Fukai Shota, Lefor Alan Kawarai, Nishida Kazuhiro
Department of Surgery, Tokyo Bay Medical Center, 3-4-32 Todaijima, Urayasu, Chiba, 279-0001, Japan.
Department of Surgery, Jichi Medical University, 3311-1 Yakushiji, Shimotsuke-shi, Tochigi, 329-0498, Japan.
Int J Surg Case Rep. 2021 Feb;79:327-330. doi: 10.1016/j.ijscr.2021.01.062. Epub 2021 Jan 19.
The majority of gastrointestinal sarcoma is gastrointestinal stromal tumors and intestinal leiomyosarcoma is rare. Small intestinal mesenchymal tumors are often large at diagnosis, and they commonly present with bleeding or intussusception. We report a perforation associated with intestinal leiomyosarcoma.
A 66-year-old man presented with severe epigastric pain. A physical examination showed tachycardia and a diffusely tender and rigid abdomen. Computed tomography showed a massive tumor and free air. A laparotomy was performed to treat lower digestive perforation. Massive tumor, which invaded surrounding intestine, was 20 cm in size at the ileum. The involved intestine was perforated. We confirmed that feeding artery was superior mesenteric artery and performed partial intestinal resection. His clinical course was uneventful and discharged 10 days postoperatively. The pathological findings showed spindle shaped and the tumor invaded the mucosa at the perforated site. Immunohistochemical spectrum resulted c-kit negative, S-100 negative, Desmin positive, alpha smooth muscle actin(αSMA) positive and Ki-67 30-40 %. The pathological findings were leiomyosarcoma.
Gastrointestinal sarcoma is sometimes found by bleeding. In our patient, leiomyosarcoma invaded surrounding intestine, it made the intestine wall frail and caused perforation. The intestinal perforation which was involved by leiomyosarcoma has been rarely reported to the best of our knowledge since WHO refined leiomyosarcoma.
Although intestinal leiomyosarcoma is rare, we should know that it can involve surrounding intestines and make them perforated.
大多数胃肠道肉瘤是胃肠道间质瘤，而肠道平滑肌肉瘤较为罕见。小肠间质瘤在诊断时通常体积较大，常见症状为出血或肠套叠。我们报告一例与肠道平滑肌肉瘤相关的穿孔病例。
一名66岁男性因上腹部剧痛就诊。体格检查发现心动过速，腹部弥漫性压痛且僵硬。计算机断层扫描显示有巨大肿瘤及游离气体。行剖腹手术以治疗下消化道穿孔。在回肠处发现一个侵犯周围肠管的巨大肿瘤，大小为20厘米。受累肠管发生穿孔。我们确认供血动脉为肠系膜上动脉，并进行了部分肠切除术。他的临床过程平稳，术后10天出院。病理检查结果显示肿瘤细胞呈梭形，在穿孔部位侵犯了黏膜。免疫组化结果显示c-kit阴性、S-100阴性、结蛋白阳性、α平滑肌肌动蛋白（αSMA）阳性，Ki-67为30%-40%。病理诊断为平滑肌肉瘤。
胃肠道肉瘤有时因出血而被发现。在我们的患者中，平滑肌肉瘤侵犯周围肠管，使肠壁变脆弱并导致穿孔。据我们所知，自世界卫生组织对平滑肌肉瘤进行分类以来，很少有关于平滑肌肉瘤累及肠道穿孔的报道。
尽管肠道平滑肌肉瘤罕见，但我们应了解它可累及周围肠管并导致穿孔。
