THE KURUME MEDICAL JOURNAL Vol.37, p.171-175, 1990 Leiomyosarcoma Rectum with Sarcoid-Like Reaction A Case Report MASAYUKI NAKAMURA, AKIHIRO IEMURA, MASAMICHI KOJIRO, HIROSHI UMETANI AND MAKOTO ISOBE Department Surgery, Yamaguchi University School Medice, Ube, 755 Departments o f Pathology Surgery, Kurume University School Medice, Kurume, 830 Japan Received for Publication April 4, 1990 Summary: A 57 year-old man admitted to hospital because bloody stools. A barium enema coloscopy disclosed a tumor rectum. resected tumor diagnosed as a leiomyosarcoma, histologically. Many epilioid granulomas with Langhans type giant cells found tumor, re no evidence suggestive generalized sarcoidosis, tuberculosis or mycosis. Thus, epilioid granulomas seen leiomyosarcoma terpreted as a sarcoid-like reaction. As far as could be determed, re has been no reported case a sarcoid-like reaction associated with a leiomyosarcoma. occurrence sarcoid- like reaction present case could be due to reaction to metabolites or a degenerative substance leiomyosarcoma, or to host resistance to tumor itself. Key words : sarcoid-like reaction-leiomyosarcoma-epilioid granuloma Introduction Although a sarcoid-like reation is occationally associated with malignant tumors (Gherardi 1950; Gorton Lrell 1957; Anderson et al. 1962; Gregolie et al. 1962; James 1973; Kyo et al. 1973), re has been no report a sarcoid-like reaction with a leiomyosarcoma. A case a sarcoid-like reaction with a leiomyosarcoma is described. Report a Cace A 57 year-old man admitted to hospital because bloody stools. A barium enema coloscopy disclosed a tumor protrudg to lumen lower part rectum. Leiomyosarcoma diagnosed from a biopsy tumor. An abdomnoperitoneal resection performed. Pathologic Fdgs resected tumor 8 ~8 ~6 cm size, solid a hard consistency. tumor well defed located maly propria muscularis protruded to lumen with a superficial ulceration (Fig. 1). tumor consisted maly spdle-shaped cells with nor- Address for all correspondence to : Masamichi Kojiro, M.D. First Department Pathology, Kurume University School Medice, 67 Asahi-machi, Kurume, 830 Japan 171
NAKAMURA, 172 mochromatic slightly nuclei eosophilic moderate cytoplasm. totic figures little seen. re no evidence based regional on diagnosed nuclear lymph size Few mi- atypia However, tumor, as a leiomyosarcoma it rec- tum. Many epilioid Fig. pansive lower granulomas, 1. part growth. tumor, which 8 ~6 ~6cm rectum. AL. relatively well-defed contaed Langhans type giant cells lymphocytes, observed tumor (Fig. 2). No microorganisms identified granulomas by Zeel-Neelsen, Periodic Acid-Schiff (PAS), Grocott stas. granulomas seen tumor, but not observed regional lymph nodes. metastasis nodes. sizes ET size, tumor with ulcerations well-defed with located an ex-
LEIOMYOSARCOMA Fig. cells 2. OF THE Epilioid granulomas proment. Lymphocytes tumor consisted atypia seen. spdle-shaped (H. E., RECTUM SARCOID-LIKE leiomyosarcoma. cells. A ~50, WITH B ~100) termgled Only a few REACTION Langhans mitotic type granulomas. figures giant nuclear 173
174 NAKAMURA, ET AL. Discussion Sarcoidosis is a systemic disease from an unknown cause which produces epilioid granulomas various organs. Similar epilioid granulomas are ten formed affected organ itself regional lymph nodes or diseases, such granulomas are described as sarcoid-like reactions. James (1973) described some causal diseases which generated sarcoid-like reactions, cludg malignant tumors, mycosis, toxoplasmosis, chemical substances such as beryllium, extrsic allergic terstitial pneumonia like farmer's lung anticancer chemorapy. In comparg epilioid granuloma a sarcoid-like reaction to that sarcoidosis, Gorton Lell (1957) Symmers (1951) described followg unique features epilioid granuloma sarcoid-like reaction; 1) number epilioid cells is smaller, re is lymphocyte filtration, 2) granulomas are more sporadic, 3) lymph nodes, granulomas are not discrete from surroundg lymph node tissue. However, Anderson et al. (1962) stated that granulomas sarcoid-like reaction difficult to distguish from those sarcoidosis by histologic fdgs only, clical symptoms should be considered as well. sarcoid-like reaction malignant tumor described by Lennert (1961) Gregorie et al. (1962). It frequently observed utere cancer, breast cancer gastric cancer. y also mentioned that a sarcoid-like reaction observed regional lymph nodes almost all cases re few cases with a sarcoid-like reaction with tumor. Thus, almost all sacoid-like reactions observed malignant tumors /or regional lymph nodes organs bearg tumors, re has been no report a sarcoid-like reaction associated with a leiomyosarcorma. re are many disputes on histogenesis sarcoid-like reactions associated with malignant tumors. Gherardi (1950) considered it to be a histological reaction due to host resistance agast malignant tumor. Kyo et al. (1973) predicted that sarcoid-like reaction is a manifestation a defense reaction, while cancer is limited to a small part organ, sarcoid-like reaction might be dimished due to a weakened host resistance as tumor progresses. On or h, Gorton Lell (1957) noted that sarcoid-like reaction should occur more frequently malignant tumors if it is a reaction to metabolites or degenerative substances from tumors. Moreover, Ref vem (1956) reported that epilioid granulomas formed experimentally by usg lipovitell. This supports conclusion Gorton Lell (1957). In present case, epilioid granulomas seen a leiomyosarcoma rectum. As re few epilioid cells re lymphocyte filtration, granulomas present case similar to a sarcoid-like reaction. When judged on se properties clical symptoms, possibility sarcoidosis this case uncerta sce no symptoms eyes respiratory system no swellg superficial lymph nodes, suggestive sarcoidosis, observed. Moreover, swellg hilar lymph nodes fibrosis lung not found on chest X-ray film; although Kveim's test, angiotens-convertg enzyme serum urary calcium not examed, tubercul test negative. As to histogenesis sarcoid - like reaction present case, it is not due to mycosis or chemical substances, such as beryllium. It might be caused by metabolites or degenerative substances from leiomyosarcoma or host resist-
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