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Image of Issue Successful resection and diagnosis of primary gastric myxoid liposarcoma using endoscopic submucosal dissection
Kimitoshi Kubo1,orcid, Noriko Kimura2orcid

DOI: https://doi.org/10.5946/ce.2024.330
Published online: March 13, 2025

1Departments of Gastroenterology, National Hospital Organization Hakodate Medical Center, Hakodate, Japan

2Department of Pathology, National Hospital Organization Hakodate Medical Center, Hakodate, Japan

Correspondence: Kimitoshi Kubo Department of Gastroenterology, National Hospital Organization Hakodate Medical Center, 18-16 Kawahara-cho, Hakodate, 041-8512 Hokkaido, Japan E-mail: kubotti25@yahoo.co.jp
• Received: December 7, 2024   • Revised: December 24, 2024   • Accepted: December 25, 2024

© 2025 Korean Society of Gastrointestinal Endoscopy

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (https://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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A 72-year-old man with anemia underwent esophagogastroduodenoscopy, which revealed a pedunculated polyp with an erosion invagination into the duodenum from the anterior antral wall. When pulled back into the stomach, it presented as a large submucosal tumor with a mucosal defect at its apex (Fig. 1A, B). Computed tomography revealed an intraluminal polypoid lesion without any evidence of lymph node enlargement or distant metastasis. Since the biopsy was inconclusive, endoscopic submucosal dissection (ESD) was attempted as a diagnostic treatment for a suspected submucosal tumor (SMT) (Fig. 1C–F). Histological examination revealed the myxoid liposarcoma lesion of 6060 mm (Fig. 2). Histological examination revealed no residual tumor after partial gastrectomy (PG), reducing the risk of local recurrence. Her course of recovery was uneventful for the following three months.
Primary gastric liposarcoma is extremely rare, and its etiology remains uncertain; however, it is believed to develop from undifferentiated mesenchymal cells in the lamina propria or submucosa. Although there is no consensus on its treatment, a surgical treatment that allows for a wide negative margin is often chosen. Given the advances in endoscopic therapy, endoscopic resection may be used for early-stage tumors.
To date, reported primary gastric liposarcomas endoscopically resected following endoscopic resection/dissection for SMT include a mixed-type liposarcoma,1 a well-differentiated liposarcoma,2 and a dedifferentiated liposarcoma,3 each exhibiting no recurrence during follow-up.
In the present case, the liposarcoma in the patient was resected and diagnosed using ESD. Further investigation is required to determine whether endoscopic resection is an option of interest.
This study was conducted with the approval of the institutional review board of Hakodate Medical Center and in accordance with the Declaration of Helsinki and its later amendments, as well as Good Clinical Practice. Informed consent was obtained from the patient for the publication of this report and the accompanying images.
Fig. 1.
A pedunculated polyp with an erosion invagination into the duodenum from the anterior antral wall. (A) A large submucosal tumor (white-light imaging). (B) A mucosal defect at the apex (indigo carmine dye). (C–F) Liposarcoma was successfully resected using endoscopic submucosal dissection.
ce-2024-330f1.jpg
Fig. 2.
A 60×60 mm myxoid liposarcoma was revealed in the histological examination. (A) Hematoxylin and eosin staining. (B) Alcian blue- periodic acid-Schiff staining. (A, B) Scale bar: 50 μm.
ce-2024-330f2.jpg
  • 1. Yamamoto K, Teramae N, Uehira H, et al. Primary liposarcoma of the stomach resected endoscopically. Endoscopy 1995;27:711.ArticlePubMed
  • 2. Kang WZ, Xue LY, Wang GQ, et al. Liposarcoma of the stomach: report of two cases and review of the literature. World J Gastroenterol 2018;24:2776–2784.ArticlePubMedPMC
  • 3. Cho JH, Byeon JH, Lee SH. Primary gastric dedifferentiated liposarcoma resected endoscopically: A case report. World J Gastroenterol 2022;28:2625–2632.ArticlePubMedPMC

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      Successful resection and diagnosis of primary gastric myxoid liposarcoma using endoscopic submucosal dissection
      Image Image
      Fig. 1. A pedunculated polyp with an erosion invagination into the duodenum from the anterior antral wall. (A) A large submucosal tumor (white-light imaging). (B) A mucosal defect at the apex (indigo carmine dye). (C–F) Liposarcoma was successfully resected using endoscopic submucosal dissection.
      Fig. 2. A 60×60 mm myxoid liposarcoma was revealed in the histological examination. (A) Hematoxylin and eosin staining. (B) Alcian blue- periodic acid-Schiff staining. (A, B) Scale bar: 50 μm.

      Fig. 1.

      Fig. 2.

      Successful resection and diagnosis of primary gastric myxoid liposarcoma using endoscopic submucosal dissection
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