DOI: http://dx.doi.org/10.18203/2349-2902.isj20185051

Giant jejunal leiomyosarcoma: a rare case

Jakkula Srikanth, E. Rajesh Goud, Sri Harsha Muvva, Kanmathareddy Amulya

Abstract


Unlike other gastrointestinal neoplasms, small bowel tumours are often rare. Of this, leimyosarcoma of jejnum is extremely uncommon. Most of these patients are asymptomatic however in few cases may present with acute presentation such as intestinal obstruction, bleeding and perforation. A 35 years old female presented to the hospital with complaints of pain and vomiting. On palpation, an irregular 21x18cms lump with variable consistency and irregular borders which was intraabdominal and intraperitoneal. CECT revealed heterogenous, hypoechoic mass extending from epigastric to hypogastric region with probable diagnosis of mesenchymal tumour (probably GIST/LEIOMYOSARCOMA), however exact site of origin couldn’t be traced. Patient underwent exploratory laprotomy, 25x20cms irregular mass arising from jejunum was resected and sent for histopathological examination. HPE and immunohistochemistry revealed grade 3 leiomyosarcoma.


Keywords


Asymptomatic, Bleeding, Chemotherapy, Immunohistochemistry, Nulliparous

Full Text:

PDF

References


Jemal A, Siegel R, Ward E, Hao Y, Xu J, Murray T, et al. Cancer statistics, 2008. CA Cancer J Clin. 2008;58(2):71-96.

McGrath PC, Neifeld JP, Lawrence W Jr, Kay S, Horsley JS 3rd, Parker GA. Gastrointestinal sarcomas. Analysis of prognostic factors. Ann Surg. 1987;206(6):706-10.

Aggarwal G, Sharma S, Zheng M, Reid MD, Crosby JH, Chamberlain SM, et al. Pri-mary leiomyosarcomas of the gastrointestinal tract in the post-gastrointestinal stromal tumor era. Ann Diagn Pathol. 2012;16(6):532-40.

Arts R, Bosscha K, Ranschaert E, Vogelaar J. Small bowel leiomyosarcoma: a case report and literature review. Turk J Gastroenterol 2012;23(4):381-4.

Coco C, Rizzo G, Manno A, Mattana C, Verbo A. Surgical treatment of small bowel neoplasms. Eur Rev Med Pharmacol Sci. 2010;14(4):327-33.

Bilimoria KY, Bentrem DJ, Wayne JD, Ko CY, Bennett CL, Talamonti MS. Small bowel cancer in the United States. Ann Surg. 2009;249:63-71.

Evans HL. Smooth muscle tumors of the gastrointestinal tract: a study of 56 cases followed for a minimum of 10 years. Cancer. 1985;56:2242-50.

Hill MA, Mera R, Levine EA. Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. Am Surg. 1998;64(1):53-61.

Miettinen M, Kopczynski J, Makhlouf HR, Sarlomo-Rikala M, Gyorffy H, Burke A, et al. Gastrointestinal stromal tumors, intramural leiomyomas, and leiomyosarcomas in the duodenum: a clinicopathologic, immunohistochemical, and molecular genetic study of 167 cases. Am J Surg Pathol. 2003;27:625-41.

Luis J, Ejtehadi F, Howlett DC, Donnellan IM. Leiomyosarcoma of the small bowel: report of a case and review of the literature. Int J Surg Case Rep. 2015;6:51-4

Blanchard DK, Budde JM, Hatch GF 3rd, Wertheimer-Hatch L, Hatch KF, Davis GB, et al. Tumors of the small intestine. World J Surg. 2000;24:421-9.

Maglinte DDT, Kelvin FM, O’Connor K, Lappas JC, Chernish SM. Current status of small bowel radiography. Abdom Imag. 1996;21:24757.

Megibow AJ, Balthazar EJ, Hulnick DH, Naidich DP, Bosniak MA. CT evaluation of gastrointestinal leiomyomas and leiomyosarcomas. Am J Roentgenol. 1985;144:727-31.

Kim BS, Li BT, Engel A, Samra JS, Clarke S, Norton ID, et al. Diagnosis of gastrointestinal bleeding: a practical guide for clinicians. World J Gastrointest Pathophysiol. 2014;5:467-78.

Punt SE, Eary JF, O‘Sullivan J, Conrad EU. Fluorodeoxyglucose positron emission tomography in leiomyosarcoma: imaging characteristics. Nucl Med Commun. 2009;30(7):546-9.

Joensuu H, Hohenberger P, Corless CL. Gastrointestinal stromal tumour. Lancet. 2013;382(9896):973-83.

Coindre JM, Nguyen BB, Bonichon F, de Mascarel I, Trojani M. Histopathologic grading in spindle cell soft tissue sarcomas. Cancer. 1988;61(11):2305-9.

Guillou L, Coindre JM, Bonichon F, Nguyen BB, Terrier P, Collin F, et al. Com-parative study of the National Cancer Institute and French Federation of Cancer Centers Sarcoma Group grading systems in a population of 410 adult patients with soft tissue sarcoma. J Clin Oncol. 1997;15(1):350-62.

Skandalakis JE, Gray SW, Skandalakis LJ. Metastasis of malignant smooth muscle tumors of the gastrointestinal tract: pattern and process. J Med Assoc Ga. 1991;80:701-9.

Gill SS, Heuman DM, Mihas AA. Small intestinal neoplasms. J Clin Gastroenterol. 2001;33:267-82

Lang H, Nussbaum KT, Kaudel P, Frühauf N, Flemming P, Raab R. Hepatic metastases from leiomyosarcoma: a single-center experience with 34 liver resections during a 15-year period. Ann Surg. 2000;231:500-5.

Duffaud F, Bui BN, Penel N, et al. A FNCLCC French Sarcoma Group–GETO multicenter randomized phase II study of gemcitabine versus gemcitabine and docetaxel in patients with metastatic or relapsed leiomyosarcoma. J Clin Oncol. 2008;26:10511.

Edge SB, Byrd DR, Compton CC. AJCC (American Joint Committee on Cancer) Cancer Staging Manual. 7th ed. New York: Springer; 2010:285.