2 CASE PRESENTION
A 30-year-old female referred to our hospital with the chief complain of
melena and fatigue for 3 weeks. There were no significant positive signs
other than anemic appearance. Routine blood examination showed that her
hemoglobin level was 6.7g/dL. Contrast-enhanced computed tomography (CT)
revealed an obvious arterially enhancing mass in the small intestine and
continuous enhancement in the delayed phase of enhancement (Figure 1).
Capsule endoscopy indicated a possible mucosal eminence in the jejunum
(Figure 2A). Because the photographs captured by capsule endoscopy were
limited, oral single-balloon enteroscopy was further applied to
determine the mass. After insertion of about 250cm past pylorus, a
2.0*2.0cm tumor without epithelial lining was discovered (Figure 2B).
The patient was then transferred to the Department of
Gastrointestinal Surgery and underwent a partial enterectomy.
At
surgery, a 3.5cm long segment of jejunum was removed.
Gross pathology showed a 2.0*1.3*1.3cm gray-red polypoid protuberance in
the small intestinal mucosal surface (Figure 3A).
HE
stain illustrated that the tumor was well limited by a thin fibrous
capsule, interspersed with congestive capillaries of various size, and
admixed with smooth muscle bundles (Figure 3B and 3C). Muscularis
propria and serosa didn’t show any damage.
Immunohistochemical
study showed that the tumor cells were strongly positive for SMA and
collagen type Ⅳ (Figure 3D and 3E), and negative for CD31, CD34, CD117,
Desmin, DOG-1, CgA, Syn, S100, EMA, STAT6, β-catenin, Caldesmon and
Calponin. Ki-67 proliferation index was less than 1% (Figure 3F) and
mitotic activity is about 1/50 HPF.
According
to the CT results, endoscopic images and pathologic findings,
the case was finally diagnosed as benign GT. Postoperatively, the
gastrointestinal
hemorrhage was completely resolved. And no recurrence or metastasis was
observed
during
a follow-up period of 6 months.