and clear edges. The surrounding mucosa and gastric wall are normal, without peristaltic dysfunction. In patients with tumor complications such as ulcers, a deep cavity shadow can often be seen in the area of filling defect formed by the tumor, with smooth surrounding edges and no mucosal aggregation, different from general peptic ulcers. When subserosal tumors or tumors protrude outward, due to the traction and compression of the tumor, the gastric wall may produce deformation or present as an external indentation-like defect. However, it is difficult to detect extracavitary tumors and early tumors, and it is easy to misdiagnose gastric smooth muscle tumors with ulcers as peptic ulcers.

　　2. Abdominal ultrasound examination

　　Using the drinking water method for ultrasound examination can clearly show the location, size, growth pattern, and internal echo structure of the tumor, which is of certain value for the diagnosis of gastric smooth muscle tumors. The disadvantage is that it is difficult to determine its nature and tissue origin. If combined with gastroscopy biopsy examination, it can greatly improve the diagnostic rate. The ultrasound image shows that the smooth muscle tumor has smooth edges and a uniform hyperechoic internal structure.

　　3. Ultrasound endoscopy

　　It is currently considered to be the most valuable means to improve the early diagnosis rate, with a literature-reported coincidence rate of 63%. It can simultaneously display the full view of the tumor inside and outside the gastric cavity, not only discover early lesions, but also understand the size and depth of the tumor, but due to its high cost, it has not been popularized in China.

　　4. CT examination

　　The imaging characteristics are: a solid mass in the upper abdomen, closely related to one side of the gastric wall, sometimes clearly showing the protrusion of the gastric wall into the gastric cavity or outward, the mass is usually less than 5cm, round or oval, and the surface is smooth. The mass density is usually uniform, and calcification is occasionally seen. Enhanced scanning shows that the lesions in the arterial phase often present with low enhancement, the delayed scanning often presents with uniform moderate enhancement, and occasionally there may be a central necrotic low-density focus without enhancement.

　　5. Gastroscopy

　　Common endoscopy can directly observe the morphological size and growth characteristics of intracavitary tumors, and can also directly perform tissue biopsy to obtain pathological evidence, even performing resection of gastric smooth muscle tumors through gastroscopy. However, for tumors without invasion of the mucosa and extracavitary tumors, it is of little significance. It can be seen as hemispherical or spherical protrusions, with the surface mucosa being tense and smooth, the color being the same as that of the surrounding mucosa. Sometimes, ischemic and necrotic ulcers may appear at the top, and preoperative diagnosis is difficult, often requiring histological examination to confirm.

　　The above are the laboratory examination items for gastric smooth muscle tumors. Through these laboratory examinations, it can be determined whether it is a gastric smooth muscle tumor, and the most important histological examination can confirm the diagnosis.

　　Gastric leiomyoma is a benign tumor originating from smooth muscle tissue, which is the most common interstitial benign gastric tumor. The clinical symptoms of this disease are non-specific, and early surgical treatment has a good prognosis. Therefore, it is worthy of clinical attention to strive for early detection, early diagnosis, and treatment. The diet of patients with gastric leiomyoma is also very important. The following introduces the dietary taboos for patients with gastric leiomyoma.

　　1. Gastric leiomyoma patients are suitable for eating nutritious and easily digestible foods.

　　2. Foods that gastric leiomyoma patients should not eat:

　　1) Eat less or no fried foods.

　　2) Avoid cold, hard, or hot foods.

　　3) Avoid eating刺激性 foods such as chili, curry, excessive salt, soy sauce, spices, and candies, coffee, strong tea, and tobacco.

　　The above is a list of dietary taboos for gastric leiomyoma patients. Active, scientific, and reasonable diet is conducive to the recovery of the disease and can shorten the recovery time.

　　Since the differentiation between gastric leiomyoma and leiomyosarcoma is difficult, and leiomyomas can also undergo malignant transformation, surgical treatment is recommended. Generally, a wide local resection is chosen, with a margin from the tumor edge of at least 2 to 3cm. For those suspected of having malignant changes, subtotal gastrectomy or total gastrectomy should be performed.

　　For solitary, pedunculated tumors with a diameter less than 2cm, endoscopic electroresection can be performed. For multiple, sessile, tumors with a diameter greater than 2cm or with symptoms such as bleeding, obstruction, or for those suspected of having malignant changes based on endoscopic biopsy or cytological examination, laparoscopic or laparotomy resection should be performed.

　　The surgical method can be determined according to the specific condition of the lesion. For gastric body, antrum, and fundus leiomyomas with a diameter less than 5cm, if the tumor boundary is clear, there is no necrosis in the tumor, there is no ulceration in the gastric mucosa of the tumor site, and there are no metastatic foci in the peritoneum, local resection of the tumor can be performed with a margin from the tumor of 1cm. For leiomyomas located at the pylorus or cardia, conservative local resection or wedge resection of part of the gastric wall can be performed when the tumor diameter is less than 3cm.

　　For larger leiomyomas (diameter ≥ 5cm), they must be treated as malignant tumors unless the final pathological examination can definitely determine their true nature. Or if the tumor diameter in the pylorus or cardia is greater than 3cm, a subtotal gastrectomy with a distal or proximal resection of most of the stomach, with a surgical margin from the tumor of 2 to 3cm, should be performed.