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Gastric leiomyoblastoma(A clinical and ultrastructural study)

Ten cases of gastric leiomyoblastoma are presented, 4 of which were followed for periods greater than 5 years. To date, only 1 example of leiomyoblastoma has exhibited malignant behavior, with metastases leading to death of the patient. It would appear that leiomyoblastoma can be evaluated with reasonable success for benign or malignant behavior by the ordinary pathologic criteria applicable to smooth muscle tumors, especially by gross size and frequency of mitoses. However, because of the difficulty of completely accurate prognosis, it is recommended that symptomatic leiomyoblastomas be treated by partial gastric resection rather than simple enucleation. Electron microscopic study of examples of leiomyoblastoma has demonstrated that the vacuolated cell of leiomyoblastoma is an artifact of fixation, probably caused by delay in fixation rather than by the chemical nature of the fixative. Since a similar artifact can occasionally be prominent in gastric leiomyomas or leiomyosarcomas, it is suggested that vacuolization be abandoned as a histologic criterion of leiomyoblastoma and that the diagnosis be confined to those tumors which after prompt fixation demonstrate a predominance of nonvacuolated epithelioid cells.