nikhilesh todkari. mr. mc 76 yr old gentleman pmhx- t2dm htn ihd microalbuminuria vit b12...

IS IT JUST REFLUX OR COULD IT BE A TUMOUR?

Nikhilesh Todkari

Mr. MC 76 yr old gentleman

PMHx- T2DM HTN IHD Microalbuminuria Vit B12 deficiency

Meds Metformin Atenolol Aspirin Gliclazide MR

Had presented initially in 1 year previously with reflux symptoms.

OGD – small hiatus hernia. Nil else CT Abdomen – 7.5x7 cm

heterogeneous mass extending from jejunum.

Was booked for urgent follow up

Presented again No weight loss, SOBOE + microcytic

anaemia (Hb 7.8) Abdominal exam – normal. No

lymphadenopathy

CT TAP – Jejunal mass. Still well defined. No splenomegaly or lymphadenopathy.

Initial CT abdomen

Follow up CT abdomen

Laparatomy + excision of mass performed

Histology - Gross specimen of jejunal mass

Histology- Small bowel leiomyoma

Abundance of smooth Muscle Cells C-kit negative stain

No evidence of increased mitotic activity, haemorrhage or necrosis

Desmin positive for muscle tissue

LEIOMYOMAS

Leiomyomas comprise approximately one fourth of the benign gastrointestinal tumors

most common symptomatic benign tumors of the small bowel. Approximately

Jejunum 50% of cases ileum in 31% of cases Duodenum Almost one half of all lesions are <5 centimeters

The tumor is usually single Firm grayish-white well-defined Encapsulated

Originates from the mesenchyma and arises from spindle cells of the muscular layer of the intestine

Symptoms can be vague and non-specific, making it difficult to diagnose.

Investigations

CT scan - can show 90% of leiomyomas

magnetic resonance imaging(MRI) barium studies Endoscopy endoscopic ultrasound angiography

differential diagnoses GIST Lymphomas Adenocarcinomas mesenteric cysts cystic lymphangiomas

Surgical resection is the treatment of choice for gastrointestinal leiomyomas by conventional or laparoscopic approach

Conclusion

Patient Post-operatively

Leiomyomas are benign in nature

Diagnosis can be delayed due to non-specific symptoms

CT scan is best modality of investigations and Surgical resection is best modality of treatment

Patient did very well post operatively.

Discharged POD 7 OPD in 2/52