Leiomyoma of the Jejunum with Hemorrhage

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Abstract
Smooth-muscle tumors of the gastrointestinal tract are uncommon. They grow slowly and produce rather definite signs and symptoms and are nearly always resectable. In the absence of metastases, distinction between benign and malignant forms cannot be made grossly. Histologically the presence of two or more mitotic figures per high-power field and poor differentiation indicate malignancy. The malignant tumors usually grow slowly and metastasize late. Surgical excision is the treatment of choice and affords a high percentage of cures. These tumors may be subserosal, intra-mural, or submucosal. They are rarely of the hourglass type. The submucosal lesions may ulcerate and bleed or may lead to intusussception. When occurring in the duodenum, they mimic duodenal ulcer, with pain, spasm, and bleeding. Intramural lesions are most commonly incidental autopsy findings, in the form of pea-shaped nodules in the stomach wall. Sub -serosal tumors produce symptoms only when relatively large; such symptoms are the result of torsion or pressure by the mass. Because of the favorable prognosis, awareness of this type of lesion and its behavior is important. The following case is typical of benign leiomyoma of the small bowel with hemorrhage. case report M. C. S., a 74-year-old white male, was admitted to the hospital Dec. 14, 1954, for arteriosclerotic disease with decompensation. He gave a history of pain in the chest, most severe on exertion, beginning about a year earlier, and of some ankle edema at night for the past two years. He had been taking digitalis for four years. The blood pressure was 120/68 and the pulse 99 and regular. Râles were present in both lung bases and a systolic murmur was audible at the apex of the heart, being transmitted to the left axilla. The liver was slightly enlarged. The ankles and feet showed 3-plus edema. On the day of admission the white blood cell count was 10,200, hemoglobin, 7.5 gm. per cent, and red cell count 4,190,000. Repeated hemoglobin estimates ranged between 5.5 gm. and 9 gm. per cent. Roentgen examination of the chest showed a hypertensive type of heart, a rather wide aortic shadow, and mild congestive changes in both lung fields. Gastrointestinal studies revealed a diverticulum of the duodenum and a sessile tumor of the jejunum just distal to the ligament of Treitz. After preliminary surgery for unrelated conditions, a tumor of the proximal jejunum, with a 6 cm. segment of bowel and its mesentery, was resected on April 20, 1955, and an end-to-end anastomosis of the jejunum was carried out. The tumor was submucosal, with an active bleeding ulcer measuring 1 × 1.5 cm. Convalescence was uneventful. The patient's blood count returned to normal and he has remained in excellent health. The microscopic diagnosis was benign leiomyoma of the jejunum.

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