Gastric Leiomyoma: Is It Malignant?

Gastric leiomyoma is a type of benign tumor that originates from the smooth muscle tissue of the stomach. It most commonly develops from the circular or longitudinal muscle layers of the gastric wall, although in some cases, it may arise from the muscularis mucosae. As the most common benign stromal tumor of the stomach, leiomyoma has a relatively high incidence rate and is typically found in the gastric fundus or gastric body. It is more frequently observed on the lesser curvature compared to the greater curvature, and more often on the posterior wall than the anterior wall.

Small gastric leiomyomas measuring less than 2 cm usually do not cause any noticeable symptoms. When symptoms do occur, they are typically related to the tumor's location, size, growth pattern, and whether any complications are present. Common symptoms may include gastrointestinal bleeding, abdominal pain, bloating, and the presence of an abdominal mass. Among these, gastrointestinal bleeding is the most frequently reported symptom.

Treatment options depend on the size and clinical presentation of the tumor. For tumors smaller than 2 cm, endoscopic submucosal excavation (ESE) is a minimally invasive and effective treatment choice. This method allows for tumor removal without the need for partial gastrectomy, resulting in faster recovery and lower overall costs.

However, if complications such as bleeding, perforation, or malignant transformation occur, more aggressive treatment may be required. In such cases, surgical resection is often necessary to prevent further complications. Although most gastric leiomyomas are benign, they do carry a risk of becoming malignant, especially when the tumor size exceeds 2 cm. Early removal is recommended for larger tumors to reduce the risk of cancerous changes.

In rare cases where malignancy develops and metastasis occurs, a combination of surgery, chemotherapy, and radiation therapy may be needed. Regular follow-up and early intervention are crucial for patients diagnosed with gastric leiomyoma to ensure optimal outcomes.