eMedicine Specialties > Gastroenterology > Intestine

Intestinal Leiomyosarcoma: Follow-up

Coauthor(s): George Brasinikas, MD, Staff Physician, Department of Pathology, Birmingham Baptist Medical Center
Contributor Information and Disclosures

Updated: Jan 7, 2010

Follow-up

Further Outpatient Care

  • Local and systemic recurrence is a real possibility, and even a probability, in many cases. Closely monitor the patient for such a recurrence, but specific guidelines for follow-up are lacking because of the relatively rare nature of this tumor.
  • Certainly, regularly scheduled CT scans and, as appropriate, endoscopic examinations together with blood work (blood counts and liver profile) should be performed. The authors suggest a follow-up CT scan of the abdomen and endoscopy, if possible, at 3 and 6 months after surgery. This is followed with yearly screening.
  • Stool should be screened for occult blood with the same frequency.
  • Any abdominal complaint should be evaluated aggressively.
  • A chest radiograph should be performed with each screening, together with a blood count.

Prognosis

  • With curative resection, the 5-year survival rate for patients with leiomyosarcoma of the small intestine is 40-50%, according to Hill's review.5
  • In cases in which the grade of the tumor was documented, the median survival for patients with high-grade tumors was 25 months in one study, whereas the median survival for patients with low-grade tumors was approximately 98 months.4
  • A benign initial report on a resected tumor does not remove the patient from consequences because these tumors sometimes recur as malignancies—about 6% in one study.6
  • In a report on the characteristics of duodenal GISTs, Miki et al compared the clinicopathologic findings in and recurrence-free survival of 7 patients with these lesions with the same data for 34 patients with GISTs of the stomach or elsewhere.12 The investigators determined that the rates for symptomatic lesions were 86% in the duodenum, 32% in the stomach, and 56% elsewhere, with melena and anemia being the most common symptoms associated with duodenal GISTs.12 The rates of 2-year recurrence-free survival among patients were 51.4% for duodenal GISTs, 78.4% for stomach GISTs, and 100% for other GISTs. Using multivariate Cox analysis, the authors concluded that in terms of GIST recurrence, significant prognostic factors included symptoms, mitotic index, and tumor location.12

Miscellaneous

Medicolegal Pitfalls

  • Positive test results for occult blood in the stool of a patient demand a source. If colonoscopy and EGD results are negative, investigate the small bowel with a radio-opaque follow-through or further endoscopy.
 
Acknowledgments

The authors and editors of eMedicine gratefully acknowledge the contributions of previous authors, Jill Halonen, MD, and Richard K Spence, MD, to the development and writing of this article.



More on Intestinal Leiomyosarcoma

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

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

  2. DiSario JA, Burt RW, Vargas H, McWhorter WP. Small bowel cancer: epidemiological and clinical characteristics from a population-based registry. Am J Gastroenterol. May 1994;89(5):699-701. [Medline].

  3. 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].

  4. 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].

  5. 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].

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

  7. 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].

  8. Yoshida S, Yamashita K, Yokozawa M, et al. Diagnostic findings of ultrasound-guided fine-needle aspiration cytology for gastrointestinal stromal tumors: proposal of a combined cytology with newly defined features and histology diagnosis. Pathol Int. Oct 2009;59(10):712-9. [Medline].

  9. Tien YW, Lee CY, Huang CC, Hu RH, Lee PH. Surgery for gastrointestinal stromal tumors of the duodenum. Ann Surg Oncol. Oct 20 2009;epub ahead of print. [Medline].

  10. D'Adamo D. Advances in the treatment of gastrointestinal stromal tumor. Adv Ther. Oct 2 2009;epub ahead of print. [Medline].

  11. Guo T, Hajdu M, Agaram NP, et al. Mechanisms of sunitinib resistance in gastrointestinal stromal tumors harboring KITAY502-3ins mutation: an in vitro mutagenesis screen for drug resistance. Clin Cancer Res. Nov 15 2009;15(22):6862-70. [Medline].

  12. Miki Y, Kurokawa Y, Hirao M, et al. Survival analysis of patients with duodenal gastrointestinal stromal tumors. J Clin Gastroenterol. Oct 3 2009;epub ahead of print. [Medline].

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

  14. 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.

  15. 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].

  16. Yang WL, Yu JR, Wu YJ, et al. Duodenal gastrointestinal stromal tumor: clinical, pathologic, immunohistochemical characteristics, and surgical prognosis. J Surg Oncol. Dec 1 2009;100(7):606-10. [Medline].

  17. 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] [Chinese]. Zhonghua Wei Chang Wai Ke Za Zhi. Sep 2006;9(5):383-7. [Medline].

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Further Reading

Related eMedicine Topics

Clinical Trials

Clinical Guidelines

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Keywords

intestinal leiomyosarcoma, leiomyosarcoma, gastric cancer, gastrointestinal stromal tumors, GIST tumor, GIST tumors, gastrointestinal stromal tumor, intestinal tumor, gut stromal tumors

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Contributor Information and Disclosures

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, Columbia Medical Society, South Carolina Gastroenterology Association, and South Carolina Medical Association
Disclosure: Pricara Honoraria Speaking and teaching; UCB Consulting fee Consulting

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

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, Associate Dean for Undergraduate Medical Education, Associate Professor of 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 & Ethics, American Trauma Society, Association of American Medical Colleges, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
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