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Intestinal Leiomyosarcoma Clinical Presentation

  • Author: Jaspreet K Ghumman, DO; Chief Editor: BS Anand, MD  more...
 
Updated: Jan 11, 2016
 

History

Symptoms are usually lacking; if present, they are nonspecific. Vague complaints, such as malaise, fatigue, and nonfocal abdominal pain, are often described.

The sign most often cited is bleeding. These tumors sometimes necrose and bleed into the bowel. In one study, 59% of patients with leiomyosarcomas were symptomatic. For 70% of these patients, bleeding was the primary symptom. Of those who bled, 69% bled acutely, and 82% of the acute bleeders required transfusions. Of those who bled acutely, 45% required emergent laparotomy. Duodenal tumors bled most often. Of the duodenal tumors, 75% bled, requiring an average replacement of 11.5 units of blood.

Complaints of malaise and fatigue likely are due to anemia, which often is present in patients who bleed chronically.

Weight loss is reported as a late feature, with an incidence of around 20%.

Past medical history: One study reported a possible relationship between leiomyosarcomas and Crohn disease. In this series, which reviewed more than 11,000 cases, 6% of the patients with leiomyosarcomas also had a history of Crohn disease.[6]

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Physical

Unless the patient is bleeding or is acutely obstructed, physical findings usually are absent.

A mass rarely is palpable.

Patients with malignancy may present with the findings of obstruction, such as distention, borborygmi, a palpable mass, and diffuse mild-to-moderate abdominal tenderness.

Other patients present with jaundice secondary to either biliary obstruction or hepatic replacement by metastases.

Cachexia, hepatomegaly, and ascites may be present in patients with advanced metastatic disease.

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Contributor Information and Disclosures
Author

Jaspreet K Ghumman, DO Fellow, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital

Jaspreet K Ghumman, DO is a member of the following medical societies: American College of Gastroenterology, American College of Osteopathic Internists, American Gastroenterological Association, American Osteopathic Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Coauthor(s)

Michael H Piper, MD Clinical Assistant Professor, Department of Internal Medicine, Division of Gastroenterology, Wayne State University School of Medicine; Consulting Staff, Digestive Health Associates, PLC

Michael H Piper, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Gastroenterology, American College of Physicians, Michigan State Medical Society

Disclosure: Nothing to disclose.

Janice M Fields, MD, FACG, FACP Assistant Professor of Internal Medicine, Oakland University William Beaumont School of Medicine; Consulting Staff, Department of Internal Medicine, Section of Gastroenterology, Providence Hospital, St John Macomb-Oakland Hosptial

Janice M Fields, MD, FACG, FACP is a member of the following medical societies: American College of Gastroenterology, American College of Physicians-American Society of Internal Medicine, American Gastroenterological Association, American Medical Association, American Society for Gastrointestinal Endoscopy, National Medical Association

Disclosure: Nothing to disclose.

Bradley J Warren, DO, FACG, FACOI Consulting Staff, Digestive Health Associates, PLC

Bradley J Warren, DO, FACG, FACOI is a member of the following medical societies: American College of Gastroenterology, American Osteopathic Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Specialty Editor Board

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Received salary from Medscape for employment. for: Medscape.

Noel Williams, MD, FRCPC FACP, MACG, Professor Emeritus, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Professor, Department of Internal Medicine, Division of Gastroenterology, University of Alberta, Edmonton, Alberta, Canada

Noel Williams, MD, FRCPC is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada

Disclosure: Nothing to disclose.

Chief Editor

BS Anand, MD Professor, Department of Internal Medicine, Division of Gastroenterology, Baylor College of Medicine

BS Anand, MD is a member of the following medical societies: American Association for the Study of Liver Diseases, American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy

Disclosure: Nothing to disclose.

Additional Contributors

Rajeev Vasudeva, MD Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine

Rajeev Vasudeva, MD is a member of the following medical societies: American College of Gastroenterology, Columbia Medical Society, South Carolina Gastroenterology Association, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, South Carolina Medical Association

Disclosure: Received honoraria from Pricara for speaking and teaching; Received consulting fee from UCB for consulting.

Acknowledgements

George Brasinikas, MD Staff Physician, Gallup Indian Medical Center

George Brasinikas, MD is a member of the following medical societies: American Medical Association, College of American Pathologists, and Medical Association of the State of Alabama

Disclosure: Nothing to disclose.

Jill Halonen, MD Staff Physician, Department of Surgery, St Agnes Medical Center

Disclosure: Nothing to disclose.

Richard K Spence, MD Senior Vice President for Clinical Affairs, Infonale

Disclosure: Nothing to disclose.

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Colonic mucosa with gastrointestinal stromal tumor (GIST) involving adjacent submucosa (hematoxylin and eosin [H&E] stain, medium power).
Clusters of tumor cells separated by a hyaline and mucin-rich stroma (hematoxylin and eosin [H&E] stain, medium power).
Oval- to spindle-shaped cells forming a fascicle (hematoxylin and eosin [H&E] stain, high power).
CD-34 stain showing a tumor (medium power). CD-34 is a myeloid progenitor cell antigen.
High-power magnification with CD-34 antigen immunohistochemical stain showing membrane positivity of tumor cells.
 
 
 
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