nikhilesh todkari. mr. mc 76 yr old gentleman pmhx- t2dm htn ihd microalbuminuria vit b12...
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IS IT JUST REFLUX OR COULD IT BE A TUMOUR?
Nikhilesh Todkari
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Mr. MC 76 yr old gentleman
PMHx- T2DM HTN IHD Microalbuminuria Vit B12 deficiency
Meds Metformin Atenolol Aspirin Gliclazide MR
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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
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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.
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Initial CT abdomen
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Follow up CT abdomen
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Laparatomy + excision of mass performed
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Histology - Gross specimen of jejunal mass
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Histology- Small bowel leiomyoma
Abundance of smooth Muscle Cells C-kit negative stain
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No evidence of increased mitotic activity, haemorrhage or necrosis
Desmin positive for muscle tissue
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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.
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Investigations
CT scan - can show 90% of leiomyomas
magnetic resonance imaging(MRI) barium studies Endoscopy endoscopic ultrasound angiography
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differential diagnoses GIST Lymphomas Adenocarcinomas mesenteric cysts cystic lymphangiomas
Surgical resection is the treatment of choice for gastrointestinal leiomyomas by conventional or laparoscopic approach
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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