Korean J Gastroenterol.  2020 Feb;75(2):94-97. 10.4166/kjg.2020.75.2.94.

Duodenal Leiomyosarcoma Presenting with Gastrointestinal Bleeding and Obstruction: A Case Report

• Hong SM
• Kim GH
• Kim D
• Lee S

• KMID: 2471148
• DOI: http://doi.org/10.4166/kjg.2020.75.2.94

Abstract

Duodenal leiomyosarcoma is a rare condition with a poor prognosis. Early diagnosis of duodenal leiomyosarcoma is challenging because it presents with nonspecific symptoms and endoscopic biopsies usually do not enable a definitive diagnosis. Duodenal leiomyosarcomas are diagnosed on the basis of the histopathological identification of a mesenchymal lesion composed of malignant tumor cells that on immunohistochemical examination is positive for smooth muscle actin and desmin. We report the case of a 38-year-old man who presented with gastrointestinal bleeding and obstruction who was diagnosed with duodenal leiomyosarcoma after surgical resection.

Keyword

Duodenal obstruction; Gastrointestinal hemorrhage; Leiomyosarcoma

MeSH Terms

Actins
Adult
Biopsy
Desmin
Diagnosis
Duodenal Obstruction
Early Diagnosis
Gastrointestinal Hemorrhage
Hemorrhage*
Humans
Leiomyosarcoma*
Muscle, Smooth
Prognosis
Actins
Desmin

Figure

• 

  Fig. 1. (A) Contrastenhanced abdominal computed tomography image showing an ulcerative hypodense lesion at the duodenal bulb (arrow).(B) Endoscopic image showing an ulceroinfiltrative mass at the duodenal bulb nearly obstructing duodenal lumen.

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  Fig. 2. (A) Macroscopic examination revealed an ill-defined, solid white mass measuring 1.6×1.0 cm in size in muscularis propria of the duodenal bulb (arrows). (B) Histopathological examination of the resected specimen showed the mass was composed of proliferating spindle cells mixed with inflammatory cells within duodenal muscularis propria (H&E, ×12.5). (C) Spindle cells showed marked pleomorphism and the mitotic count was 21/10 high-power fields (H&E, ×400).

• 

  Fig. 3. Immunohistochemical examination revealed tumor cells with immunonegative for (A) c-kit, (B) DOG-1, (C) S-100, and (D) ALK-1 and (E) immunopositive for smooth muscle actin and (F) desmin (original magnification, ×200).

Reference

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