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IS IT JUST REFLUX OR COULD IT BE A TUMOUR?
Nikhilesh Todkari
Mr. MC 76 yr old gentleman
PMHx- T2DM HTN IHD Microalbuminuria Vit B12 deficiency
Meds Metformin Atenolol Aspirin Gliclazide MR
Had presented initially in 1 year previously with reflux symptoms.
OGD – small hiatus hernia. Nil else CT Abdomen – 7.5x7 cm
heterogeneous mass extending from jejunum.
Was booked for urgent follow up
Presented again No weight loss, SOBOE + microcytic
anaemia (Hb 7.8) Abdominal exam – normal. No
lymphadenopathy
CT TAP – Jejunal mass. Still well defined. No splenomegaly or lymphadenopathy.
Initial CT abdomen
Follow up CT abdomen
Laparatomy + excision of mass performed
Histology - Gross specimen of jejunal mass
Histology- Small bowel leiomyoma
Abundance of smooth Muscle Cells C-kit negative stain
No evidence of increased mitotic activity, haemorrhage or necrosis
Desmin positive for muscle tissue
LEIOMYOMAS
Leiomyomas comprise approximately one fourth of the benign gastrointestinal tumors
most common symptomatic benign tumors of the small bowel. Approximately
Jejunum 50% of cases ileum in 31% of cases Duodenum Almost one half of all lesions are <5 centimeters
The tumor is usually single Firm grayish-white well-defined Encapsulated
Originates from the mesenchyma and arises from spindle cells of the muscular layer of the intestine
Symptoms can be vague and non-specific, making it difficult to diagnose.
Investigations
CT scan - can show 90% of leiomyomas
magnetic resonance imaging(MRI) barium studies Endoscopy endoscopic ultrasound angiography
differential diagnoses GIST Lymphomas Adenocarcinomas mesenteric cysts cystic lymphangiomas
Surgical resection is the treatment of choice for gastrointestinal leiomyomas by conventional or laparoscopic approach
Conclusion
Patient Post-operatively
Leiomyomas are benign in nature
Diagnosis can be delayed due to non-specific symptoms
CT scan is best modality of investigations and Surgical resection is best modality of treatment
Patient did very well post operatively.
Discharged POD 7 OPD in 2/52
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