Background

Most gastric leiomyomas are asymptomatic and benign subepithelial tumors (SETs); however, some may increase in size or become symptomatic. Understanding their natural history is therefore important to their management. We investigated the natural history of histologically proven gastric leiomyomas.

Methods

We retrospectively reviewed histologically proven gastric leiomyoma cases at a tertiary center. The baseline characteristics of these cases were analyzed, and those with a follow-up period of at least 12 months without immediate resection were evaluated. The primary outcome was the frequency of size increase of more than 25% during the follow-up period, and the secondary outcome was the histopathologic results in cases that underwent resection.

Results

Among the 231 patients with histologically proven gastric leiomyomas, the most frequent location was the cardia (77.1%), and the median size was 3 cm (IQR 2–4 cm). Eighty-four cases were followed up over a median period of 50.8 months (IQR 27.2–91.3 months). During the follow-up period, tumor size increased in two cases (2.4%). Surgical results showed that one case was leiomyoma, and the other was leiomyosarcoma. Among the remaining cases without change in size, 15 underwent surgical resection (n = 10) or endoscopic resection (n = 5), and all cases were confirmed as leiomyoma.

Conclusions

Most gastric leiomyomas are benign SETs, and an increase in size is not frequent, even in large-sized cases. Close monitoring with routine follow-up without resection may be sufficient in cases of histologically proven gastric leiomyoma. However, in cases of ulceration or size increase, resection may be beneficial.

Graphical abstract

中文翻译：

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胃平滑肌瘤的自然史

背景

大多数胃平滑肌瘤是无症状的良性上皮下肿瘤（SET）；然而，有些可能会增大或出现症状。因此，了解它们的自然史对于它们的管理非常重要。我们研究了组织学证实的胃平滑肌瘤的自然史。

方法

我们回顾性审查了三级中心经组织学证实的胃平滑肌瘤病例。我们分析了这些病例的基线特征，并对随访至少 12 个月但未立即切除的病例进行了评估。主要结局是随访期间体积增加超过 25% 的频率，次要结局是接受切除病例的组织病理学结果。

结果

在231例经组织学证实的胃平滑肌瘤患者中，最常见的位置是贲门（77.1%），中位大小为3 cm（IQR 2-4 cm）。 84 例病例的随访中位时间为 50.8 个月（IQR 27.2-91.3 个月）。随访期间，有两例（2.4%）肿瘤增大。手术结果显示，1例为平滑肌瘤，1例为平滑肌肉瘤。其余大小无变化的病例中，15例接受手术切除（n = 10）或内镜切除（n = 5），所有病例均确诊为平滑肌瘤。

结论

大多数胃平滑肌瘤是良性 SET，即使在大尺寸病例中，体积增大也不常见。对于组织学证实的胃平滑肌瘤，密切监测和常规随访（无需切除）可能就足够了。然而，在溃疡或体积增大的情况下，切除可能是有益的。

图形概要