Leiomyosarcoma of the small bowel: A case report and literature review

Abstract

Introduction: Malignant tumors of the small bowel are rare. The jejunum, ileum, and duodenum represent the most common sites of intestinal leiomyosarcoma (LMS). Herein, we present a case of a 65-year-old patient having ileal LMS successfully treated with surgical resection.

Presentation of case: A 65-year-old patient, with no comorbidities, presented with chronic and paroxysmal abdominal pain. Upper endoscopy and colonoscopy showed no abnormalities. Thoracoabdominal computed tomography (CT) revealed an ileal lobulated, heterogeneously enhancing solid mass measuring 6 cm. Laparotomy was performed. Findings showed a lobulated ileal mass. We made an enlarged ileal resection with end-to-end anastomosis. The postoperative course was uneventful. Histology and IHC stains concluded into ileal LMS. No relapse of the disease was noted during the 4-month follow-up.

Clinical discussion: Ileal LMS is a rare tumor originating from the smooth muscle cells within the muscularis mucosa or muscularis propria. CT colonography (CTC) and magnetic resonance enterography (MRE) represent good options to aid the diagnosis. Histologically, LMS often has a comparable morphological appearance to GISTs. IHC is essential to differentiate those tumors. Surgery is the only curative treatment. The prognosis is poor knowing that those tumors are discovered at advanced stages.

Conclusion: Ileal LMS is a rare tumor originating from the smooth muscle cells. It has a comparable morphological appearance to GISTs. Immunohistochemistry is essential to confirm the diagnosis. Surgery is the only curative treatment. The prognosis is poor.

Keywords: Case report; Ileal neoplasms; Leiomyosarcoma; Small bowel.

Fig. 1

CT scan in the axial plane showing lobulated ileal mass.

Fig. 2

Intraoperative view.

Fig. 3

(a) Ileal location of a spindle-cell malignant mesenchymal proliferation (HE × 25); (b) the tumor cells are provided with very atypical, pleomorphic, and mitotic nuclei (HE × 100); they express H-Caldesmon (IHC × 100) (c) and Desmin (d) (IHC × 100) and were negative for CD117 (e) and Dog1 (f) (IHC × 100).