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.