Abstract
A 27-year-old male presented with intestinal obstruction due to a jejuno-jejunal intussusception, 23 years after a childhood nasopharyngeal carcinoma. He was successfully treated for the latter by radiotherapy but subsequently required a mandibuloplasty for presumably facial hypoplasia sequel to the radiotherapy. The present intussusception was resected with wide margins revealing a partly haemorrhagic, polypoid and sessile jejunal tumour measuring 7.7 × 3.5 × 2.6 cm. Microscopy with extensive immunohistochemical studies revealed a relatively rare and highly malignant epitheloid leiomyosarcoma arising from the muscularis propria with extension to the mucosa and serosa. No metastases were found and post-operative follow-up has so far been uneventful. The present case of a malignant tumour presenting as an intussusception in a young adult, was unrelated to a childhood malignant tumour in the same patient. The former was successfully treated by a wide excision in support of the advocated surgical approach to adult intussusception.
Highlights
Intussusception with consequent intestinal obstruction is not an uncommon encounter in routine surgical practice and tumours of the small bowel are recognised causes
Based on the above immunoprofile a diagnosis of epitheloid leiomyosarcoma was made, to the exclusion of a malignant gastrointestinal stromal tumours (GIST), anaplastic lymphoma and malignant melanoma
The authors describe a rare case of highly malignant jejunal epitheloid leiomyosarcoma in a young adult male who presented with a jejuno-jejunal intussusception
Summary
Intussusception with consequent intestinal obstruction is not an uncommon encounter in routine surgical practice and tumours of the small bowel are recognised causes. These tumours are benign, and they include gastrointestinal stromal tumours (GIST) [1], adenomatous polyps and adenomyomas [2,3]. Rare non-neoplastic lesions of the small intestine presenting with intussusception include the inflammatory fibrous polyps referred to as inflammatory pseudotumours [4]. Malignant tumours, those of mesenchymal origin presenting with intussusception, are rarer in the small intestine. The clinicopathological findings, surgical approach, immunohistochemical studies and prognostic considerations are discussed
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