Prognostic factors in primary gastrointestinal leiomyosarcoma: a retrospective study

Leiomyosarcoma of the rectum: A systematic review of recent literature

Leiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without.

A pooled analysis of risk factors of surgically treated leiomyosarcoma of the colon in adults

Background

This current systematic review aimed to evaluate the role of surgical management and risk factors by pooled cases from all identified patients with colonic leiomyosarcomas.

Methods

The authors searched the Ovid MEDLINE, Embase, PubMed, and Cochrane databases using the keywords “colonic,” “colon,” and “leiomyosarcoma.” Risk factors of colonic leiomyosarcoma in the pooled cohort were also evaluated.

Results

Between 1923 and 2019, 41 cases of colonic leiomyosarcoma were identified in 22 (53.7%) males and 19 (46.3%) females, with a mean and median age of 58.7 ± 2.2 years and 56.0 years. According to univariate analysis, smaller tumor size < 8 cm was significantly associated with longer progression-free survival (HR = 6.957, 95% CI 1.405–34.442; p = 0.017), and younger age < 60 years was trending toward better overall survival (HR = 2.765, 95% CI 0.924–8.272; p = 0.069).

Conclusions

Colonic leiomyosarcomas are rare neoplasms with aggressive clinical behaviors. Age < 60 years and tumor size < 8 cm were favorable factors for patients’ better survival.

Stage and histological grade of gastrointestinal stromal tumors based on a new approach are strongly associated with clinical behaviors

Tumor stage and grade for gastrointestinal stromal tumors are poorly defined. To develop a better evaluation system, we assessed 12 clinical and pathological parameters in 613 patients with follow-up information. These parameters were classified into two gross spread parameters including liver metastasis and peritoneal dissemination, five microscopic spread parameters including lymph node metastasis, vascular, fat, nerve and mucosal infiltration, and five histological parameters including mitotic count > or =10 per 50 high-power fields, muscularis propria infiltration, coagulative necrosis, perivascular pattern and severe nuclear atypia. The 5-year disease-free survival and overall survival of 293 patients without any of these predictive parameters of malignancy were 99 and 100%, respectively. They were regarded as nonmalignant and further evaluations on the stage and grade of these tumors were not performed. At least one and at most seven predictive parameters of malignancy were identified in 320 patients. For these patients, the 5-year disease-free survival and overall survival rates were 44% (mean 6.7 years) and 60% (mean 9.3 years), respectively. The disease-free survival showed significant difference between patients with and without gross spread (P<0.0001), with and without microscopic spread (P=0.0009). Disease-free survival and overall survival were associated with the number of predictive parameters of malignancy in patients without gross spread (P<0.0001 for both disease-free survival and overall survival), but not in patients with gross spread (P=0.882 and 0.441, respectively). Malignant gastrointestinal stromal tumors could be divided into clinical stage I and II based on the absence and presence of gross spread, respectively. The degree of malignancy of patients in clinical stage I could be graded according to the number of predictive parameters of malignancy. Patients in clinical stage II were of the highest degree of malignancy regardless of the number of parameters. We found that the clinical stage and grade were strongly associated with prognosis.

Partial resection of the second portion of the duodenum for gastrointestinal stromal tumor after effective transarterial embolization

We report herein the case of 64-year-old man with gastrointestinal stromal tumor (GIST), who was treated by partial resection of the duodenum after preoperative transarterial embolization. He presented to our hospital with a history of tarry stools, dizziness, and severe anemia (hemoglobin, 7.5 g/dl). Gastroduodenal endoscopy revealed the presence of a submucosal tumor in the second portion of the duodenum. The presence of the tumor was subsequently confirmed by double-contrast gastrointestinal radiography and abdominal computed tomography. Super-selective angiography showed tumor staining fed from the anterior and posterior superior pancreaticoduodenal arteries, and the inferior pancreaticoduodenal artery. Two weeks after transarterial embolization through these vessels, the tumor size was found to have shrunk to 40% of its original size. Partial resection of the duodenum was performed and absence of tumor cells at the surgical margin was confirmed by intraoperative frozen-section examination. Histopathological examination revealed that the duodenal submucosal tumor consisted of spindle cells, and immunohistochemical analysis revealed positive tumor staining for c-kit protein, CD34 and alpha-smooth muscle actin (SMA), and negative staining for desmin and S-100; the positivity rate for MIB-1 staining was 2.2%. Based on these findings, the tumor was diagnosed as a GIST of low-grade malignancy, classified as the muscular type. It is considered that preoperative treatment of duodenal GISTs, such as transarterial embolization, may be useful for reducing the extent of resection, from pancreaticoduodenenctomy to a partial resection.

Surgical management of small gastrointestinal stromal tumors of the stomach

Small gastrointestinal stromal tumors (GISTs) (< 3 cm) occasionally are found in the stomach during endoscopy. There is no consensus about the surgical management of these small tumors, although this clinical issue is crucial because some of the tumors show unexpected malignant behavior. In this study, we evaluated the clinical management of patients with gastric GISTs who underwent surgical resection. Altogether, 31 patients with gastric GISTs were examined retrospectively. Surgical resection was fundamentally indicated for the patients with gastric GISTs suspected to be malignant by endoscopy or endoscopic ultrasonography (EUS). The malignant grade of the GISTs was evaluated by the mitotic rate, tumor size, and MIB-1 index. EUS was useful for differentiating benign from malignant GISTs; but by limiting the study to patients with small tumors (< 3 cm), the diagnostic value of EUS was not satisfactory for defining the surgical indication. Tumors that were < 50 mm were successfully treated by laparoscopic surgery. Of the 31 patients, 4 had a relapse of the disease, and 1 of those 4 patients had a small tumor (30 mm). All of the recurrences were classified in the high risk category. Surgery is indicated for gastric GISTs that are > or = 20 mm or are suspected to be malignant based on EUS findings. Laparoscopic resection is feasible and is recommended as the treatment of choice for patients with tumors < 50 mm. Risk assessment can be most useful for predicting recurrence.

Analysis of prognostic and immunohistochemical factors in gastrointestinal stromal tumors with malignant potential

The aim of this study was to analyze 37 patients with malignant primary gastrointestinal stromal tumors and to compare the findings and their therapeutic implications with those previously reported. The medical records of 37 patients who were diagnosed and operated on between January 1996 and December 2002 were retrospectively reviewed. The patients' age, tumor size, type of surgery, histologic type, mitotic counts, presence of necrosis, Ki-67 proliferative index, National Institutes of Health 2001 consensus classification, immunohistochemical staining, and recurrence were examined to analyze factors affecting survival. Overall actuarial survival for all patients was 46%. When analyzed by type of resection, the complete resection group (R0 resection) had a mean overall survival of 48.2 +/- 6.18 months compared with the patients with incomplete resection (R1-R2) who survived a mean of 10.8 +/- 3.2 months (P=0.00). Univariate analysis showed development of recurrence (P=0.00), tumor size of 8 cm or greater (P=0.05), Ki-67 proliferative index greater than 0.82 (P=0.0448), desmin staining (P=0.0076), age younger than 49 years (P=0.0009), and incomplete resection (P=0.00) to be significantly correlated with a poor survival. In multivariate analysis, desmin staining (P=0.031), tumor size (P=0.033), age (P=0.01), recurrence (P=0.038), and R0 resection (P=0.02) were significant independent prognostic factors. We recommend that more careful preoperative and more frequent postoperative follow-up examinations be performed for patients with large tumors, age of younger than 49 years, and Ki-67 proliferative index greater than 0.82.

Predictive variables detailing the recurrence rate of soft tissue sarcomas

Understanding prognostic variables is important for counseling patients, selecting patients for adjuvant therapy, stratifying patients for inclusion in clinical trials, and setting goals for patient treatment. Prognostic variables in soft tissue sarcoma have been defined for local recurrence, distant recurrence, and disease-specific and overall survival. Significant prognostic variables are site-dependent and time-dependent. A recently created nomogram that accounts for tumor size, grade, histology, and depth and patient age is a tool that can be used to predict 12-year sarcoma-specific survival at diagnosis. Emerging areas in predicting outcome of patients with soft tissue sarcoma include response to neoadjuvant chemotherapy and molecular markers.

Childhood leiomyosarcoma: a report from the soft tissue sarcoma Italian Cooperative Group

BACKGROUND

Only a few reports on the clinical features and management of childhood leiomyosarcoma are available. To contribute additional information on the management of this rare tumor, we report on a series of 16 pediatric patients treated from 1982 to 1998 by the Soft Tissue Sarcoma Italian Cooperative Group.

PATIENTS AND METHODS

Primary surgery was conservative in all but two patients, and consisted of biopsy--three cases, non-radical excision--four, and radical resection--nine (involving a primary re-excision in 4 of 9). In two cases secondary radical surgery was performed after primary chemotherapy. Chemotherapy was administered to 9 of 16 patients, radiotherapy to three.

RESULTS

After a median follow-up of seven years (range 3-18), the five-year event-free survival (EFS) and overall survival were 56.3% and 72.9%, respectively; 12 of 16 patients were alive (nine of them in continuos complete remission). Univariate analysis was performed to compare EFS according to different subgroups: size represented the most significant prognostic factor.

CONCLUSIONS

Complete surgical resection is the mainstay of treatment for leiomyosarcoma. The role of both adjuvant chemotherapy and radiotherapy has yet to be established, and awaits cooperative multicentric studies.

Gastrointestinal stromal tumors

BACKGROUND

Gastrointestinal stromal tumors (GISTs) are the most common mesenchymal tumors of the gastrointestinal tract. A relationship to the interstitial cells of Cajal (ICCs) has been proposed, and expression of CD117, the c-kit receptor present in ICCs, has been suggested as a marker for GISTs.

METHODS

The English literature has been reviewed with an emphasis on histogenetic features, especially the potential relationship of GISTs to ICCs.

RESULTS

GISTs are most common in the stomach (70%), followed by small intestine (20%), colon and rectum (5%), and esophagus (<5%). GISTs commonly have activating mutations in exon 11 (or rarely exon 9 and exon 13) of the KIT gene that encodes a tyrosine kinase receptor for the stem cell factor or mast cell growth factor.

CONCLUSIONS

Malignant potential is best estimated by the simultaneous evaluation of several clinical parameters. The only absolute criterion for malignancy is tumor spread beyond the organ of origin at the time of diagnosis. The remarkable clinical response of tumors that express c-kit to treatment with the tyrosine kinase inhibitor STI571 is a triumph of molecular pharmacology.

Primary gastrointestinal sarcomas: analysis of prognostic factors and results of surgical management

BACKGROUND

This study was done to review the clinical presentation, surgical management, and prognostic factors for primary gastrointestinal sarcomas.

METHODS

We reviewed medical records of 55 patients who were treated for primary gastrointestinal sarcomas from 1981 through 1996. Mean follow-up time was 32 months.

RESULTS

Clinical findings included gastrointestinal bleeding (51%), palpable mass (36%), and abdominal pain (33%). The stomach was the most common site of disease (53%), followed by the small intestine (33%). Tumors were high grade in 76% of patients and low-grade in 24% of patients. Complete resection of all gross disease was accomplished in 35 patients (64%), incomplete resection in 17 patients (31%), and biopsy only in 3 patients (5%). Adjacent organ resection was required in 19 patients (35%). Overall actuarial survival was 22% (median survival, 32 months). Unfavorable prognostic factors were incomplete resection, high-grade histologic features, and tumor size of 5 cm or more (P<.05). En bloc resection of contiguous organs did not adversely effect survival. In patients with complete resections, tumor grade was the most important prognostic factor (median survival, 55 months vs 19 months for low-grade vs high-grade tumors; P<.05).

CONCLUSIONS

Aggressive surgical resection, including en bloc resection of locally advanced tumors, appears warranted. Despite complete resections, patients with high-grade tumors remain at risk for recurrence.

Smooth muscle tumors of the esophagus: clinicopathological findings in six patients

Preoperatively, it is difficult to discriminate leiomyoma and leiomyosarcoma of the esophagus, which are rare smooth muscle tumors. The objective of this study was to evaluate the clinicopathological findings of this unusual lesion. A search of the surgery archives of the Toyama Prefectural Central Hospital of Pathology revealed six cases of esophageal smooth muscle tumors. Clinicopathological findings were reviewed retrospectively. Only three patients (50%) presented with dysphagia, and the remaining three patients were asymptomatic. These patients underwent surgical excision. Histologically four of the six tumors were leiomyomas, and the other two tumors were leiomyosarcomas. Two tumors were in the upper to middle esophagus, and the remaining four were in the distal esophagus. On endoscopic examination, all tumors were noted to be polypoid. The two leiomyosarcomas measured over 5 cm and the four leiomyomas less than 4 cm. Neither ulceration nor necrosis proved to be of use in discriminating leiomyoma and leiomyosarcoma. The two patients with leiomyosarcoma died of liver metastasis 10 and 22 months after the treatment. Patients with leiomyosarcoma presented with distant metastasis and/or recurrence, with hematogeneous metastasis being the predominant type of recurrence.

Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival

OBJECTIVE

To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively.

SUMMARY BACKGROUND DATA

A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven.

METHODS

Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival.

RESULTS

Of the 200 patients, 46% had primary disease without metastasis, 47% had metastasis, and 7% had isolated local recurrence. In patients with primary disease who underwent complete resection of gross disease (n = 80), the 5-year actuarial survival rate was 54%, and survival was predicted by tumor size but not microscopic margins of resection. Recurrence of disease after resection was predominantly intraabdominal and involved the original tumor site, peritoneum, and liver.

CONCLUSIONS

GISTs are uncommon sarcomas. Tumor size predicts disease-specific survival in patients with primary disease who undergo complete gross resection. Tumor recurrence tends to be intraabdominal. Investigational protocols are indicated to reduce the rate of recurrence after resection and to improve the outcome for patients with GIST.

Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival

OBJECTIVE

To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively.

SUMMARY BACKGROUND DATA

A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven.

METHODS

Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival.

RESULTS

Of the 200 patients, 46% had primary disease without metastasis, 47% had metastasis, and 7% had isolated local recurrence. In patients with primary disease who underwent complete resection of gross disease (n = 80), the 5-year actuarial survival rate was 54%, and survival was predicted by tumor size but not microscopic margins of resection. Recurrence of disease after resection was predominantly intraabdominal and involved the original tumor site, peritoneum, and liver.

CONCLUSIONS

GISTs are uncommon sarcomas. Tumor size predicts disease-specific survival in patients with primary disease who undergo complete gross resection. Tumor recurrence tends to be intraabdominal. Investigational protocols are indicated to reduce the rate of recurrence after resection and to improve the outcome for patients with GIST.

Two hundred gastrointestinal stromal tumors: recurrence patterns and prognostic factors for survival

OBJECTIVE

To analyze the outcome of 200 patients with gastrointestinal stromal tumor (GIST) who were treated at a single institution and followed up prospectively.

SUMMARY BACKGROUND DATA

A GIST is a visceral sarcoma that arises from the gastrointestinal tract. Surgical resection is the mainstay of treatment because adjuvant therapy is unproven.

METHODS

Two hundred patients with malignant GIST were admitted and treated at Memorial Hospital during the past 16 years. Patient, tumor, and treatment variables were analyzed to identify patterns of tumor recurrence and factors that predict survival.

RESULTS

Of the 200 patients, 46% had primary disease without metastasis, 47% had metastasis, and 7% had isolated local recurrence. In patients with primary disease who underwent complete resection of gross disease (n = 80), the 5-year actuarial survival rate was 54%, and survival was predicted by tumor size but not microscopic margins of resection. Recurrence of disease after resection was predominantly intraabdominal and involved the original tumor site, peritoneum, and liver.

CONCLUSIONS

GISTs are uncommon sarcomas. Tumor size predicts disease-specific survival in patients with primary disease who undergo complete gross resection. Tumor recurrence tends to be intraabdominal. Investigational protocols are indicated to reduce the rate of recurrence after resection and to improve the outcome for patients with GIST.

Salvage surgery for patients with recurrent gastrointestinal sarcoma: prognostic factors to guide patient selection

BACKGROUND

Gastrointestinal sarcomas are rare stromal tumors and most are classifiable as malignant gastrointestinal stromal tumors. They have a high propensity for intraabdominal recurrence. It is unclear whether there is a survival advantage from reoperation for recurrent disease or if surgery should be confined to symptom relief. The authors have attempted to identify features that may allow the selection of patients most likely to benefit from reoperation.

METHODS

Retrospective univariate and multivariate analyses of 60 patients with recurrent gastrointestinal sarcoma, accrued from a prospective data base between July 1982 and September 1995, were performed.

RESULTS

Initial recurrence was evident by a median of 20 months from primary resection. Most patients (85%) had an initial symptomatic recurrence. Local recurrence was seen in 76% of patients, but in half of these synchronous hepatic metastases were present. None had disease outside of the abdomen. Complete resection of recurrent disease was possible in only one-third of cases. Median survival after surgery for recurrence was 15 months, but was longest for patients whose recurrence took the form of liver metastases in the absence of disease elsewhere. In multivariate analysis of post-recurrence survival, the only significant determinant of survival was the length of the disease free interval between the initial operation and recurrence.

CONCLUSIONS

Survival following recurrence of a gastrointestinal sarcoma is largely determined by the tumor biology, one manifestation of which is the disease free interval. Except for patients with a long disease free interval, surgery should be reserved largely for symptom control.

An immunohistochemical and clinicopathological study of gastrointestinal stromal tumors

Immunohistochemical and clinicopathological features of 58 gastrointestinal stromal tumors (GIST) were studied. One occurred in the esophagus, 41 in the stomach, nine in the small intestine, and seven in the large intestine. By using indirect immunoperoxidase staining for Cajal cell markers (c-kit protein and CD34), smooth muscle markers (alpha-smooth muscle actin, desmin, heavy caldesmon and calponin) and Schwann cell markers (S-100 protein and Leu 7), GIST were classified into five groups, such as Cajal cell type (n = 9), myogenic type (n = 5), Schwann cell type (n = 2), mixed cell type (n = 40) and undifferentiated type (n = 2). c-kit Protein (42/58; 72%) and CD34 (45/58; 78%) were commonly and diffusely expressed in GIST. Novel smooth muscle markers, caldesmon (29/58; 50%) and calponin (18/58; 31%), were useful in detecting myogenic characters of GIST. S-100 protein was expressed in 16 (28%) tumors, two of which were also reactive with Leu 7 (CD57). Three small bowel tumors with skeinoid fibers expressed the Cajal cell markers, and were categorizable in GIST. Clinicopathological analyses using aggressive (n = 21) and non-aggressive (n = 21) GIST indicated that the malignant potential was correlated with the intestinal location, large tumor size, high cellularity, necrosis, solid (non-interlacing bundled) pattern of growth, negativity of c-kit protein and/or CD34, high mitotic count, and high MIB-1 labeling.

Primary leiomyosarcoma arising in the lesser sac: report of a case

We describe herein a very rare case of leiomyosarcoma arising in the lesser sac. A 58-year-old man with a psychiatric disorder was admitted to our department for the investigation of epigastralgia and nausea which he had been suffering since the previous month. A laparotomy revealed that the abdominal mass, found on physical examination, was a primary lesser omental tumor, histological examinations of which confirmed a diagnosis of leiomyosarcoma. The tumor cells showed a DNA diploid pattern. Leiomyosarcoma of the lesser sac is extremely unusual and it is important that it be distinguished from an extraluminal tumor of the abdomen.

Leiomyosarcoma in childhood and adolescence

BACKGROUND

Few series of leiomyosarcoma in patients < 21 years of age have been reported. We reviewed our institutional experience with this neoplasm to learn disease characteristics, patterns of relapse, and outcome.

METHODS

The records of 21 patients with leiomyosarcoma admitted to our institution were reviewed retrospectively; 18 of these were diagnosed after 1970. Overall survival was estimated using the Kaplan-Meier method.

RESULTS

Ninety-five percent (20 of 21) were initially treated with a wide local excision that was complete with a negative microscopic margin in 10 (48%). There also was a strong correlation between grade and surgical margins. High-grade tumors were associated with a lower rate of complete resection. The majority underwent additional therapy. Radiation was used to treat both initial and recurrent disease in nine patients, with four of these undergoing brachytherapy. Thirteen patients were treated with adjuvant chemotherapy, most commonly doxorubicin (seven patients) and cisplatin (six patients). The median length of survival was 9.3 years, and there were nine disease-related deaths (43%). Of interest was the progressive decrease in survival with time. The 5-year overall survival rate was 79%; the 10-year rate was 49%. Three patients died of progressive disease > 10 years after initial diagnosis.

CONCLUSIONS

We conclude that leiomyosarcomas arising in childhood and adolescence are associated with a good initial chance of survival that decreases progressively over time. Known prognostic factors from larger adult series are consistent with the present data, but they are not provable because of the small number of patients. In particular, the grade was correlated with surgical margins.

Prognostic significance of DNA ploidy and proliferative index (MIB-1 index) in gastrointestinal stromal tumors

The DNA content and proliferative index of 61 gastrointestinal stromal tumors (GIST) were measured by image analysis and correlated with the lesion's clinicopathological features and patient's survival. DNA analysis was performed on cytospin single-cell preparations obtained from the paraffin-embedded tissue blocks. MIB-1 was the proliferation marker used on paraffin sections. DNA aneuploidy was detected in 12 tumors (18%), and high MIB-1 index (>22%) in 12 lesions (18%). DNA aneuploidy and high MIB-1 index statistically correlated with high mitotic rate (> or = 5 x 10 high-power field [HPF]) (P < .001) and with the presence of necrosis (P < .05). The patient's survival was significantly correlated with DNA ploidy (P < .01), MIB-1 index (P < .00001), mitotic rate (P < .00001), presence of necrosis (P < .0001), and size of the tumor (P < .01). Multivariate regression analysis showed that only MIB-1 index was an independent parameter in predicting the clinical outcome for patients with GIST. The mitotic rate was the only other independent prognostic factor when MIB-1 index was not allowed to enter the model.

Primary gastrointestinal sarcomas: analysis of prognostic variables

BACKGROUND

Primary gastrointestinal sarcomas are uncommon, and the clinicopathological determinants of survival remain unclear. In order to correlate clinical presentation, pathological assessment, and treatment with outcome, we have analyzed our institution's recent experience with these tumors.

METHODS

Records of adult patients admitted to our institution between July 1982 and December 1991 were reviewed.

RESULTS

During this period, 38 adult patients (> 16 years of age) were admitted to our institution with a primary gastrointestinal sarcoma. They accounted for 2% of all adult sarcoma admissions during that period. The study population was composed of 26 men and 12 women. Ages ranged from 29 to 82 years (mean 59). Disease was localized to the primary site in 30 patients (81%). The stomach was the most frequent site of disease (20 cases). The small bowel was affected in nine cases (five duodenum, four jejunum) and the large bowel in nine cases (two colon, seven rectum). Ninety-two percent of patients were symptomatic at presentation. A complete resection was performed in 27 cases, incomplete resection in seven cases, and biopsy only in the remaining three patients. Nine patients received doxorubicin-based chemotherapy. Leiomyosarcoma (n = 35) was the predominant histological diagnosis. Twenty-six tumors were classified as high grade (68%) and 12 as low grade (32%). Overall actuarial 5-year survival was 28% (median follow-up 26 months). Weight loss (p = 0.02) and pain at presentation (p = 0.05) were adverse prognostic factors. Histological grade (p = 0.0002), completeness/extent of surgical resection (p = 0.005), or small bowel primary site were significant determinants of overall survival. The resection of contiguous organs did not affect survival if the primary tumor was completely excised (p = 0.422). Age, race, sex, presentation (prior surgery), tumor size, or adjuvant therapy were not significant prognostic factors. Recurrence was noted in 44% after complete resection, and mean time to recurrence was 9 months (median 7, range < 1-37). Hepatic metastases (42%) and local recurrence (42%) were the predominant sites of initial failure. For patients with a complete resection, grade was the major prognostic determinant (5-year survival: high grade/complete resection 18% vs. low grade/complete resection 72%, p = 0.002).

CONCLUSION

The prognosis of gastrointestinal sarcomas is poor. Complete surgical excision is the optimal therapy. However, our results suggest that surgery alone is inadequate for high-grade tumors. We believe that these patients should be considered candidates for investigational adjuvant therapies.

Prognostic value of DNA ploidy in primary gastric leiomyosarcoma

The prognostic value of DNA ploidy was evaluated in 25 patients with primary gastric leiomyosarcoma, using paraffin-embedded archival specimens analysed by DNA flow cytometry. Ploidy patterns were diploid in ten tumours and non-diploid in 15. They did not correlate with clinicopathological features of the lesions such as tumour size and grade or mitotic index. A non-diploid pattern was associated with a significantly reduced patient survival rate (P < 0.05), as was higher tumour grade (P < 0.01). Neither tumour size nor mitotic index correlated with patient survival.

Intussusception and leiomyosarcoma of the gastrointestinal tract in a pediatric patient. Case report and review of the literature

Intestinal leiomyosarcoma is a rare tumor in infants and children; only 46 cases have been reported in the English literature. Presenting signs and symptoms include abdominal pain and gastrointestinal obstruction and bleeding. We describe a neonate with the unique presentation of ileocecal intussusception accompanying an ileal leiomyosarcoma. In contrast to adult patients, where intussusception is associated with smooth muscle tumors in 30% of cases, leiomyosarcoma and subsequent intussusception is rare in infancy and childhood. The overall prognosis for long-term survival is similar for both pediatric and adult patients with leiomyosarcoma of the intestinal tract, with a five-year survival in reported cases of 53% and 40%, respectively.