Leiomyoma and Leiomyosarcoma of the Duodenum: Case Reports and a Review of Cases in the Japanese Literature

Abstract

and leiomyosarcoma (LMS) of the duodenum are relatively rare, and precise, differential diagnosis is not necessarily easy in either case. We report one case each of LM and LMS, and review the 165 cases of LM (1935-1985) and 126 cases of LMS (1975-1985), including our cases, in the Japanese literature. 1) The main symptom of LM is melena; that of LMS, abdominal mass. 2) If an upper gastrointestinal series reveals displacement of the stomach and duodenum, widening of the duodenal sweep, fistula, cavity and others, LMS is highly likely. 3) LMS is disclosed as variegated findings on US and CT. 4) If angiography reveals encasement, LMS is highly likely. 5) LM is usually 2-5cm in size, and LMS 10-15cm. 6) LMS is often associated with liver metastases. From these findings we think that, in addition to histological findings, the size and nature of the tumor, especially biological malignancy, should be referred to in determining the treatment for LM and LMS.

Pancreas-sparing duodenectomy for a huge leiomyosarcoma in the third portion of the duodenum

“…Over half of the reported leiomyosarcomas arose in the second portion of the duodenum, and the rest were found in the third, first, and fourth portions, in that order of frequency . Leiomyosarcomas have been reported to grow in an extraluminal direction at an incidence of 63%‐77%, in an intraluminal direction at an incidence of 13.6%‐23%, and in both directions at an incidence of 3%‐14% . In our patient, the tumor had an exocentric shape.…”

“…This tumor sometimes spreads by local infiltration and in this way it can involve the pancreas, liver, gallbladder, transverse colon, or right kidney 10,11. Metastases have been reported in 20%‐36% of leiomyosarcomas of the duodenum, and liver metastases are most common 5,8,9. Lymph node metastases have been reported in 3%–7% of the published cases 5,6,8,9…”

“…Leiomyosarcoma of the duodenum is a quite rare lesion and accounts for 10%-33% of all malignant duodenal a common. 5,8,9 Lymph node metastases have been reported in 3%-7% of the published cases. 5,6,8,9 There seems to be no doubt that radical local resection with removal of all invaded tissues is the best treatment for a leiomyosarcoma of the duodenum.…”

“…5,8,9 Lymph node metastases have been reported in 3%-7% of the published cases. 5,6,8,9 There seems to be no doubt that radical local resection with removal of all invaded tissues is the best treatment for a leiomyosarcoma of the duodenum. A pylorus-preserving pancreatoduodenectomy or Whipple resection is the ordinary procedure for a leiomyosarcoma which invades the pancreas.…”

“…[5][6][7] Leiomyosarcomas have been reported to grow in an extraluminal direction at an incidence of 63%-77%, in an intraluminal direction at an incidence of 13.6%-23%, and in both directions at an incidence of 3%-14%. [6][7][8][9] In our patient, the tumor had an exocentric shape.…”