Gastric leiomyoma. Is there an association with Helicobacter pylori?

astric leiomyoma is the most common benign smooth muscle tumor affecting the stomach. It is well-circumscribed but nonencapsulated connective tissue lesion that may arise from any smooth muscle component of the muscular layer of the stomach wall and projects into the lumen.1 It may erode the covering mucosa producing a punched-out ulcer that may produce very brisk bleeding. Leiomyoma can also cause symptoms by obstruction, ulceration, and chronic blood loss or by compressing adjacent organs.1 Endoscopically, it appears as a large submucosal lesion, and invariably endoscopic biopsies are not deep enough to be of any diagnostic value. As leiomyoma lacks a capsule, enucleation is seldom adequate and often leaves tumor cells behind, which may lead to future recurrence. Hence, the recommended treatment is wide local excision of the surrounding stomach wall. We report 3 cases of gastric leiomyomas that were encountered and treated over 5 years of surgical practice from 1993 to 1997 at Dammam Central Hospital, Dammam, Kingdom of Saudi Arabia and raised the question of a possible association with Helicobacter pylori (H. pylori). Summary of the 3 cases is listed in Table 1. The first case was that of a 25-year-old Saudi male who presented to another hospital with 5-month history of dizziness, fatigue, palpitation and melena. There was no history of epigastric pain or weight loss. He denied any history of smoking, alcohol consumption or ingestion of any non-steroidal anti inflammatory drugs. On examination, he looked pale, well nourished, not jaundiced with normal vital signs and unremarkable abdominal examination. Blood investigations revealed iron-deficiency anemia with hemoglobin of 6g/dl. Gastroscopy revealed 2x3cm smooth-surfaced circular mass at the junction of the body and antrum. Biopsy showed mild gastritis of H. pylori. Ultrasonography showed a 3cm round solid mass to the left of the epigastric area. Diagnosis of gastric leiomyoma was suspected and hence a limited resection of the mass was performed. Histopathology confirmed presence of a gastric leiomyoma with ulceration and inflammation of covering epithelium. He was discharged 6 days later and remained well with no recurrence at 4-year follow-up. The second was a 50-year-old Saudi male presented with a history of 2 episodes of hematemesis that was associated with dizziness, palpitation and melena but no history of epigastric pain, anorexia or weight loss. He was known to have insulin-dependent diabetes and ischemic heart disease and was waiting to undergo cardiac catheterization and balloon-dilatation for a single M male, F female, H. pylori Helicobacter pylori, FU follow-up Table 1 Summary of the 3 gastric leiomyoma cases.