Gastrointestinal bleeding caused by jejunal angiosarcoma: A case report

Abstract

Background: Angiosarcoma is a rare disease with a poor prognosis. Its occurrence in the small intestine is low, and gastrointestinal bleeding caused by small intestinal angiosarcoma is unusual.

Case summary: Here, we report the case of a 57-year-old man who presented with hematochezia for 1 mo. The patient had a medical history of chronic viral hepatitis B for 15 years. The causes of gastrointestinal bleeding were initially diagnosed as esophagogastric variceal bleeding or portal hypertensive gastropathy before endoscopy. However, after a complicated diagnostic and therapeutic process, including gastroendoscopy, colonoscopy, contrast-enhanced computed tomographic (CT), positron emission computed tomography/CT, capsule endoscopy, and pathological and immunohistochemical examinations, small intestinal angiosarcoma was diagnosed. Arrest of bleeding was achieved after surgical treatment. Furthermore, the patient had lung cancer with bone and adrenal metastases. At the follow-up 10 mo after the operation, the patient was alive.

Conclusion: Gastroenterologists should maintain strong vigilance to small intestinal angiosarcoma, which is necessary for the early identification of this infrequent but fatal disease.

Keywords: Angiosarcoma; Case report; Diagnosis; Gastrointestinal bleeding; Prognosis; Small intestine.

Figure 1

Capsule endoscopy results. The total capsule operation time was 12 h and 59 min. The time of the capsule endoscopy transit in the esophagus, stomach, and small bowel was 2 min 10 s, 11 min 10 s, and 6 h 35 min, respectively. The results show that there was an ulcerated eminence lesion associated with bleeding over periods of 3 h 18 min to 3 h 23 min.

Figure 2

Positron emission computed tomography/ computed tomographic scan. A: A soft tissue nodule located in the right middle lobe of the lung, about 1.3 cm × 1.0 cm in size, with multiple burrs at the edges and abnormal concentration of tracer; B: Partial small intestinal wall thickness, and abnormal concentration of tracer; C: Bilateral nodular hyperplasia of the adrenal glands, and abnormal concentration of tracer, especially on the right; D: The sacral bone with uneven density, and abnormal concentration of tracer.

Figure 3

A mass approximately 3.4 cm × 6.0 cm in size was found in the small intestine and partial small bowel (14 cm long) was removed.

Figure 4

Microscopic examination and immunohistochemistry results. A-C: Tumor blood vessels were abundant, with the tumor cells surrounding them (hematoxylin and eosin staining; × 100, × 200, and × 400, respectively); D-I: The tumor cells were positive for CD30, CD31, CD34, VEGR, Fli-1, and FVIII (Immunohistochemical staining; × 200).