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