P3501 - A Rare Case of Metastasis to the Duodenum Secondary to Uterine Leiomyosarcoma

Rakhi Patel, ¹, Joseph Fares, MD², Bassel Al-Lahham, MD^2
1Midwestern University, Peoria, AZ; ²HonorHealth, Phoenix, AZ

Introduction: Uterine leiomyosarcoma (ULMS) is a rare and aggressive uterine malignancy with unfavorable prognosis. Common sites of metastasis include the lungs, liver, bones, and brain; whereas, metastasis to the small bowel is extremely rare. There are only a few cases of ULMS metastasis to the small intestine reported in the literature, of which only three cases have been documented in the duodenum to date. We present a rare case of acute upper gastrointestinal (GI) bleeding secondary to recurrent ULMS with metastasis to the duodenum.

Case Description/Methods: A 58-year-old female with history of uterine leiomyosarcoma presented to the emergency room for post syncopal episode and melenic stools. She was initially diagnosed with ULMS three years prior to this presentation and had undergone total abdominal hysterectomy with bilateral salpingo-oopherectomy as well as chemotherapy. The patient has no family history of gastric or colon cancer. Initial complete blood count revealed severe anemia with hemoglobin of 4.3 g/dL. Computed tomography scan of the abdomen and pelvis showed a 12 cm x 9 cm heterogeneous multilobulated mass arising from the right hepatic lobe, displacing the adjacent gallbladder, and compressing the pancreatic head, antrum and duodenum. Patient was resuscitated adequately and subsequently underwent an esophagogastroduodenoscopy with findings of an ulcerated bleeding mass in the duodenal bulb. Histopathology confirmed recurrent leiomyosarcoma with serosal near-transmural involvement and associated ulceration. Patient was ultimately transitioned to hospice care after declining further chemotherapy.

Discussion: Uterine leiomyosarcoma metastasis to the small bowel is extremely rare and is usually a sign of advanced disease with poor prognosis. We report the case of recurrent ULMS with metastasis to the duodenum presenting as an acute upper GI bleeding. We conclude that, in patient with metastatic ULMS presenting with GI bleeding, the differential diagnosis should include bowel involvement with the cancer as the etiology of the bleeding.


Disclosures:


Rakhi Patel, ¹, Joseph Fares, MD², Bassel Al-Lahham, MD². P3501 - A Rare Case of Metastasis to the Duodenum Secondary to Uterine Leiomyosarcoma, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.