J Korean Soc Radiol.  2015 Nov;73(5):323-327. 10.3348/jksr.2015.73.5.323.

CT Findings of Primary Undifferentiated Pleomorphic Sarcoma in the Small Bowel: A Case Report

• Kim YR
• Lee YH
• Yoon KH
• Yun KJ

• KMID: 2079567
• DOI: http://doi.org/10.3348/jksr.2015.73.5.323

Abstract

Undifferentiated pleomorphic sarcoma (UPS), previously known as malignant fibrous histiocytoma, is a soft tissue sarcoma arising from mesenchymal tissue of the body. UPS of the gastrointestinal tract is known to be rare and only a few cases have been reported in the literature. Based on our case and review of the other relevant literature, the CT findings of primary UPS of the small bowel included nodular bowel wall thickening with homogeneous enhancement. It presents as a rapidly growing tumor without bowel obstruction, and it may be accompanied by distant metastasis.

MeSH Terms

Gastrointestinal Tract
Histiocytoma, Malignant Fibrous
Ileum
Intestine, Small
Multidetector Computed Tomography
Neoplasm Metastasis
Sarcoma*

Figure

• 

  Fig. 1 Primary undifferentiated pleomorphic sarcoma (UPS) of the small bowel with adrenal metastases in a 51-year-old man. A. The initial computed tomography (CT) image reveals segmental nodular wall thickening of the ileum with homogeneous enhancement (arrows). The degree of tumor enhancement is lower than that of normal mural enhancement. The size of the tumor is 3.6 × 2.7 cm. B. The initial CT image presents two adrenal masses of medial (arrow) and lateral (not shown) limbs with heterogeneous enhancement. The size of upper limb tumor is 3.1 cm. C. On a follow-up CT image 80 days later, the ileal tumor grew rapidly to 6.5 × 4.2 cm on the axial image. The tumor showing enhancing nodular wall thickening became more heterogeneous (arrows). Though the thickness of the wall is 2.0 cm or more, the patent lumen is seen as an aneurysmal dilatation. D. On a follow-up CT image 80 days later, the right adrenal gland mass is 5.2 cm in size. It presents with central low-attenuation with a mild enhancing inner solid portion (arrow). E. The gross pathological findings of small bowel UPS. A 6 × 5 cm tumor with diffuse necrotic changes and ulceration is noted. F. A photomicrograph reveals the hypercellularity and storiform architecture of the pleomorphic spindle cells (hematoxylin and eosin, × 200). G. These tumor cells are immunoreactive for alpha-1-antichymotrysin (× 200).

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