TOPOISOMERASE-II AND KI-67 IMMUNOHISTOCHEMICAL STAINING IN GASTRIC LEIOMYOSARCOMA METASTATIC TO BRAIN

A 54-year-old Hispanic woman presented to the emergency room with a 2- month history of syncope and melena. She was found to have a large gas tric mass, which on histologic examination was described as consistent with a poorly differentiated carcinoma. After 1 month of preoperative chemotherapy, the patient underwent splenectomy, total gastrectomy, a nd esophagojejunostomy without complications. Nine months later, the p atient was readmitted with headache and confusion, and a mass was disc overed within the right frontal lobe. Histopathology identified this t umor as a high-grade malignant stromal neoplasm. Immunohistochemistry and electron microscopy confirmed the diagnosis of leiomyosarcoma. Sta ining for Ki-67 and topoisomerase II revealed a high proliferative rat e in both lesions, consistent with aggressive behavior of the tumor. C erebral metastases of leiomyosarcomas from any site are extremely rare ; we were unable to document any other instance of metastasis to the b rain from a primary gastric leiomyosarcoma.