Q: One of my relatives had an operation of a tumour detected in the stomach. The biopsy report states epithelioid variety of leiomyoma. It would be very kind of you if you please let me know more about this disease and what are the chances of it turning malignant (as initially it was thought to be benign)?

A:Epithelioid leiomyomatous tumours (leiomyoblastomas) of the gastric wall are tumours that affect middle-aged men primarily and usually present with upper gastrointestinal bleeding or peptic ulcer-like symptoms. They are composed of a mixture of round epithelioid and spindle cells (and hence this name). The epithelioid leiomyoma, the benign form, often arises in the mid- and distal stomach, especially on the anterior wall. Most of these tumours are biologically benign, but some show malignant changes. Malignancy is difficult to predict on the basis of morphologic criteria alone. Therefore, follow-up of these patients is essential. Counting mitotic figures has been the standard technique in making the distinction between malignant and benign forms. Tumour size is another factor frequently used to determine benign or malignant status. Tumours > 6-10 cm have been used as criteria to define malignant status. Location is also significant. Patients with gastric tumours tend to fare better than those with extra-gastric lesions. It is not uncommon, however, to observe metastasis in patients who exhibited no mitotic figures at initial evaluation. It has been suggested by some that gastroscopy should be performed on these patients at six-month intervals for the first two years, and thereafter once a year for at least the next 10 years. Surgery is the definitive therapy for patients.