Clinical Gastroenterology and Hepatology
Volume 7, Issue 9 , Page A18, September 2009

Rectal Leiomyosarcoma: An Unusual Rectal Malignancy Mimicking Fecal Impaction in a 19-Year-Old Man

  • Ting–Hui Hsieh

      Affiliations

    • Department of Medicine, Maimonides Medical Center, Brooklyn, New York
    • ,
  • Bradly D. Clark

      Affiliations

    • Department of Pathology, Maimonides Medical Center, Brooklyn, New York
    • ,
  • Kadirawel Iswara

      Affiliations

    • Division of Gastroenterology, Maimonides Medical Center, Brooklyn, New York

published online 27 February 2008.

Article Outline

 

A 19-year-old man with a 2-month history of lower abdominal pain and a 10-kg weight loss during the past year presented with difficulty in passing stool and blood in his stool for 2 days. Digital rectal examination revealed a large solid mass in the rectum. Except for iron deficiency anemia (hemoglobin, 9.3 g/dL; normal, 13–17 g/dL), laboratory test results were unremarkable.

Computed tomography of abdomen and pelvis, with and without contrast medium, showed a nonenhancing mass in the rectum, compatible with fecal impaction (Figure A). A colonoscopy revealed a large intraluminal polypoid hard mass starting about 5 cm above anal verge and extending upward about 12 cm (Figure B). The rectal lumen was almost obstructed by the mass. Endoscopic ultrasound demonstrated a rectal mass invading the perirectal fat pad and involving 1 perirectal lymph node. A biopsy was taken of the mass.

Histopathology revealed infiltrative sheets of bizarre cells ulcerating the rectal mucosa. The tumor cells had epithelioid, oval, and spindled shapes, with pleomorphic nuclei, clumped chromatin, prominent nucleoli, and abnormal mitotic figures, admixed with a moderate inflammatory component (Figure C; original magnification 400×, hematoxylin-eosin). An extensive battery of immunohistochemistry stains were noncontributory, because the malignant cells labeled only for vimentin. The best histopathologic interpretation was an anaplastic malignant tumor, possibly undifferentiated/anaplastic leiomyosarcoma.

Although extremely rare in a teenage patient, this case of anorectal leiomyosarcoma presented with deceptively bland clinical symptoms, masking the sinister prognosis of this tumor.1, 2

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References 

  1. Tsekouras DK, Katsaragakis S, Theodorou D, et al. Rectal carcinosarcoma: a case report and review of literature. World J Gastroenterol. 2006;12:1481–1484
  2. Wang TK, Chung MT. Anorectal leiomyosarcomas. J Gastroenterol. 1998;33:402–407

 Conflicts of interest The authors disclose no conflicts.

PII: S1542-3565(07)01257-8

doi:10.1016/j.cgh.2007.12.054

Clinical Gastroenterology and Hepatology
Volume 7, Issue 9 , Page A18, September 2009