eMedicine Specialties > Gastroenterology > Intestine

Intestinal Leiomyosarcoma: Differential Diagnoses & Workup

Author: Richard K Spence, MD, Senior Vice President for Clinical Affairs, Infonale
Coauthor(s): George Brasinikas, MD, Staff Physician, Department of Pathology, Birmingham Baptist Medical Center
Contributor Information and Disclosures

Updated: Nov 9, 2006

Differential Diagnoses

Gastric Cancer
Intestinal Polypoid Adenomas
Malignant Carcinoid Syndrome
Malignant Neoplasms of the Small Intestine
Metastatic Cancer, Unknown Primary Site

Other Problems to Be Considered

Lymphoma
Adenocarcinoma
Intestinal leiomyoma

Workup

Laboratory Studies

  • Unless obstruction or perforation occurs, low hemoglobin caused by acute or chronic bleeding may be the only evidence of this tumor. If the bleeding is chronic, the appropriate indices will be affected.

Imaging Studies

  • Notably, as many as 40% of these tumors are discovered incidentally. With this in mind, the principle symptom or sign of leiomyosarcomas is GI bleeding, sometimes massive.
  • If findings on esophagogastroduodenoscopy (EGD) and colonoscopy are normal, always consider a focused contrast study of the small bowel followed by a CT scan in case the source of bleeding is not identified. Unfortunately, early detection of the tumor by CT scan depends on size and may not be helpful.
  • A single report describes the use of preoperative endoscopic ultrasound in helping to plan resection (Ludwig DG, 1997). Ludwig postulated that this modality might be useful; further study is necessary.
  • A 2004 study by Ping-Hong Zhou and colleagues evaluated the use of miniprobe ultrasonography during colonoscopy in diagnosing submucosal tumors of the large intestine. Leiomyosarcomas were identified as having inhomogeneous echoes and irregular borders. Zhou et al also concluded that this technique provided information about size and layer of origin. As leiomyosarcoma account for only 0.1% of colonic malignancies, miniprobe ultrasonography is more useful in other submucosal tumors, such as lipomas and leiomyomas.

Procedures

  • Because these tumors are intramural in origin and tend to grow extraluminally, biopsy findings from the luminal wall obtained from over the tumor often will be reported as benign mucosa.
  • If possible, endoscopic ultrasound with guided biopsy may be diagnostic.

Histologic Findings

These tumors are spindle cell in character, with high cellularity. The mitotic figure count is of supreme importance. A count of more than 5 mitotic figures per 10 high-powered fields places a tumor into the high-grade category. Necrosis often occurs with high-grade tumors.

More on Intestinal Leiomyosarcoma

Overview: Intestinal Leiomyosarcoma
Differential Diagnoses & Workup: Intestinal Leiomyosarcoma
Treatment & Medication: Intestinal Leiomyosarcoma
Follow-up: Intestinal Leiomyosarcoma
Multimedia: Intestinal Leiomyosarcoma
References
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References

  1. Artigau Nieto E, Luna Aufroy A, Dalmau Portulas E, et al. Gastrointestinal stromal tumors: experience in 49 patients. Clin Transl Oncol. Aug 2006;8(8):594-8.

  2. Demetri GD, van Oosterom AT, Garrett CR, et al. Efficacy and safety of sunitinib in patients with advanced gastrointestinal stromal tumour after failure of imatinib: a randomised controlled trial. Lancet. Oct 14 2006;368(9544):1329-38.

  3. Evans HL. Smooth muscle tumors of the gastrointestinal tract. A study of 56 cases followed for a minimum of 10 years. Cancer. Nov 1 1985;56(9):2242-50. [Medline].

  4. Hill MA, Mera R, Levine EA. Leiomyosarcoma: a 45-year review at Charity Hospital, New Orleans. Am Surg. Jan 1998;64(1):53-60; discussion 60-1. [Medline].

  5. Hines OJ, Nelson S, Quinones-Baldrich WJ, Eilber FR. Leiomyosarcoma of the inferior vena cava: prognosis and comparison with leiomyosarcoma of other anatomic sites. Cancer. Mar 1 1999;85(5):1077-83. [Medline].

  6. Ludwig DJ, Traverso LW. Gut stromal tumors and their clinical behavior. Am J Surg. May 1997;173(5):390-4. [Medline].

  7. Martin RG. Malignant tumors of the small intestine. Surg Clin North Am. Aug 1986;66(4):779-85. [Medline].

  8. Zhan J, Xia ZS, Zhong YQ, et al. Clinical analysis of primary small intestinal disease: A report of 309 cases. World J Gastroenterol. Sep 1 2004;10(17):2585-7. [Medline].

  9. Zhan WH, Wang PZ, Shao YF, et al. Efficacy and safety of adjuvant post-surgical therapy with imatinib in gastrointestinal stromal tumor patients with high risk of recurrence: interim analysis from a multicenter prospective clinical trial [in Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. Sep 2006;9(5):383-7.

  10. Zhou PH, Yao LQ, Zhong YS, et al. Role of endoscopic miniprobe ultrasonography in diagnosis of submucosal tumor of large intestine. World J Gastroenterol. Aug 15 2004;10(16):2444-6. [Medline].

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Further Reading

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Keywords

gut stromal tumors, gastrointestinal stromal tumors, GISTs

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Contributor Information and Disclosures

Author

Richard K Spence, MD, Senior Vice President for Clinical Affairs, Infonale
Richard K Spence, MD is a member of the following medical societies: American Association of Blood Banks, American College of Physician Executives, American College of Surgeons, American Federation for Clinical Research, American Medical Association, American Medical Writers Association, American Society for Artificial Internal Organs, American Society for Parenteral and Enteral Nutrition, American Venous Forum, Association for Academic Surgery, Association for Surgical Education, Biomedical Engineering Society, Eastern Vascular Society, International College of Angiology, Medical Society of New Jersey, Medical Society of the State of New York, New York Academy of Sciences, Pan-Pacific Surgical Association, Peripheral Vascular Surgery Society, Shock Society, Society for Clinical Vascular Surgery, Society for Experimental Biology and Medicine, Society for Surgery of the Alimentary Tract, Society for Vascular Surgery, Society of Critical Care Medicine, Society of University Surgeons, Southeastern Surgical Congress, Surgical Infection Society, Transplantation Society, and Wound Healing Society
Disclosure: Nothing to disclose.

Coauthor(s)

George Brasinikas, MD, Staff Physician, Department of Pathology, Birmingham Baptist 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.

Medical Editor

Rajeev Vasudeva, MD, FACG, Clinical Professor of Medicine, Consultants in Gastroenterology, University of South Carolina School of Medicine
Rajeev Vasudeva, MD, FACG is a member of the following medical societies: American College of Gastroenterology, American Gastroenterological Association, American Society for Gastrointestinal Endoscopy, and South Carolina Medical Association
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Noel Williams, MD, 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 is a member of the following medical societies: Royal College of Physicians and Surgeons of Canada
Disclosure: Nothing to disclose.

CME Editor

Alex J Mechaber, MD, FACP, Assistant Dean for Medical Curriculum, Associate Professor of Medicine, Division of General Internal Medicine, University of Miami Miller School of Medicine
Alex J Mechaber, MD, FACP is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians-American Society of Internal Medicine, and Society of General Internal Medicine
Disclosure: Nothing to disclose.

Chief Editor

Julian Katz, MD, Clinical Professor of Medicine, Drexel University College of Medicine; Consulting Staff, Department of Medicine, Section of Gastroenterology and Hepatology, Hospital of the Medical College of Pennsylvania
Julian Katz, MD is a member of the following medical societies: American College of Gastroenterology, American College of Physicians, American Gastroenterological Association, American Geriatrics Society, American Medical Association, American Society for Gastrointestinal Endoscopy, American Society of Law Medicine and Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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