Severe anemia inducing preshock caused by sarcomatoid carcinoma of the small intestine

Abstract

A 55-year-old man consulted the outpatient department because of shortness of breath on effort and palpitation. Clinical examination showed severe anemia, a tumor with an ulcer on jejunography, with isodensity in contrast enhancement computed tomography, and a tumor stain on angiography, with middle intensity in T1- and T2-weighted images on magnetic resonance imaging. During laparotomy, we found jejunal tumors and lymph node swelling (TMN stage T3 N4 M1), and we performed a partial resection of the jejunum. Pathological examination showed a sarcomatoid carcinoma extending to the subserosal layer with multiple nodal metastases. The tumor was composed mainly of sheets of spindle cells and partially anaplastic cells appearing to be of epithelial cell origin. Histochemical staining showed a negative reaction for leukocyte common antigen and UCHL-1 and a weakly positive reaction for cytokeratin and epithelial membrane antigen. The patient died on postoperative day 283.