PRIMARY LEIOMYOSARCOMA OF THE OMENTUM

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1 THE KURUME MEDICAL JOURNAL Vol. 27, P , 1980 PRIMARY LEIOMYOSARCOMA OF THE OMENTUM AKIRA TANIMURA, TAKANORI CHOP, MASATOSHI NOHARA, MASANORI YAMASHITA, YOSHIAKI HOSOKAWA, HIDEO YAMAMOTO AND HISASHI UCHIYAMA Second Department Pathology Second Department Surgery, Kurume University School Medice, Kurume, 830, Japan Received f publication March 27, 1980 Two cases leiomyosarcoma developed from great gastrohepatic respectively are repted. Case 1 is a 52-year-old female chief complat a mass abdomen, which found to be a primary gastrohepatic upon laparotomy, histologically diagnosed as leiomyosarcoma. Case 2 is a 46-year-old male chief complat precdial pa. Upon laparotomy a part found adhered to gastric serosa. excised toger stomach. Microscopic observation revealed filtration spread gastric wall. In eir case no metastatic focus found at time operation, no recurrence is expected although 3 years 7 years, respectively, passed after operation. INTRODUCTION In a broad sense peritoneum consists peritoneum, great mesentery, on which grows rarely. refe only a few repts, namely, those Ackerman (1954), Yannopoulos Stout (1963) Stout (1963) are available. Referrg to peritoneum, when limited to great gastrohepatic, leiomyosarcoma is quite seldom, only beg found one case repted by Sanes Kenny (1934), 2 cases by Levy Pund (1940), one case by Stout (1963) one case by Yannopoulos Stout (1963). We have experienced two cases leiomyosarcoma grown on great omenturn gastrohepatic respectively. CASE 1 : 52-year-old female Chief complat : Mass abdomen. Present illness : Sce March 1975 a palm-sized mass palpable at upper abdomen, but she did not seek medical aid havg no subjective symptom at all. patient visited hospital because mass grew larger gradually became as large as man's head uneven. It firm movable. examations blood, ure, serum ors revealed no abnmalities. Upon laparotomy found to be confmity gastrohepatic, showg neir filtration n metastasis to surroundg tissues comparatively sharp demarcation. excised. 101

2 TANIMURA. 102 Macro- microscopic enveloped out fibrous ( like long shaped Cells slightly tosis also several as CASE rich cellu spdle- arranged ir- ( pleomphic at 2). a fields, ob- microscope spirals found visual agnosed Hem acidophilic bundles cut lobulation cyst spdles nucleus regular relatively apparent showed Under size tissue no 1). tissue. served lar AL. : cm capsule. connective rhage, gray 15 connective elastic 26 ~ filtration fdgs 11 ~ ET rate thus it mi- one di- 1. Tum consists grayish-white, solid, lobulated mass hemrhage. (Case 1). leiomyosarcoma. 2 : 46-year-old male Chief complat : epigastralgia Present illness : Sce May 1979 (one month pri to admission) patient had epigastralgia visited hospital. At epigastric region movable palm-sized mass palpable, which elastic. X-ray examation epigastric area revealed that mass located near stomach pressg greater curvature. Gastroscopically no abnmality observed on mucosa stomach. Laparatomy revealed a palmsized layg between great greater curvature. enucleated toger stomach, sce it adhered to serosa on greater curvature side stomach. Macro- tic tive tissue. cut gray microscopic solid encapsulated It fdgs measured solid : th elasconnec- 10 ~ 8 ~ 10 cm. fully about covered 1/4 to 1/3 ranged sta 2. Tum reveals bundle, spdle spirals. ar(h. E 5 ~40). which showed hemrhage ( 3). fibrously adhered to serosa on greater curvature side stomach. Under microscope it rich cellular spdle round shapes mixed ly ( 4), giant observed near hemrhagic areas. In comparatively solid part maly spdleshaped arranged bundle runs. Pleomphism observed, mitosis seen spadically. At part adhesion to serosa stomach filtration observed.

3 PRIMARY LEIOMYOSARCOMA OF THE OMENTUM 103 By PTAH stag both Case 1 2 showed myibrils, which, however, not apparent round-shaped Case 2, specimen f electron microscopy prepared from materials fixed fmale, a few myibrils basal membrane observed round-shaped. By silver stag, eir case showed reticular fibers envelopg sgle several ( 5). 3. Tum consists grayish-white, solid hemrhage proment, compared case are 1. From above-mentioned both Case 1 Case 2 as leiomyosarcoma. fdgs diagnosed DISCUSSION Two great mentum 4. Tum, (H. E. fiber. 5. (Silver is spdle reveal sta few tissue rich cellular round shaped arrangement. 5 ~40). In silver are sta sta enveloped 5 ~20). dividual by reticular a cases shows no lymph nodes. leiomyosarcoma repted metastasis on gastrohepatic eir to o- which surroundg Tums possibly grow on peritoneum, mesentery great beg igated from blood vessel, fibrous tissue, fat, nerves, etc., but its frequency is very small, which has been discussed by Ackerman (1954), Yannopoulos Stout (1963), Stout(1963). In Japan repts Okajima et al. (1968), Kurosawa et al. (1973), Kojima et al. (1976) are available. Accdg to study Yannopoulos Stout (1963) 44 cases nonepilial mesenteric 7 cases smooth muscle covered 16 % total mesenteric out which 29 to leiomyoma, while remag 71 % leiomyosarcoma. In ir repts one case found to be leiomyosarcoma developed from gastrohepatic (32-year-old male). Stout (1963) repted on 24 cases developed from gastrocolic omenturn, which cluded 10 cases smooth muscle (42%), i. e., 3 cases

4 104 TANIMURA, ET AL. leiomyosarcoma 7 cases leiomyoma. Out 16 cases benign developed from great, 7 cases leiomyoma (44 o) out 9 cases malignant 3 cases leiomyosarcoma (33 %). When s smooth muscle on mesentery great are compared, fmer appears to be me malignant latter are me benign. In Japan Okajima et al. (1968) repted on leiomyosarcoma developed from peritoneum, addition on s developed from peritoneum mesentery clearly diagnosed histopathologically as leiomyosarcoma based on English Japanese literatures, accdg to which 9 cases developed from peritoneum, cludg 4 cases from great one case from gastrohepatic. Furr studies made it possible to add 5 me cases Japan, namely, two cases leiomyosarcoma developed from gastrohepatic (Kojima, et al., 1976, Kurosawa, et al., 1973), one case from great (Miwaki, et al., 1973) two cases as mentioned above by present auths. A total 10 cases leiomyosarcoma developed from great gastrohepatic, namely, five cases referred by Okajima et al. as well as 3 additional repts two cases auths' are shown Table 1. age ranged from 26 to 70 years old, 45.5 years on average, weight which is cled to younger compared leiomyosarcoma digestive system (60-year-old), specially stomach. Difference TABLE 1

5 PRIMARY LEIOMYOSARCOMA OF THE OMENTUM 105 scarecelly observed sex 6 males 4 females. Clically, re 5 cases mass abdomen, 4 cases a sensation fullness discomft hypochondriac region, one case :ors complats. se symptoms are caused maly by pressure based on rapid growth as general characteristics malignant. size s 10 cases ranged from 5 to 20 cm beg larger than those benign ones. It is considered that size is largely fluenced by characteristics onset regions, such as mesentery great. Stout (1963), his studies, classified s on great clically to those out symptoms, found that malignant s had symptoms all cases, while benign showed only 5 cases symptoms out 13 cases, thus those symptoms generally had s larger size, Grossly, s on smooth muscle are solid, enveloped by capsule, cut which beg gray, solid, necrotic bleedg. Histological pictures differ much case by case, but it comprises mixture bundle arrangement spdle-shaped round-shaped, re are many to look at cludg pleomphism, mitosis, etc. In auths' experiences mitosis observed at a rate one several high power fields toger slight pleomphism. In case smooth muscle boundary beg benign malignant is difficult. When filtration metastasis are seen it is clear, however, if y are not found diagnosis must be given careful consideration upon checkg pleomhism, mitosis, size mixg bizarre, etc. prognosis grave five patients out 10 (cludg one unknown) beg died metastasis, eir one which showed metastasic foci at time operation. Two patients died postoperative complications. two cases repted this paper progressed favably 3 years 7 years respectively, no sign recurrence metastasis. Acknowledgement auths are grateful to Pr. T. Nakashima f help advice. REFERENCES ACKERMAN, L. V. (1954). Tums retroperitoneum, Mesentery peritoneun. Section VI, AFIP. KOJIMA, Y., MURA, T., HARYO, S., KASAI, M. KIGOSHI, H. (1976). Primary leiomyosarcoma gastro-hepatic. Surgery, 38, , (Tokyo). KUROSAWA, K., KUSASA, R., TOJIMA, H., NARU- TO, H., NAMIKI, M. SHIMIZU, Y. (1973). A case giant leiomyosarcoma gastro-hepatic. Surgery, 35, 78-82, (Tokyo). LEVY, J. H. PUND, E. R. (1940). Primary sarcoma ; rept two cases. Amer. J. Cancer, 40, MORIWAKI, S., FUJITA, T., MIKI, H. ISHIMI- TSU, T. (1973). An autopsy case double cancer : Hepatoma omental leiomyosarcoma collidg liver. Jpn. J. Cancer Cl. 19, , (Tokyo). OKAJIMA, K.,et al. (1968). Primary leiomyosarcoma peritoneum, mesentery. Jap. Cancer d. (Tokyo). Sanes, S. Kenny, F. E. (1934). Primary sarcoma great. Amer. J. Cancer, 21, STOUT, A. P., HENDRY, J. PURDIE, F. J. (1963). Primary solid s great. Cancer, 16, YANNOPOULOS, K. STOUT, A. P. (1963). Primary solid s mesentery. Cancer, 16,

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