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

Seung Min Hong; Gwang Ha Kim; Dami Kim; Sojeong Lee

doi:10.4166/kjg.2020.75.2.94

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Hong, Kim, Kim, and Lee: Duodenal Leiomyosarcoma Presenting with Gastrointestinal Bleeding and Obstruction: A Case Report

Case Report

Korean J Gastroenterol 2020;75(2):94-97.

Published online: 4 October 2020

DOI: https://doi.org/10.4166/kjg.2020.75.2.94

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

Seung Min Hong, Gwang Ha Kim¹, Dami Kim, Sojeong Lee²

Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea

¹Biomedical Research Institute, Pusan National University Hospital, Busan, Korea

²Department of Pathology, Pusan National University School of Medicine, Busan, Korea

Correspondence to: Gwang Ha Kim, Department of Internal Medicine, Pusan National University School of Medicine, Biomedical Research Institute, Pusan National University Hospital, 179 Gudeok-ro, Seo-gu, Busan 49241, Korea. Tel: +82-51-240-7869, Fax: +82-51-244-8180, E-mail: doc0224@pusan.ac.kr, ORCID: https://orcid.org/0000-0001-9721-5734

Received 27 August 2019 Revised 15 September 2019 Accepted 27 October 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Duodenal obstruction, Gastrointestinal hemorrhage, Leiomyosarcoma

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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.

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).

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ORCID iDs: Gwang Ha Kim
https://orcid.org/0000-0001-9721-5734
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