Lower Extremity Varicose Veins: An Unusual Presentation of Small Bowel Leiomyosarcoma

Abstract

Leiomyosarcomas (LMSs) are extremely rare and comprise only 1.2% of small bowel malignancies. Advancements in immunohistochemical techniques have allowed for the differentiation between LMSs and gastrointestinal stromal tumors. LMSs remain difficult to detect via endoscopy and require a more intricate diagnostic approach. The staging and sizing of these tumors are important prognostic indicators. We report a case of a 67-year-old male who presented with bulging lower extremity veins, abdominal bloating, and weight loss. A CT of the abdomen and pelvis revealed a pelvic mass arising from the small bowel and a metastatic hepatic lesion, which was found to be compressing the inferior vena cava. A biopsy of the hepatic lesion confirmed the diagnosis of metastatic LMS.

Keywords: Gastrointestinal stromal tumor; Leiomyosarcoma; Small intestine; Stromal tumors.

Fig. 1

Coronal CT post-contrast images showing a 12-cm heterogenous and lobulated pelvic mass, arising from the small bowel. Several hepatic masses, with a 4-cm lesion projecting from the dome of the liver and compressing the inferior vena cava.

Fig. 2

Axial CT post-contrast images showing a 12-cm heterogenous and lobulated pelvic mass, arising from the small bowel. Several hepatic masses, with a 4-cm lesion projecting from the dome of the liver and compressing the inferior vena cava.

Fig. 3

Mitotically active spindle-shaped cells with moderate atypia and abundant eosinophilic cytoplasm.

Fig. 4

Mitotically active spindle-shaped cells with moderate atypia and abundant eosinophilic cytoplasm.

Fig. 5

Immunohistochemical staining positive for desmin.