A CASE REPORT OF EPIDERMOID LEIOMYOSARCOMA OF THE DUODENUM

A 69-year-old man was admitted to the hospital because of lower abdominal pain and constipation. Handgrip-sized mass was palpable at the left upper quadrant of the abdomen. CT scan of the abdomen revealed about 16×10cm solid tumor at the same region. After some other examinations small intestinal tumor derived from non-epithelial lesion was suspected. Upon laparotomy tumor grew extramurally from the third portion of duodenum and the peritoneum showed several disseminated nodules. A partial resection of the lesion with reconstruction by side to side anastomosis between the defect and jejunum was carried out. Postoperative histopathological findings on H-E staining revealed compact proliferation of round or spindle shaped cells with epitheloid arrangement. Immunohistochemiccal analysis showed positive staining for vimentin, and negative for smooth muscle actin, CD 34 antigen, S-100 protein. From these findings, this tumor was diagnosed as epitheloid leiomyosarcoma of the duodenum. This patient was predicted malignant because of tumor size and high miotic ratio (more than 1 mitose per one HPF). He died from the disease 18 months after the operation. Epidermoid leiomyosarcoma of the duodenum is so rare that only 17 cases including ours have been reported in the Japanese literature as far as we could review.