case_images: PMC11249453_01
case_images: Coronal (left) and axial (right) computed tomography (CT) views identifying a markedly thickened heterogenous jejunal loop up to 3 cm along an affected segment measuring up to 7 cm in the left hemiabdomen, identified by blue arrows.
case_images: gat-2023-0010-0001-538430_F01.jpg
case_images: PMC11249453_01_gat-2023-0010-0001-538430_F01.jpg
case_images: F1
case_images: Computed tomography (CT) of the abdomen and pelvis with contrast revealed markedly thickened heterogenous jejunal loop in the left hemiabdomen with associated mesenteric adenopathy and small volume pelvic ascites (shown in Fig. 1).
case_images: Endoscopic visualization of a single, malignant appearing and ulcerated mass measuring 45 mm x 45 mm in the proximal jejunum.
case_images: gat-2023-0010-0001-538430_F02.jpg
case_images: PMC11249453_01_gat-2023-0010-0001-538430_F02.jpg
case_images: F2
case_images: Gastroenterology was consulted with subsequent esophagogastroduodenoscopy with push enteroscopy revealing a single, malignant appearing and ulcerated mass measuring 45 mm x 45 mm in the proximal jejunum (shown in Fig. 2).
case_images: Coronal (top) and axial (bottom) positron emission tomography-CT views demonstrating a hypermetabolic, multilobulated, ill-defined mass involving multiple loops of jejunum, identified by blue arrows.
case_images: gat-2023-0010-0001-538430_F03.jpg
case_images: PMC11249453_01_gat-2023-0010-0001-538430_F03.jpg
case_images: F3
case_images: Positron emission tomography-CT demonstrated a hypermetabolic, multilobulated, ill-defined mass involving multiple loops of jejunum (shown in Fig. 3).
case_images: Histological sections demonstrate a high-grade spindle cell malignancy forming long fascicles with herringbone growth pattern. The spindle cells are atypical with enlarged, hyperchromatic nuclei and occasional bizarre forms. Mitotic rate is up to 37 mitoses/10 high-power fields. Tumor necrosis is present accounting for approximately 40% of the tumor volume. Immunohistochemical stains show the spindle cells are strongly and diffusely positive for caldesmon and SMA, patchy positive for desmin, and are negative for S100, SOX10, CD117, DOG1, myogenin (image not shown), MSA (image not shown), and MUC4 (image not shown).
case_images: gat-2023-0010-0001-538430_F04.jpg
case_images: PMC11249453_01_gat-2023-0010-0001-538430_F04.jpg
case_images: F4
case_images: Immunohistochemical stains of the spindle cells were strongly and diffusely positive for caldesmon and EMA, patchy positive for SMA, BCL2, and desmin and negative for MSA, CD117, DOG1, consistent with leiomyosarcoma, FNCLCC grade 3 (of 3) with 40% tumor necrosis (shown in Fig. 4).