Presentation
Investigation for melena.
Patient Data
Age: 60 years
Gender: Male
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An intensely enhancing solid tumor mass with irregular contour is visualized in the jejunal part of the small intestine, with focal dilatation of the bowel loop. The tumor is invading the serosa.
Case Discussion
Leiomyosarcoma of the jejunum, pathology-proven. No metastases were detected.
Leiomyosarcoas account for approximately 10% of the small-bowel malignancies. Although they may occur anywhere in the small intestine, the duodenum is less commonly affected (in contrast to adenocarcinoma).
Tumor characteristics:
- the main site of predilection is the ileum (50%).
- most tumors are larger than 6 cm
- 66% show extraluminal growth. As a result bowel obstruction is somewhat unusual or reflects a late tumor stage.
- leiomyosarcomas are rarely asymptomatic and are clinically manifested by abdominal pain and melena.
- intraperitoneal hematogenous seeding is common, where lymphogenous metastases are rare.
MRI specifics:
- comparable to leiomyoma:
- rounded and well-circumscribed
- submucosally located
- 1-10 cm in diameter
- intermediate signal intensity on T1
- slighly increased signal on T2
- homogeneous moderate to high contrast enhancement
- signal voids can be caused by calcifications
- zones of tumor necrosis may produce map-like hypointense areas on T1 after contrast
- irregular lesion margins and enlarged lymph nodes should raise a suspicion of leiomyosarcoma
- MRI is better than enteroclysis for detecting eccentric tumor components
- MRI can also detect cystic metastases in the peritoneal cavity and liver