Leiomyosarcoma of the Duodeno-Jejunal Angle: Two Case Reports and Literature Review

Hichem Jerraya, Ahmed Guirat, Foued Frikha, Issam Beyrouti

Surgical Unit “B”, Charles Nicolle Hospital, Faculty of Medicine of Tunis, Tunis, Tunisia.
Surgical Unit, Habib Bourguiba Hospital, Faculty of Medicine of Sfax, Sfax, Tunisia.

DOI: 10.4236/ss.2013.47061                

Abstract

The duodenal leiomyosarcoma is a rare tumor. Its location in the duodenum makes diagnosis difficult and often delayed. Surgical treatment is not consensual because it must take into account anatomical imperatives which vary depending on the duodenal portion and oncological requirements that are not currently well known especially with regard to the utility of lymphadenectomy. We report 2 cases of leiomyosarcomas located at the angle of Treitz. This location is exceptional and only few cases were reported in the literature. From these 2 new cases and a review of the literature, we analyze the clinical features, diagnosis and treatment of duodenal leiomyosarcoma.

Keywords

Leiomyosarcoma; Duodenal Tumors; Surgery

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	T. Diamond, T. G. Parks and M. H. D. Danton, “Smooth Muscle Tumours of the Alimentary Tract,” Annals of the Royal College of Surgeons of England, Vol. 72, No. 5, 1990, pp. 316-320.
[2]	T. E. Starzl, V. M. Bernhard and G. C. Henegar, “Leiomyosarcoma of the Duodenum,” International Abstracts of Surgery, Vol. 110, 1960, pp. 313-322.
[3]	D. G. Marshall and F. Kim, “Leiomysorcoma of the Duodenum,” Journal of Pediatric Surgery, Vol. 122, No. 11, 1987, pp. 1007-1008. doi:10.1016/S0022-3468(87)80498-0
[4]	M. Kanematsu, T. Imaeda, G. Iinuma, S. Mori, et al., “Leiomyosarcoma of the Duodenum,” Gastrointestinal Radiology, Vol. 16, No. 2, 1991, pp. 109-112. doi:10.1007/BF01887321
[5]	M. Elabsi, M. Amraoui, M. Elouannani, M. Echarrab, et al., “Duodenal Leiomyosarcoma Revealed by Gastrointestinal Hemorrhage,” La Presse Médicale, Vol. 36, No. 11, 2007, pp. 1585-1588. doi:10.1016/j.lpm.2007.03.039
[6]	M. Pitcher, A. Colfor, E. Moskovic and J. M. Thomas, “Duodenal Leiomyosarcoma as a Cause of Retroperitoneal Sepsis,” European Journal of Surgical Oncology, Vol. 21, No. 1, 1995, pp. 85-86. doi:10.1016/S0748-7983(05)80075-7
[7]	S. Yassinger, T. J. Imperato, R. Midgley, et al., “Leiomyosarcoma of the Duodenum,” Gastrointestinal Endoscopy, Vol. 24, No. 1, 1977, pp. 38-40. doi:10.1016/S0016-5107(77)73440-6
[8]	A. Watanabe, D. Korenaga, H. Baba, et al., “Long Survival of a Woman with a Huge Leiomyosarcoma of the Duodenum after Pancreaticoduodenectomy and Transverse Colectomy: A Case Report,” Surgery, Vol. 108, No. 1, 1990, pp. 110-113.
[9]	G. A. Petralia, P. D. Hansen, R. C. Bowyer and R. C. Williamson, “Duodenal Leiomyosarcoma,” Digestive Surgery, Vol. 16, No. 1, 1999, pp. 22-25. doi:10.1159/000018689
[10]	M. Cagetti, A. Nicolosi and A. Mereu, “Duodenal Leiomyosarcoma with Left Hepatic Metastasis Treated by Total Exeresis,” Annales De Chirurgie, Vol. 35, No. 10, 1981, pp. 854-856.
[11]	S. Pedrazzoli, C. Sperti, C. Militello, A. Chiappetta, et al., “Duodenal Leiomyosarcoma and Its Multiple Recurrences: Good Surgical Result after Three Years of FollowUp,” The Italian Journal of Surgical Sciences, Vol. 14, No. 4, 1984, pp. 321-326.
[12]	R. Colovic, M. Micev and S. Zogovic, “Leiomyosarcoma of the Duodenum. A Successful Reoperation after Recurrency,” Acta Chirurgica Iugoslavica, Vol. 48, No. 2, 2001, pp. 45-48.
[13]	J. J. Dodds and O. H. Beahrs, “Leiomyosarcoma of the Duodenum,” American Journal of Surgery, Vol. 105, No. 2, 1963, pp. 245-249. doi:10.1016/0002-9610(63)90298-8
[14]	C. M. Peterson, C. U. Franklin and W. R. Peterson, “Leiomyosarcoma of the Duodenum: A Case Report,” Journal of the National Medical Association, Vol. 56, No. 4, 1964, pp. 331-332.
[15]	M. A. Meyers, “Leiomyosarcoma of the Duodenum,” Clinical Radiology, Vol. 22, No. 2, 1971, pp. 257-260. doi:10.1016/S0009-9260(71)80069-7
[16]	C. Sperti, C. Pasquali, F. Di Prima, R. Baffa and S. Pedrazzoli, “Duodenum Leiomyosarcoma Mimicking a Pancreatic Pseudocyst,” HPB Surgery, Vol. 8, No. 1, 1994, pp. 49-52. doi:10.1155/1994/71873
[17]	M. Fleet, A. F. Mellon, J. A. Lee, et al., “Duodenal Leiomyosarcoma Presenting with Iron Deficiency Anemia,” Journal of Pediatric Surgery, Vol. 29, No. 12, 1994, pp. 1601-1603. doi:10.1016/0022-3468(94)90233-X
[18]	L. Sebkova, N. Saccà, S. Rodinòet, et al., “Duodenal Leiomyosarcoma Revealed by a Gastrointestinal Hemorrhage,” Digestive and Liver Disease, Vol. 40S, 2008, pp. S1-S195.
[19]	S. H. uzuki and A. Yasui, “Pancreas-Sparing Duodenectomy for a Huge Leiomyosarcoma in the Third Portion of the Duodenum,” Journal of Hepato-Biliary Pancreatic Surgery, Vol. 6, No. 4, 1999, pp. 414-417. doi:10.1007/s005340050142
[20]	N. Kawano, M. Ryu, T. Kinoshita, M. Konishi, et al., “Segmental Resection of the Duodenum for Treating Leiomyosarcoma Associated with von Recklinghausen’s Disease: A Case Report,” Japanese Journal of Clinical Oncology, Vol. 25, No. 3, 1995, pp. 109-112.
[21]	Y. N. Ho, Y. P. Leong, A. S. Sakijan, M. Swaminathan and K. Sarvananthan, “Duodenal Leiomyosarcoma: A Report of a Rare and Aggressive Tumour,” Singapore Medical Journal, Vol. 33, No. 3, 1992, pp. 297-298.
[22]	R. Orda, J. Sayfan and I. Wasserman, “Surgical Treatment of Leiomyosarcoma of the Distal Duodenum,” Digestive Surgery, Vol. 17, No. 4, 2000, pp. 410-412. doi:10.1159/000018890