Laparoscopic transgastric enucleation of a giant leiomyoma near the esophagogastric junction: A case report.

INTRODUCTION AND IMPORTANCE: Gastric subepithelial tumors are surgically treated by tumorectomy without lymphadectomy, and many operations are currently performed via the minimally invasive technique. However, when they occur near the esophagogastric junction and the pyloric ring, there is a possibility that subtotal or total gastrectomy is required for tumor resection.

CASE PRESENTATION: An 18-year-old man presented with anemia. A giant subepithelial tumor near the esophagogastric junction was seen on a gastroscopy performed to find the cause of anemia. A computed tomography scan revealed a 7.5-cm homogeneous soft tissue mass near the esophagogastric junction, suggesting leiomyoma or gastrointestinal stromal tumors as gastric subepithelial tumors. Endoscopic ultrasound revealed an inhomogeneous and hypoechoic mass, consistent with a gastrointestinal stromal tumor. An endoscopic ultrasound-guided fine needle biopsy was performed, resulting in a diagnosis of leiomyoma. We performed the laparoscopic transgastric enucleation, and the final pathology report showed complete resection of a benign leiomyoma.

CLINICAL DISCUSSION: Laparoscopic surgery may be challenging for subepithelial tumors of the esophagogastric junction, but laparoscopic transgastric enucleation may be considered if the lesion is benign after a fine needle biopsy.

CONCLUSION: We report a case of a very young patient for whom laparoscopic transgastric enucleation of a giant gastric leiomyoma near the esophagogastric junction was a feasible organ-sparing procedure.