Obstructive mobile small intestinal tumor without radiographic stigmata of bezoar

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Small bowel tumors are extremely rare.

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When large enough, a small bowel tumor can cause a small bowel obstruction.

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Small bowel tumors may be mobile and act pathologically similar to a bezoar but lack the typical radiologic imaging of a bezoar.

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With the consideration that an obstruction may be caused by a tumor, appropriate management can be started more efficiently, limiting complications such as bowel ischemia.

Introduction

Gastrointestinal leiomyomas are often clinically silent until they bleed or grow large enough to cause local mass effect.

Presentation of case

We report the unique case of an otherwise healthy 69-year-old male who developed a small bowel obstruction secondary to a mobile small intestinal leiomyoma. During initial evaluation, computed tomography did not demonstrate the cause of obstruction. Because of worsening clinical status with conservative management, the patient required emergency laparotomy. Operative findings were significant for an intraluminal leiomyoma that had detached from its pedicle, traveled to the tight lumen of the distal ileum and acted as an obstructive “bezoar” composed of native tissue. Removal of the mass resulted in rapid metabolic stabilization and relief of symptoms.

Discussion

This case report illustrates the complexity of diagnosing obstruction secondary to intraluminal native tissue. Clinicians must be aware that such masses may clinically present as but not have corresponding radiographic stigmata of typical bezoars.

Conclusion

In the absence of clear clinical or radiographic etiology for obstruction, developing a heightened degree of suspicion for native tissue “bezoar” may allow quick and appropriate management of similar cases and limit complications associated with prolonged obstruction. To our knowledge, this is the first reported case of mobile intraluminal leiomyoma causing small bowel obstruction.

Recurrent retroperitoneal liposarcoma in a patient with neurofibromatosis type I

INTRODUCTION

Liposarcoma complicating neurofibromatosis is very rare. Only a few cases have been described until now. We present a case of recurrent dedifferentiated retroperitoneal liposarcoma in a patient with neurofibromatosis type I (NF-1).

CASE PRESENTATION

A 47-year-old Caucasian woman with NF-1 presented to the hospital initially complaining of left lumbar pain irradiating to the anterior thigh and knee. Physical examination showed atrophy of the lower extremities bilaterally and decreased motor strength on the left lower extremity. Radiological studies demonstrated an enhancing lesion in the left paraspinal region, suggesting malignancy. The patient underwent local resection of tumour with safety margins. Pathological examination was consistent with dedifferentiated liposarcoma (DDLS) with positivity for MDM2 and CDK4 markers. No evidence of metastasis was noted on the radiological studies. The final diagnosis was DDLS, high-grade (G3), pT2bN0M0, stage III. After 6 weeks post-tumour resection, the patient experienced recurrence of malignancy. Chemotherapy with cisplatin and doxorubicin was initiated in the patient.

CONCLUSIONS

Liposarcoma in the context of neurofibromatosis is very rare. To the best of our knowledge, only six cases have been reported until now in the literature. We are presenting this case to underline the possibility of recurrence in the case of retroperitoneal DDLSs despite local tumour resection. Also, although the role of chemotherapy is controversial we decided to start treatment with cisplatin and doxorubicin given the success of chemotherapy in similar case presentations.