Saudi Journal of Gastroenterology

RADIOLOGY QUIZ
Year
: 2007  |  Volume : 13  |  Issue : 4  |  Page : 211--212

A 57-year old with abdominal lumps


Aswini K Pujahari 
 Sr. Adv. Surg. and GI Surgery, Command Hospital, AF, Bangalore - 560007, India

Correspondence Address:
Aswini K Pujahari
Department of Surgery, Command Hospital, AF, Bangalore - 560 007, Karnataka
India




How to cite this article:
Pujahari AK. A 57-year old with abdominal lumps.Saudi J Gastroenterol 2007;13:211-212


How to cite this URL:
Pujahari AK. A 57-year old with abdominal lumps. Saudi J Gastroenterol [serial online] 2007 [cited 2020 Apr 8 ];13:211-212
Available from: http://www.saudijgastro.com/text.asp?2007/13/4/211/36758


Full Text

A 57-year-old male presented with abdominal lumps of 5-month duration. It started as a painless lower abdominal mass that gradually increased in size over the last one month. There was no anorexia, vomiting, change in bowel habits, or urinary complaints. He had lost 10 kg of body weight in last 6 months. There were no significant past illness. He used to chew tobacco 10-15 g daily for the last 30 years and occasionally consumed alcohol. On examination, he did not look unwell and his vital signs were normal. No pallor, jaundice or lymphadenopathy was detected. The abdominal examination revealed three intra-abdominal lumps, with the largest one being 15 cms in the suprapubic area, the second one was in the left upper quadrant and the third was in the right lumbar region. They were nontender, firm, and had restricted mobility and was immobile with respiration. His hematological and biochemical parameters were within the normal limit. The ultrasound examination of the abdomen had shown three mixed echogenic masses observed intraabdominally. The organ of origin could not be assessed. Liver and spleen were normal in size and echogenicity. There was no ascites or lymphadenopathy. CT scan abdomen and pelvis was performed [Figure 1]. It showed multiple masses with solid and cystic components in all the quadrants of abdomen related to the small bowel without causing any obstruction.

 Q1. What is the Organ of Origin of the Mass ?



The intraoperative findings are shown below [Figure 2].

 Q2. What is the Diagnosis ?



 View Answer

 Answers



All the bigger masses were within the greater omentum with few small hanging fruit-type lesions from the serosal surface of the small bowel. There were no liver nodules and no ascites. The entire part of the greater omentum and the hanging lesions of the small bowel were excised.

Organ of origin

The organ of origin is the greater omentum.

The diagnosis

Greater omental leiomyosarcomatosis

 Discussion



Primary omental tumors are rare. Most of the information in the medical literature is from case reports. On CT, when the tumors are multilobulated, pancake-like with enhancing solid and multicystic densities located in the most anterior part of the peritoneal cavity are usually from greater omentum. [1] In the present case, all the tumors are touching the parietal peritoneum. Large tumor, cystic or necrotic changes, secondaries in the liver and lungs (also showing necrotic changes), are typical features of leiomyosarcoma. [2]

Selective angiography showing the, feeding from omental artery confirmed the diagnosis. [3] Gastrointestinal stromal tumors (GISTs) are considered to be specific to the interstitial cells of Cajal of gastrointestinal tract; however, the primary tumors of the greater omentum and mesentery are phenotypically identical with GISTs with the CD 117-positivity. [4] When there are multiple serosal lesions, it can be termed as leiomyosarcomatosis. The prevalence of leiomyosarcomatosis appears to be higher when it originates from large primary tumors. [5] Painless abdominal mass on physical examination led to medical imaging examination. Ultrasound visualized accurately the internal structure of the lesion, but failed to determine the site of origin. Computed tomography and angiography determined the greater omental origin of the tumor before the surgery. [6]

References

1Lee JT, Kim MJ, Yoo KS, Suh JH, Leong HJ. Primary leiomyosarcoma of the greater omentum: CT findings. J Comput Assist Tomogr 1991;15:92-4.
2Joe DH, Yang JM, Kim HS, Kim SS, Choi SW, Choi SH, et al . A case of primary leiomyosarcoma of the lesser omentum. Korean J Intern Med 1999;14:88-90.
3Kumai T, Suzuki T, Kobayashi E, Morita K, Yoshioka N, Ogawa Y, et al . A case report of great omental leiomyosarcoma with perforation into the jejunum. Rinsho Hoshasen 1990;35:1073-6.
4Miettinen M, Monihan JM, Sarlomo-Rikala M, Kovatich AJ, Carr NJ, Emory TS, et al . Gastrointestinal stromal tumors/smooth muscle tumors (GISTs) primary in the omentum and mesentery: Clinicopathologic and immunohistochemical study of 26 cases. Am J Surg Pathol 1999;23:1109-18.
5Rha SE, Ha HK, Kim AY, Kim TK, Choi BG, Byun JY, et al . Peritoneal leiomyosarcomatosis originating from gastrointestinal leiomyosarcomas: CT features. Radiology 2003;227:385-90.
6Ishida J, Ishida H, Konno K, Komatsuda T, Abe K. Primary leiomyosarcoma of the greater omentum. J Clin Gastroenterol 1999;28:167-70.