Perforation of intestinal leiomyosarcoma: A case report

Area of Science:

• Gastroenterology
• Surgical Oncology
• Pathology

Background:

• Intestinal leiomyosarcoma is a rare malignancy within the spectrum of gastrointestinal sarcomas.
• Small intestinal mesenchymal tumors often present at advanced stages, commonly with bleeding or intussusception.

Observation:

• A 66-year-old male presented with acute abdominal pain, tachycardia, and a rigid abdomen, indicative of peritonitis.
• CT scan revealed a massive ileal tumor with evidence of free air, suggesting perforation.
• Surgical exploration identified a 20 cm ileal leiomyosarcoma invading adjacent bowel, which was perforated.

Findings:

• Immunohistochemical analysis confirmed leiomyosarcoma, characterized by spindle-shaped cells invading the mucosa at the perforation site.
• Tumor markers were Desmin positive, alpha-smooth muscle actin (αSMA) positive, c-kit negative, and S-100 negative, with a Ki-67 proliferation index of 30-40%.

Implications:

• This case underscores that intestinal leiomyosarcoma, though rare, can lead to bowel perforation due to transmural invasion.
• Awareness of this potential complication is crucial for timely diagnosis and management of intestinal leiomyosarcoma.