Abstract
A 37-year-old man was admitted with complaints of a tumor in the left upper abdomen and hematemesis. A gastrointestinal series revealed an extragastric type of leiomyosarcoma of the stomach with ulceration. Subtotal gastrectomy with lymphnode dissection was performed on February 15, 1983. The resected elastic hard encapsulated tumor, 15×15×13cm in size, was histologically diagnosed as leiomyosarcoma. During nine years and two months after the initial operation, four operations were carried out for intra-peritoneal recurrent tumors. Two of the tumors were located in the perigastric area and the other two were in the mesoileum and at the diaphragma. Two extirpations, a partial resection of the ileum and a partial resection of the diaphragma, were performed. All recurrent tumors were diagnosed as leiomyosarcomas, and the largest tumor was 22×10×10cm in size. Up to now, the patient has been leading a good life without recurrence. Thesuspected cause of recurrence was implantation of tumor cells at the initial operation. Accordingly we propose the no touch isolation method as efficient for avoiding recurrence. Better prognosis can be expected by aggresive surgical treatment for resectable intraperitoneal seeding, because leiomyosarcoma is less apt to metastasize to thelymph node than gastric cancer.
