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. [7]
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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Colonic mucosa with gastrointestinal stromal tumor (GIST) involving the adjacent submucosa (hematoxylin and eosin [H&E] stain, medium power).
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Clusters of tumor cells separated by a hyaline and mucin-rich stroma (hematoxylin and eosin [H&E] stain, medium power).
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Oval- to spindle-shaped cells forming a fascicle (hematoxylin and eosin [H&E] stain, high power).
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CD-34 stain showing a tumor (medium power). CD-34 is a myeloid progenitor cell antigen.
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High-power magnification with CD-34 antigen immunohistochemical stain showing membrane positivity of the tumor cells.
