A Case of Leiomyosarcoma of the Duodenum Detected before Surgery

Tetsuya Kajimoto, Naoshi Tashiro, Masaru Naruse, Toshihiko Sasaki, Ryunosuke Ogawa, Haruyuki Akita^*, Yosio Inoue^*, Teruaki Aoki^* and Masahiro Ikegami^**

Department of Surgery, Sakuragaoka Hospital
Departments of Surgery^* and Pathology^**, Jikei University School of Medicine

A 52-year-old male was hospitalised because of melena and general fatigue. Endoscopic examination revealed a protruding lesion resembling a submucosal tumor which was accompanied by an ulcer opposite the major papilla of the duodenum. The tumor was also observed on abdominal computed tomography and hypotonic duodenographic examination in the descending part of the duodenum. Endoscopic ultrasonography showed that the tumor was derived from the muscle layer of the duodenal wall. In consideration of these findings and angiographic evidence in which enlargement, encasement and hypervascularity of the feeding artery to the tumor was observed, we diagnosed the tumor as a leiomyosarcoma of the duodenum. Partial resection of the duodenum including the tumor, which showed exoenteric growth along the descending and transverse part of the duodenum, was performed. The tumor was 64mm long and associated with an ulcer on the mucosa. The inside of the tumor had an irregular and cystic appearance, which was thought to be because of necrotic changes. Histological examination demonstrated leiomyosarcoma. In conclusion, we need to consider leiomyosarcoma when a duodenal tumor is found and to perform the above examinations. Among the examinations, endoscopic ultrasonography is thought to be the most useful one for diagnosis of duodenal leiomyosarcoma and, therefore, we suggest that endoscopic ultrasonography should be performed if possible.

Key words
duodenal leiomyosarcoma, duodenal submucosal tumor, endoscopic ultrasonography

Reprint requests
Tetsuya Kajimoto Department of Surgery Sakuragaoka Sogo Hospital, 12-23 Sakuragaoka-cho, Shimizu, 424-0856 JAPAN

Accepted
December 22, 1999

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