Presentation
Abdominal pain and blood loss.
Patient Data
Oval soft tissue mass centered on the distal ileum. This does not obstruct the small bowel. No adenopathy, peritoneal nodularity, or solid organ metastasis. No free fluid.
Case Discussion
The final pathology report confirmed "sarcomatoid carcinoma (carcinosarcoma)" without perineural or lymphovascular invasion. This is an extremely rare malignant neoplasm of the small bowel with a very poor prognosis. Only about 30 cases have been reported to date.
More commonly, small bowel tumors are adenocarcinoma, carcinoid, mesenchymal (such as GIST), and lymphoma. Given the relatively bland imaging features and lack of small bowel obstruction, lymphoma was favored in this case. Sarcomatoid carcinomas have histologic features of carcinoma and sarcoma. Aggressive surgical management is the primary treatment modality.
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