DIAGNOSTIC AND THERAPEUTIC MANAGEMENT FOR LEIOMYOMA OF THE UPPER GASTROINTESTINAL TRACT

Abstract

Summary. Leiomyoma is the most common type of mesenchymal tumor in the esophagus (70-80 %) and the second most common type of mesenchymal tumor (about 45 %) in the stomach. But in the last 20 years, we can find only a small number of publications devoted to them. And in it the leiomyoma mainly became the subject of differential-diagnostic comparison when evaluating other subepithelial neoplasms. Aim. Based on our own experience of treating patients with leiomyoma of the upper gastrointestinal tract, as well as being guided by current clinical recommendations related to the diagnosis and treatment of SEP, we will develop a diagnostic and therapeutic algorithm that will help to optimize the management tactics of patients with leiomyoma of the upper gastrointestinal tract. Materials and methods. After the analysis of the results of the treatment of 36 patients with confirmed leiomyoma of the esophagus, stomach and duodenum, a diagnostic and treatment algorithm was proposed, and it is a synthesis of our own experience and current global recommendations of such organizations as ESGE, ESMO, NCCN, JGCA, CSCO. Results. The management of leiomyoma will depend of the size of the neoplasm at the time of initial diagnosis. Taking into account the specifics of the clinical situation, an active or passive treatment strategy can be used in each individual case. The most effective methods of diagnosis and methods of surveillance are EGDS and EUSG. When choosing the surgical intervention, preference is given to endoscopic resection or laparoscopic resection. Postoperative determination of the etiology of the SEL is carried out by performing pathomorphological and immunohistochemical diagnostics. Within their histological type, leiomyoma may be characterized by a certain pathohistological pleomorphism, and are divided into leiomyoma of simple and proliferating clinical - morphological variants. Leiomyoma of the proliferating clinical-morphological variant have significantly higher indicators of such immunohistochemical markers as Ki-67 and CD31 in comparison with leiomyoma of a simple clinical-morphological variant. Therefore, leiomyoma of the proliferating clinical and morphological variant can reach much larger sizes. The size of the leiomyoma, in turn, has a direct proportional effect on the likelihood of complications. Conclusions. Leiomyoma are the common and heterogeneous type of subepithelial lesions that require a deep and detailed study.