Spontaneous Regression of Gastric Reticulum Cell Sarcoma

Abstract

Spontaneous regression of tumor metastases is a rare phenomenon. We report a patient with gastric leiomyoblastoma with extensive peritoneal metastases who had an incomplete excision of the primary. He has survived 29 years since the diagnosis was first documented. He received no adjuvant therapy. The author speculates on the cause of this regression. First, this type of tumor is somewhere between leiomyoma and leiomyosarcoma in terms of its malignancy, so it is possible that a tumor with a limited malignancy potential can, after an aggressive stage, reverse itself either spontaneously or after a large portion of the tumor mass is removed. The author suggests a second possible cause of the observed regression could be an increase in immunological resistance. Possibly, the operative trauma and postoperative infection in this case might be contributing factors.

Case Details

Personal Characteristics

A sixty-year-old puerto rican female

Clinical Characteristics

Epigastric pain, a 20 pound weight loss, and nausea. Abdominal examination revealed a fixed, slightly tender, 5 centimeter round mass in the right upper quadrant. Laboratory data revealed a hematocrit of 35%, normal liver function tests, and normal routine blood chemistry. An upper gastrointestinal examination revealed a large, irregular, lobulated mass in the antrum with ulceration on the greater curvature, radiologically interpreted as gastric carcinoma.

Remission Characteristics

In 1968, the patient was well, had no weight loss and was asymptomatic. X-ray film examination of the stomach in 1968 revealed some stiffness in the distal antrum, but no mass defect. Repeat x-ray films in 1970 and 1971 showed essentially normal findings, with most of the contrast material emptying by way of the duodenum. In march 1971, the patient remained asymptomatic. Physical examination, hemoglobin, liver function tests, skeletal survey, barium enema, intravenous pyelography, and gastroscopy, revealed normal findings.

Treatment & Mechanisms

Proposed Remission Mechanisms

Not discussed

Clinical Treatment

Gastroenterostomy

Additional Notes

The patient received no therapy other than gastroenterostomy. The tumor was considered unresectable. A biopsy of the tumor was taken where it extended into the mesocolon, and the frozen section diagnosis was undifferentiated carcinoma. The permanent slides were also interpreted as showing undifferentiated carcinoma, probably of gastric origin. The patient made an uneventful recovery and was discharged. It was planned to employ radiotherapy and/or chemotherapy as indicated by the patient’s clinical course. Because of the unusual course, the pathologic slides were reviewed by the senior members of the department of clinical pathology. The biopsy specimen was infiltrated with cords and strands of necrotic cells with enlarged, hyperchromatic nuclei with a coarse chromatin network. The mitotic rate was brisk. An epithelial type of reticulum network was revealed on Laidlaw silver stain. The diagnosis at the time was changed to reticulum cell sarcoma, gastric organ. Because of her benign clinical course for two years, no therapy was given.