Mesenteric Tumor Research Articles

Prediction scores of postoperative liver metastasis and long-term survival of pancreatic head cancer based on the distance between the mesenteric vessels and tumor, preoperative serum carbohydrate antigen 19-9 level, and lymph node metastasis rate.

The shortest distance between the superior mesenteric artery (SMA) or superior mesenteric vein (SMV) and the tumor margin was combined with preoperative serum carbohydrate antigen (CA) 19-9 and lymph node ratio (LNR) to evaluate joint effects on long-term survival and liver metastasis in patients with pancreatic head cancer after radical surgery. This retrospective study included 149 patients who underwent pancreaticoduodenectomy for pancreatic head cancer at Harbin Medical University Tumor Hospital from May 2011 to March 2021. The preoperative serum CA 19-9 level and LNR were combined with the SMA or SMV distance. The joint association between long-term survival and postoperative liver metastasis was evaluated. Based on the receiver operating characteristic curve of postoperative liver metastasis or long-term survival, the optimal cut-off values of SMV distance were 3.1 and 0.7 mm, respectively, whereas the optimal cut-off value of SMA distance was 10.25 mm. The univariate model identified the liver metastasis score (p < 0.001) as a negative factor for postoperative liver metastasis of pancreatic head carcinoma. The SMV distance (p=0.003), SMA distance (p < 0.001), LNR score (p < 0.001), and survival score (p < 0.001) were negatively correlated with long-term survival after pancreatic head cancer. The multivariate model highlighted SMA distance (p < 0.001), survival score (p=0.001), and LNR score (p < 0.001) as independent risk factors for long-term survival in pancreatic head cancer. Liver metastasis score may be an independent predictor of postoperative liver metastasis in patients with pancreatic head cancer. Survival and LNR scores may be independent predictors of long-term postoperative survival in patients with pancreatic head cancer. However, the LNR score appears to improve long-term survival.

Mesenteric lymphangioma – a rare tumor of the abdomen

Mesenteric lymphangioma (ML) is a cystic tumor developed at the base of the mesentery, which occurs frequently in children, rarely in adults, with nonspecific symptoms, often diagnosed late. The diagnosis is made by computer tomography and the curative treatment is the surgical one with good results and with optimal postoperative outcome. A 44-year-old patient for whom mesh surgery for incisional hernia post appendectomy has been performed was admitted to our clinic for nonspecific gastrointestinal symptoms for which he has also been investigated multiple times in other services. On the right flank and iliac fossa, a tumor of firmelastic consistency is detected, relatively well delimited. Computed tomography (CT) describes the lesion as a mesenteric tumor. Intraoperatively, a cystic tumor is detected, which is punctured, the biochemical result highlighting the lymphatic character. The surgical treatment was represented by segmental intestinal resection with entero-enteroanastomosis. No postoperative events were reported.

Abstract 14: Resolution of obesity-driven proinflammatory adipose signaling by weight loss or an NSAID is associated with reduced tumor burden in a mouse model of colon cancer

Abstract Obesity increases the incidence and progression of colon cancer. The chronic low-grade inflammation that often accompanies obesity is purported to promote these adverse outcomes. In obesity, remodeling of visceral white adipose tissue contributes to an inflammatory state via increased immune cell recruitment and production of proinflammatory cytokines. The aim of this study in a mouse model of obesity and colon carcinogenesis was to compare the effects of weight loss versus treatment with a nonsteroidal anti-inflammatory drug (sulindac) on tumor development and adipose and tumoral transcriptional changes. Azoxymethane (10 mg/kg) was intraperitoneally injected weekly into FVB/N male mice for 5 weeks to induce colon tumors. Mice were then randomized to an ad libitum 10 kcal% fat diet (control, n=20) or 60 kcal% fat diet to promote diet-induced obesity (DIO, n=55). After 15 weeks, DIO mice were randomized again to receive for an additional 7 weeks either: a) DIO diet (n=18); b) DIO diet supplemented with 140ppm sulindac (DIO+Su, n=19), or c) 10 kcal% fat control diet to generate formerly obese (FOb-LFD) mice (n=18). Mesenteric fat and colon tumors were collected for an Affymetrix Clariom D mouse gene expression microarray (n=5-6/group). FOb-LFD mice, but not DIO+Su mice, lost significant body weight and body fat. Relative to DIO mice, tumor burden and multiplicity were lower in control, DIO+Su, and FOb-LFD mice. Gene set enrichment analysis (GSEA) using the Hallmark gene sets revealed strikingly concordant transcriptional changes in the control, DIO+Su, and FOb-LFD mesenteric fat depots compared with DIO mice. Of the 8 immune related gene sets, 7 were uniformly suppressed (Normalized enrichment score (NES) &amp;gt;1.66, FDR q&amp;lt;0.05) across all groups relative to DIO. Moreover, compared with DIO, metabolism gene sets (e.g., FATTY_ACID_ METABOLISM, GLYCOLYSIS) were significantly enriched (NES &amp;gt;1.45, FDR q&amp;lt;0.05), and none were suppressed in control, DIO+Su, and FOb+LFD tumors. Tumor transcriptional changes were less coherent with EPITHELIAL_MESENCHYMAL_TRANSITION and COAGULATION being the only gene sets commonly suppressed across all groups relative to DIO. A leading-edge analysis revealed that Lum, Pthlh, Sfrp4, Mmp8, and Serpine1 were commonly suppressed amongst tumors from groups other than DIO mice. Both weight loss and sulindac impeded the effects of chronic obesity on colon tumorigenesis. GSEA analyses of immune related gene sets indicated that weight loss and sulindac effectively suppressed inflammation in the adipose tissue but not in the tumor. The conserved immunological and metabolic transcriptional programs in the adipose tissue relative to the tumor suggests the possibility that paracrine signaling from the adipose to the tumor may underpin the observed beneficial effects of these interventions on obesity-driven colon tumor growth. Citation Format: Elaine M. Glenny, Laura W. Bowers, Michael F. Coleman, Jatin Roper, Stephen D. Hursting. Resolution of obesity-driven proinflammatory adipose signaling by weight loss or an NSAID is associated with reduced tumor burden in a mouse model of colon cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 14.

A lymphatic route for a hyperbranched heteroglycan from Radix Astragali to trigger immune responses after oral dosing

Gut barrier makes a huge research gap between in vivo and in vitro studies of orally bioactive polysaccharides: whether/how they contact the related cells in vivo. A hyperbranched heteroglycan RAP from Radix Astragali, exerting antitumor and immunomodulatory effects in vitro and in vivo, is right an example. Here, we determined first that RAP's antitumor activity is immune-dependent. Being undegraded and non-absorbing, RAP quickly entered Peyer's patches (PPs) in 1 h where it directly targeted follicle dendritic cells and initiated antitumor immune responses. RAP was further delivered to mesenteric lymph node, bone marrow, and tumor. By contrast, the control Dendrobium officinale polysaccharide did not enter PPs. These findings revealed a blood/microbiota-independent and selective lymphatic route for orally administrated RAP to directly contact immune cells and trigger antitumor immune responses. This route bridges the research gap between the in vitro and in vivo studies and might apply to many other bioactive polysaccharides.

150 When the maternal abdomen holds more than just a baby - an unexpected finding in a 15-year-old patient’s cesarean section

Introduction and aims of the study: Lymphangiomas are rare and benign cystic lymphatic tumors. Less than 1% occur in small intestine mesentery. The authors describe the incidental finding of such a mesenteric tumor in a 15-year-old patient’s emergent cesarean section. Methods: Clinical information was obtained from CHTMAD’s Obscare® and SClinico® databases. Results: A 15-year-old pregnant patient was referred to CHTMAD’s outpatient obstetrical clinic at 32 weeks due to inadequate pregnancy surveillance.

Non-phosphorylatable cyclin D1 mutant potentiates endometrial hyperplasia and drives carcinoma with Pten loss.

Cyclin D1 is a regulatory subunit of -Cyclin Dependent Kinases 4 and 6 (CDK4/6) and regulates progression from G1 to S phase of the cell cycle. Dysregulated cyclin D1-CDK4/6 contributes to abnormal cell proliferation and tumor development. Phosphorylation of threonine 286 of cyclin D1 is necessary for ubiquitin-dependent degradation. Non-phosphorylatable cyclin D1 mutants are stabilized and concentrated in the nucleus, contributing to genomic instability and tumor development. Studies investigating the tumor-promoting functions of cyclin D1 mutants have focused on the use of artificial promoters to drive the expression which unfortunately may not accurately reflect tumorigenic functions of mutant cyclin D1 in cancer development. We have generated a conditional knock-in mouse model where cyclin D1T286A is expressed under the control of its endogenous promoter following Cre-dependent excision of a lox-stop-lox sequence. Acute expression of cyclin D1T286A following tamoxifen-inducible Cre recombinase triggers inflammation, lymphocyte abnormality and ultimately mesenteric tumors in the intestine. Tissue-specific expression of cyclin D1T286A in the uterus and endometrium cooperates with Pten loss to drive endometrial hyperplasia and cancer. Mechanistically, cyclin D1T286A mutant activates NF-κB signaling, augments inflammation, and contributes to tumor development. These results indicate that mutation of cyclin D1 at threonine 286 has a critical role in regulating inflammation and tumor development.

Mesenteric Tumor of an Infant: A Clinical and Pathological Surprise

Inflammatory myofibroblastic tumor (IMT) is a tumefactive proliferation of spindled myofibroblastic cells admixed with inflammatory infiltrate. This tumor has a predilection for pulmonary location and also involves visceral soft tissues in children and adults. Tumors in extrapulmonary locations like abdomen, mesentery, bowel, head &amp; neck, genitourinary and musculoskeletal are more aggressive locally and mimic malignancy. IMTs from colon are very rare and are treated by surgical excision. We report a case of a 9-month old female with IMT of sigmoid colon with no bowel complaints, treated by complete surgical excision with no further treatment needed.

Comparison between findings of gallium-68 Dota PET-CT and contrast enhanced CT scan in neuroendocrine tumors.

Objective: To compare the efficiency of contrast enhanced CT-SCAN and Gallium 68-DOTA PET CT for the detection of neuroendocrine lesions. Study Design: Cross Sectional and Analytical study. Setting: INMOL (Institute of Nuclear Medicine and Oncology Lahore). Period: February 2020 to December 2020. Material &amp; Methods: Total of 70 patients between 18-68 year of age coming to Nuclear Medicine department of INMOL (Institute of Nuclear Medicine &amp; Oncology Lahore) were included in the study convenient sampling technique were used to collect the data. Results: 70 patients were selected who had malignant type of tumor (mass forming or metastatic) patients, 29(41%) were diagnosed with Pancreatic Tumors, 12 (17%) were diagnosed with Metastatic Tumors, 10 (14%) were diagnosed with Mesenteric Tumors, 7 (10%) were diagnosed with Renal Tumors, 7 (10 %) were diagnosed with Liver Tumors, 3 (4%) were diagnosed with Thyroid Tumors, 1(1.4 %) was Breast Tumor and 1(1.4%) was mediastinal Tumor. In CT-Scan out of 70 patients 42(60%) patients were diagnosed with tumor while 28(40%) patients were normal, meanwhile in PET CT, out of 70 patients 55(79%) patients were diagnosed with tumor while 15(21%) patients were normal. Out of 70 patients PET CT was able to identify all 55/55 tumor patients correctly while CT visualized 42 patients correctly but omitting I 3 patients, causing false negative diagnosis. PET CT has sensitivity and Specificity of 100% &amp; 99.9% respectively whereas CT had sensitivity &amp; Specificity of 76.8 % and 51.8% respectively. Conclusion: In contrast with international studies PET CT have better diagnostic finding for evaluation and follow up of Neuroendocrine tumors as compared to contrast enhanced CT Scan. We can say PET CT is a good and better modality other then any contrast enhanced modality like contrast enhanced CT scan for the evaluation of neuroendocrine tumors.

A Case of Mesenteric Desmoid Tumor without a History of Abdominal Surgery

A Case of Mesenteric Desmoid Tumor without a History of Abdominal Surgery

Two Cases of Mesenteric Desmoid Tumors Diagnosed after Colon Cancer Surgery

Two Cases of Mesenteric Desmoid Tumors Diagnosed after Colon Cancer Surgery

Massive mesenteric tumor in an adult patient with chronic abdominal pain

A 50-year-old male patient with no relevant medical or surgical history presented with abdominal pain with 1 year of evolution, with worsening in the evening and improvement associated with decubitus. Physical examination revealed significant abdominal distension and global dullness on percussion, with no other findings. Radiologic study was performed by abdominal CT, showing a voluminous mass in the root of the mesentery of fatty densitometry, encapsulated, with septa in its interior and causing displacement of intestinal loops (Fig 1).

Evaluation of Pathologic Prognostic Factors in Neuroendocrine Tumors of the Small Intestine.

The precise contributions of histopathologic features in the determination of stage and prognosis in small intestinal neuroendocrine tumors (NETs) are still under debate, particularly as they pertain to primary tumor size, mesenteric tumor deposits (TDs), and number of regional lymph nodes with metastatic disease. This single-institution series reviewed 162 patients with small bowel NETs (84 females, mean age: 60.3±12.0 y). All cases examined (100%) were immunoreactive for both chromogranin A and synaptophysin. Primary tumor size >1 cm (P=0.048; odds ratio [OR]=3.06, 95% confidence interval [CI]: 1.01-9.24) and lymphovascular invasion (P=0.007; OR=4.85, 95% CI: 1.53-15.40) were associated with the presence of lymph node metastasis. Conversely, TDs (P=0.041; OR=2.73, 95% CI: 1.04-7.17) and higher pT stage (P=0.006; OR=4.33, 95% CI: 1.53-12.28) were associated with the presence of distant metastasis (pM). A cutoff of ≥7 positive lymph nodes was associated with pM (P=0.041), and a thusly defined modified pN stage (pNmod) significantly predicted pM (P=0.024), compared with the prototypical pN (cutoff of ≥12 positive lymph nodes), which did not. Over a median follow-up of 35.7 months, higher pNmod (P=0.014; OR=2.15, 95% CI: 1.16-3.96) and pM (P<0.001; OR=11.00, 95% CI: 4.14-29.20) were associated with disease progression. Proportional hazards regression showed that higher pNmod (P=0.020; hazard ratio=1.51, 95% CI: 1.07-2.15) and pM (P<0.001; hazard ratio=5.48, 95% CI: 2.90-10.37) were associated with worse progression-free survival. Finally, Kaplan-Meier survival analysis demonstrated that higher pNmod (P=0.003), pM (P<0.001), and overall stage group (P<0.001) were associated with worse progression-free survival, while higher pM also predicted worse disease-specific survival (P=0.025). These data support requiring either chromogranin or synaptophysin, but not both, for small bowel NET diagnosis, the current inclusion of a 1 cm cutoff in primary tumor size and the presence of TDs in staging guidelines, and would further suggest lowering the cutoff number of positive lymph nodes qualifying for pN2 to 7 (from 12).

A CALCIFIED CARCINOID TUMOR

TOPIC: Lung Cancer TYPE: Fellow Case Reports INTRODUCTION: Pulmonary carcinoid tumor is a neuroendocrine tumor of enterochromaffin cells representing about 1–5% of all lung malignancies. It usually presents in never smokers typically in proximal airways. Patients present with chronic cough, hemoptysis, and bronchial obstruction. These tumors show a low to moderate activity on PET scan. We present a case of a calcified carcinoid tumor. CASE PRESENTATION: A 49-year-old never-smoker male with medical history known for obesity, diabetes mellitus, hypothyroidism and exposure to welding presented complaining from progressive dyspnea with cough, wheezing and a history of mild hemoptysis. A Pulmonary function test (PFT) was performed which showed a FEV1/FVC ratio of 73% (post-bronchodilator), FEV1 77%, TLC 112%, RV 152% and DLCO of 77%. Findings were suggestive of a moderate obstructive lung defect and no significant bronchodilator response associated with decreased diffusion capacity and air trapping. The patient was started on umeclidium-vilanterol and a Chest X-ray was performed that showed atelectasis with prominence of the right hilum suggestive of pulmonary artery enlargement or potentially underlying lymphadenopathy/nodule. Thus, a Chest computer topography (CT) was scheduled. However, the patient developed an episode of hemoptysis and presented to the emergency department (ED) acutely prior to performing the chest CT. Chest CT was performed upon presentation to the ED which showed a calcified right hilar mass. Upon presentation the patient denied having any other complaints. He was started on antibiotics and steroids. A bronchoscopy with endobronchial ultrasound was performed that showed an endobronchial mass at the level of the secondary carina between the right upper lobe and bronchus intermedius bulging into the bronchus intermedius with about 85% obstruction of the bronchus intermedius not allowing the bronchoscope to pass distally with cobblestone mucosa. A transbronchial needle aspiration from the right hilar mass was performed as well as an endobronchial biopsy from right lung mass and lateral wall of the bronchus intermedius. Brushing from the right lung mass in the bronchus intermedius and bronchioalveolar lavage from bronchus intermedius was done. Pathology from the right upper lobe biopsy was positive for a neuroendocrine tumor (carcinoid). BAL, brushing, and lymph nodes were negative. A PET CT scan was done which confirmed the presence of a partially calcified right posterior hilar soft tissue mass with low FDG uptake and no definite metastatic disease. Patient underwent a right pneumonectomy. DISCUSSION: Calcifications has been reported in mesenteric carcinoid tumors, however, no prior cases of pulmonary carcinoid calcification were reported in the literature. This case describes an unusual presentation of pulmonary carcinoid tumor. CONCLUSIONS: This presentation highlights the importance of proper evaluation of a calcified mass. REFERENCE #1: https://pubmed.ncbi.nlm.nih.gov/7839976/ DISCLOSURES: No relevant relationships by Ahmad Albalbissi, source=Web Response No relevant relationships by Girendra Hoskere, source=Web Response No relevant relationships by AYA MASADEH, source=Web Response

Sporadic intra-abdominal desmoid tumor with a very unusual onset: two case reports

BackgroundIntra-abdominal desmoid tumors are rare soft tissue tumors that arise mainly in the mesentery and pelvis. Their etiology may include genetic mutations, estrogen-associated changes after childbirth, and mechanical factors such as a history of abdominal surgery. However, there are cases of intra-abdominal desmoid tumors that develop in the absence of such causes. Since they are rare, diagnosis is often difficult based on clinical findings. We encountered two cases of patients with sporadic intra-abdominal desmoid tumors with a very unusual onset and contrasting features.Case presentationThe first patient was a 51-year-old asian man who presented with sudden onset of abdominal pain. He was referred to our department because of a giant tumor detected on abdominal ultrasonography. Imaging revealed a 19-cm tumor with internal tumoral hemorrhage; however, no definitive diagnosis was made. Tumor resection was performed for diagnostic and therapeutic purposes. The second patient was a 41-year-old asian man, and right hydronephrosis was detected on abdominal ultrasonography during a periodic medical checkup. We diagnosed invasion of the primary mesenteric tumor into the right ureter using diagnostic imaging and performed ileocecal resection with partial right ureteral resection for a definitive diagnosis and therapeutic purposes. Although the tumors of both patients had developed from the ileal mesentery, the tumors were substantially different from each other based on their imaging findings, macroscopic morphology, and progression pattern. Meanwhile, they showed similar pathological characteristics. Both consisted of bundles of collagen fibrils of spindle-shaped fibroblasts with low cell atypia. Moreover, they were diagnosed as desmoid tumors using positive immunohistochemical staining for β-catenin.ConclusionsNeither patient had susceptibility factors for desmoid tumors, and to our knowledge, there have been very few reports to date of intra-abdominal desmoid tumors that were diagnosed because of acute abdominal pain caused by tumoral hemorrhage or asymptomatic obstructive uropathy. Furthermore, it is clinically interesting that the two patients showed contrasting progression patterns and imaging findings. Intra-abdominal desmoid tumors are rare and may present with various symptoms and findings similar to those observed in our patients. Diagnosis therefore requires experience and knowledge that is not bound by preconceptions.

Gastric Pneumatosis: An Atypical Presentation of Desmoid Tumor.

Case presentationA middle-aged woman presented to the emergency department with a chief complaint of abdominal pain, fever, vomiting, and diarrhea. Abdominal computed tomography revealed gastric pneumatosis and air in the portal system. The patient had an unfavorable clinical course with pneumoperitoneum and septic shock due to secondary peritonitis. She underwent emergency laparotomy where neoformation of the mesentery root was found with infiltration of the small intestine and jejunal perforation. The anatomopathological study of the tumor revealed that it was a desmoid tumor.DiscussionTo our knowledge this is the first report in the literature of gastric pneumatosis as the initial presentation of a mesenteric desmoid tumor. Although it usually has a benign clinical course, its locally invasive characteristics can lead to critical illness. Physicians shouldn’t overlook these types of complications, as early identification and surgical intervention can modify the prognosis and shorten hospital stay.

Prognostic features of gastro-entero-pancreatic neuroendocrine neoplasms in primary and metastatic sites: Grade, mesenteric tumour deposits and emerging novelties.

Updates in classification of gastro-entero-pancreatic neuroendocrine neoplasms better reflect the biological characteristics of these tumours. In the present study, we analysed the characteristics of neuroendocrine tumours that could aid in a more precise stratification of risk groups. In addition, we have highlighted the importance of grade (re)assessment based on investigation of secondary tumour lesions. Two hundred and sixty-four cases of neuroendocrine tumours of gastro-entero-pancreatic origin from three centres were included in the study. Tumour morphology, mitotic count and Ki67 labelling index were evaluated in specimens of primary tumours, lymph node metastases and distant metastases. These variables were correlated with overall survival (OS) and relapse-free survival (RFS). Tumour stage, number of affected lymph nodes, presence of tumour deposits and synchronous/metachronous metastases were tested as possible prognostic features. Mitotic count, Ki-67 labelling index, primary tumour site, tumour stage, presence of tumour deposits and two or more affected lymph nodes were significant predictors of OS and RFS. At the same time, mitotic count and Ki-67 labelling index can be addressed as continuous variables determining prognosis. We observed a very high correlation between the measures of proliferative activity in primary and secondary tumour foci. The presence of isolated tumour deposits was identified as an important determinant of both RFS and OS for pancreatic (hazard ratio [HR]=7.61, 95% confidence interval [CI]=3.96-14.6, P<0.0001 for RFS; HR=3.28, 95% CI=1.56-6.87, P=0.0017 for OS) and ileal/jejunal neuroendocrine tumours (HR=1.98, 95% CI=1.25-3.13, P=0.0036 for RFS and HR 2.59, 95% CI=1.27-5.26, P=0.009 for OS). The present study identifies the presence of mesenterial tumour deposits as an important prognostic factor for gastro-entero-pancreatic neuroendocrine tumours, provides evidence that proliferative parameters need to be treated as continuous variables and further supports the importance of grade determination in all available tumour foci.

Leiomyoma of mesentery in a young male: a case report and review of literature

Primary tumours of mesentery are relatively rare, and its biological behaviour is unpredictable. We herein describing a case of incidentally detected mesenteric leiomyoma along with review of literature in a 19-year-old gentleman, who had a mass in the mesentery of terminal ileum, which was detected during surgery. Mesentric masses can be both solid as well as cystic. Published reports have consisted of small numbers of cases, which makes it difficult to determine the incidence of specific tumor types. Reasonable estimates of incidence ranges from 1 case per 200,000 population and in 30-40% cases they are cystic and more in females. Diagnosis is delayed unless they become symptomatic with haemorrhage, obstruction or mass per abdomen. As primary mesenteric tumors are rare, particularly in young patients, it is considered important that this type of unusual tumor be included in the differential diagnosis for mesenteric tumors. Since the biologic behaviour of mesenteric smooth muscle tumours seems to be unpredictable long term follow up is warranted.

CYSTIC LYMPHANGIOMA A CASE REPORT

Cystic lymphangioma of the pancreas is a rare benign vascular tumor. Its histogenesis is still hypothetical and its preoperative diagnosis difficult to establish. We report a case in a 26-year-old boy who presented with abdominal pain with the notion of a constipation-type transit disorder. Radiological investigations showed an intraperitoneal mesenteric cystic tumor. A complete resection of the mass was performed. Pathological examination of the operative specimen confirmed the presence of cystic formations, the wall of no need keep it.to the end which was lined by a squamous, endothelial epithelium with a fibrous wall dotted with a few lymphoid clusters in favor of cystic lymphangioma.

Peritoneal or mesenteric tumours revealing histiocytosis

ObjectivePeritoneal or mesenteric tumours may correspond to several tumour types or tumour-like conditions, some of them being represented by histiocytosis. This rare condition often poses diagnostic difficulties that can lead...

Pleomorphic leiomyosarcoma of colonic mesentery: an unusual cause of lower GI bleed - case report and literature review

Mesenteric masses are infrequent lesions ranging from benign cyst to aggressive malignancies and often present as diagnostic and therapeutic challenge. The mesentery is a frequent recipient of metastasis from the gastrointestinal tract, pancreas, and biliary cancers. Primary mesenteric tumours are relatively rare, mostly mesenchymal in origin and benign in nature. Examples include gastrointestinal stromal tumours and smooth muscle tumours. Pleomorphic leiomyosarcoma of mesocolon is extremely rare with a reported incidence of 1:350,000. So accurate preoperative diagnosis of mesenteric soft tissue tumours is generally difficult. It accounts for less than 1% of the malignant tumours found in colon. Leiomyosarcoma is a malignant tumour arising from smooth cell lineage. These tumours occur most commonly in middle aged individuals. We describe a case of pleomorphic leiomyosarcoma arising from the colonic mesentery in a 27-year-old male patient, with massive lower gastrointestinal bleed (LGI bleed) causing drop in haemoglobin level from 9 mg/dl to 6 mg/dl. Ultrasonography and CECT abdomen suggestive of (17.5×11.6×10.6) cm mass in left side upper abdomen in splenic hilar region. Left hemicolectomy with excision of mass with splenectomy and distal pancreatectomy done. The diagnosis was based on histopathological evaluation using immunohistochemistry (IHC). Histopathological report suggestive of pleomorphic leiomyosarcoma with SMA and vimentin positivity on immunohistochemistry but CD 34 and CD 117 were negative, differentiating it from GIST.