Huang K, Wang W, Xu ML, He YS, Zhao JY, Hu XF. Pleomorphic gastric leiomyosarcoma with retroperitoneal extension and hepatic metastasis: A case report. World J Gastrointest Surg 2026; 18(3): 115216 [DOI: 10.4240/wjgs.v18.i3.115216]
Corresponding Author of This Article
Xiao-Feng Hu, Professor, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400000, China. 401366741@qq.com
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Oncology
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Case Report
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Mar 27, 2026 (publication date) through Mar 30, 2026
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World Journal of Gastrointestinal Surgery
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Huang K, Wang W, Xu ML, He YS, Zhao JY, Hu XF. Pleomorphic gastric leiomyosarcoma with retroperitoneal extension and hepatic metastasis: A case report. World J Gastrointest Surg 2026; 18(3): 115216 [DOI: 10.4240/wjgs.v18.i3.115216]
World J Gastrointest Surg. Mar 27, 2026; 18(3): 115216 Published online Mar 27, 2026. doi: 10.4240/wjgs.v18.i3.115216
Pleomorphic gastric leiomyosarcoma with retroperitoneal extension and hepatic metastasis: A case report
Kun Huang, Wen Wang, Mei-Ling Xu, Yun-Shen He, Jiang-Ying Zhao, Xiao-Feng Hu
Kun Huang, Wen Wang, Mei-Ling Xu, Yun-Shen He, Department of General Surgery, Mianyang Hospital of Traditional Chinese Medicine, Mianyang 621000, Sichuan Province, China
Jiang-Ying Zhao, Department of Pathology, Mianyang Hospital of Traditional Chinese Medicine, Mianyang 621000, Sichuan Province, China
Xiao-Feng Hu, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, Chongqing 400000, China
Author contributions: Huang K and Wang W designed the study, managed the patient perioperatively, and drafted the manuscript; Xu ML and He YS collected the clinical data and performed the literature review; Zhao JY performed and interpreted the pathological examinations; Hu XF supervised the study, critically revised the manuscript for important intellectual content, and approved the final version; All authors have read and approved the final manuscript.
Supported by the Mianyang Municipal Health Commission Scientific Research Fund, Sichuan Province, China, No. 202309; Key Laboratory of Development and Utilization of Traditional Chinese Medicine in Mianyang, Sichuan Province, Open Fund 2025, No. 25ZYKF04; 2024 Hospital-University Joint Innovation Fund of Chengdu University of Traditional Chinese Medicine, No. LH202402010.
Informed consent statement: The patient, as the involved subject, provided written informed consent for inclusion in this report and for publication of all relevant clinical data and images.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Corresponding author: Xiao-Feng Hu, Professor, Department of Nursing, The First Affiliated Hospital of Chongqing Medical University, No. 1 Youyi Road, Yuanjiagang, Yuzhong District, Chongqing 400000, China. 401366741@qq.com
Received: October 14, 2025 Revised: December 16, 2025 Accepted: January 21, 2026 Published online: March 27, 2026 Processing time: 167 Days and 7.1 Hours
Abstract
BACKGROUND
Pleomorphic leiomyosarcoma (LMS) of gastric origin is extremely rare, especially when accompanied by retroperitoneal extension and hepatic metastasis. Since the introduction of KIT (cluster of differentiation 117) immunohistochemistry, many gastric mesenchymal tumors have been reclassified as gastrointestinal stromal tumors, making true gastric LMS unusual. We report a large pleomorphic gastric LMS initially misdiagnosed as retroperitoneal sarcoma to highlight diagnostic pitfalls and the central role of complete surgical resection.
CASE SUMMARY
A 58-year-old woman presented with a 1-month history of progressive abdominal distension and bilateral lower limb edema and had a 1-year history of a self-palpated abdominal mass. Computed tomography showed a 26.8 cm heterogeneous abdominal mass, a 4.4 cm left hepatic lesion, and a left adrenal nodule, suggesting retroperitoneal sarcoma with hepatic metastasis. Laparotomy revealed a tumor arising from the gastric greater curvature invading the pancreatic body-tail and a synchronous liver metastasis. Margin-negative (R0) resection, including partial gastrectomy, distal pancreatectomy, and partial hepatectomy, was performed. Histology and immunohistochemistry confirmed pleomorphic LMS. The patient declined chemotherapy and took Huaier granules as adjunctive therapy. No recurrence was detected during 17 months of follow-up.
CONCLUSION
Pleomorphic gastric LMS may mimic retroperitoneal sarcoma, and complete margin-negative (R0) resection remains the key treatment.
Core Tip: Pleomorphic leiomyosarcoma of gastric origin is an exceptionally rare and aggressive tumor, especially when accompanied by retroperitoneal invasion and hepatic metastasis. We report a unique case initially misdiagnosed as retroperitoneal sarcoma, later confirmed intraoperatively to arise from the stomach near the pylorus. Complete curative (R0) resection including distal pancreatectomy and partial hepatectomy achieved favorable short-term outcomes. The patient refused conventional adjuvant therapy and received Huaier granules, a traditional Chinese medicine with potential antitumor effects. This case emphasizes the diagnostic challenges of gastric leiomyosarcoma and suggests that Huaier granules may have a role in postoperative disease control.
