Leiomyoma of the stomach is a benign neoplasm which is formed by proliferation of cells of the smooth muscle fibers of the walls of the body and can reach gigantic proportions. This tumor is characterized by slow progression, long latent period, scant symptomatology and a tendency to malignancy (malignancy). Often the pathology is not making itself felt before the development of serious complications that threaten the patient’s life – perforation of the stomach, heavy bleeding and acute inflammation of the peritoneum (peritonitis). For the diagnosis of leiomyoma apply ultrasound, x-rays and endoscopic techniques. In some cases to verify the diagnosis, you may need laparoscopy. Conservative therapy is not effective in identifying tumors are shown urgent surgical intervention.
In clinical practice with this disorder have to face comparatively rare. According to medical statistics, in the General structure of tumors of the stomach, the share of non-epithelial tumors account for no more than 12%, but most of them is leiomyoma. In women, they detected three times more often than men.
The causes of leiomyoma of the stomach
To determine the exact cause of tumor development have not yet succeeded. To uncontrolled mitotic division of muscle cells with the formation of one or several nodes may lead a number of internal and external factors.
According to experts among the predisposing factors include:
- genetically determined predisposition;
- hormonal disorders;
- the weakening of the immune system;
- viral infection;
- pathogenic microorganisms of bacterial nature;
- frequent injuries of the stomach wall (including coarse or poorly chewed food);
- excessive ultraviolet radiation (including with frequent sun exposure);
- bad ecology;
- exposure to ionizing radiation;
- chronic gastritis;
- nicotine addiction;
- consumption of alcoholic beverages;
- frequent errors in diet (particularly irregular meals and the abuse of junk food).
Most often, nodes are discovered on the rear wall of the antrum. For their formation requires months and often years. The growth is in several directions – subserous (in the direction of the abdominal cavity), inside the stomach cavity (submucous) or inside wall (intramural).
Described in the case of removal of non-epithelial tumors, whose weight was 7 kg.
Rounded submucosal nodes have a wide base, and sometimes a fairly long leg. Gastroscopy they are often mistaken for polyps. Subserous tumors do not affect the neighboring structures, until they reach a respectable size. Large tumors of this type are sometimes able to twist, moving parallel to the pelvic area. In such cases, it develops clinical symptoms suggestive women have ovarian cysts.
The surface of the node tends to ulcerate, and in thicker tumors tissue disintegrate, forming a cavity. Large leiomyoma partially close the lumen of the stomach, preventing passage of food bolus in the intestines.
It is important
Leiomyoma can degenerate into a malignant tumor – leiomyosarcoma.
The symptoms of leiomyoma of the stomach
For a long time, the tumor can develop without symptoms because it grows slowly, and on the functional activity of nearby organs, and overall health of the patient, is not affected. Only in complicated cases or when the size of tumors more than 5 cm clinical symptoms appear. They are nonspecific, making it difficult to timely diagnosis.
Leiomyoma often find out only when a patient develops significant bleeding or perforation of the stomach wall, rapidly leading to peritonitis.
If a massive site closes the lumen of the stomach, symptoms of dyspepsia, nausea and vomiting. The patient may complain of a feeling of heaviness in the upper quadrant (right or left side) and pain in the epigastric region.
Ulceration of the surface of the tumor often leads to its rupture, which is accompanied by intense acute pain and massive bleeding. In such situations, it is often misdiagnosis of “perforated ulcer”, and the true cause of the complications becomes clear in the course of the operation.
Movable subserous nodes are able to twist, causing them blood circulation, and develop necrotic changes. In such cases, developing a clinic “acute abdomen”.
Asymptomatic observed in 85-90% of cases.
Submucosal ulcerated nodes manifest symptoms typical of peptic ulcer disease.
- “hungry” pain in the morning;
- vomiting “coffee grounds” (i.e., with clots of coagulated blood);
- staining of stool in black color;
- intense abdominal pain;
Periodic bleeding lead to anemia, which is manifested by fatigue, dizziness and pale skin. The patient losing weight because the tumor interferes with the normal digestion of food and absorption of nutrients.
During massive bleeding on the background of the gap node, blood loss may exceed the 1.5 l, which poses a serious danger to the life of the patient.
When malignancy (transformation to leiomyosarcoma) the process of expansion many times uskoryaetme. The patient has symptoms characteristic of almost any cancer – the signs of intoxication and cachexia (rapid exhaustion).
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Only early diagnosis and timely surgical treatment can ensure that you prevent malignancy.
Tumors reached large sizes, sometimes discovered by chance during palpation of the study during the inspection at the therapist or the gastroenterologist.
Nonspecific symptoms only develops in 15% of cases.
Methods of instrumental and instrumental diagnostics of uterine leiomyomas:
To confirm the diagnosis it is often necessary laparoscopic study, and to identify the nature of the tumor needed a biopsy with subsequent histological and cytological analysis of tissue samples.
During radiography double-contrast in the leiomyoma revealed a defect fill of round shape. In large tumors there is a concentration of the mucosal folds around the circumference of the hub.
The endoscopy is almost impossible to identify subserous and vnutrizonovye tumors, but submucosal nodes it is quite possible not only to detect but also to remove. Usually diagnosed with “polyps of the stomach” to refute that allows only the histopathological analysis. The sample of tissue sampling is necessarily performed upon detection of the ulcerated site to getdiagnostic with leiomyosarcomas.
Large subserous growths are an indication for diagnostic laparoscopy, which assesses connection with the walls of the body and plan the operation.
Modern methods of treatment of leiomyoma of the stomach
Conservative treatment is ineffective. Patients which confirmed the diagnosis “leiomyoma”, shall be immediately transferred to the surgical Department. Surgical intervention may be delayed only in the presence of serious pathologies of the cardiovascular system or diabetes mellitus.
Currently, uncomplicated tumors more than 3 cm practiced their excision (excision) within the boundaries of unaltered tissue (2 cm from the edge node). When ulceration, hemorrhage or suspected malignancy requires gastric resection together with the tumor.
If the node size in the range of 2-3 cm, abdominal surgery can be avoided. Modern techniques allow us to carry out the enucleation of the tumor without opening the lumen of the stomach. Small leiomyomas can be removed endoscopically with the use of innovative cryosurgical techniques. Exposure to low temperatures promotes degradation of the cells remaining after removal of the primary tumor.
Postoperatively, the patient shows a pharmacotherapy for the relief of inflammation. Recommended medication from the group of blockers of the proton pump, and when detected in the stomach of the bacterium Helicobacter pylori – antibacterial drugs.
It is highly recommended to avoid trying to get rid of a leiomyoma of the popular methods. None of the “healers” of recipes is not able to help in this situation. The result of self-medication will only become a waste of time and the development of life-threatening conditions.
Diet for leiomyoma of the stomach
Adjustments in the diet is one of the conditions of successful treatment and prevention of complications. Patients should give up foods and drinks that irritate the gastric mucosa, including smoked meats, pickles, alcohol and coffee.
Heavy meals (red meat and mushrooms) to consume highly undesirable.
Patients are encouraged to consume cereals, lean meats and fish, steamed vegetable dishes, fruit, juices and herbal teas based on gastric fees.
Recurrence in the absence of malignant transformation usually does not occur, and long-term prognosis is quite favorable.
If the histological examination of the removed node detected cancer cells, the patient is referred to a specialist-an oncologist, who conducts an additional examination and is further treatment plan. After chemo – and radiotherapy 5-year survival rate of patients is up to 50 %.
Plisov Vladimir, doctor, medical commentator