Abstract
The patient was a 39-year-old male, whose past medical history included resection of a leiomyosarcoma of the scrotum nine years earlier, and resection of metastatic lung tumors three and two years earlier at another hospital. He was admitted to our hospital with acute-onset epigastric pain. Abdominal CT revealed evidence of small intestinal obstruction, and an emergency operation was performed. Intraoperatively, a 4-cm movable foreign substance was detected in the ileum, and the oral aspect of the small intestine was dilated. The serosa of the ileum was denatured and there was a 2-cm mass arising from the wall. We carried out partial resection of the ileum and extirpated the movable foreign substance and mass. The foreign substance was a polypoid mass measuring 3.8 cm in diameter. A tumefactive lesion was also noted in the resected ileum. We judged that it was the stem of the polypoid mass and that the small intestinal obstruction was caused by the freed polypoid mass. Histologically, the mass could not be traced to the muscularis propria or mucosal muscle of the ileum. Immunohistochemistry revealed positive staining for SMA and HHF, and negative staining for c-kit and CD34 ; the Ki67 index was 70%. These findings were similar to those of immunohistochemical examination of the previously resected leiomyosarcoma of the scrotum. Therefore, we diagnosed the patient as a case of metastatic small intestinal tumor from leiomyosarcoma of the scrotum.
