부산대학교 도서관

The small bowel represents a rare site for primary neoplasms, with an incidence of less than 2% of all that are located in the digestive tract. The early diagnosis of these tumors is often difficult due to the lack of specificity of the clinical presentation, but it can make a difference in matters of 5-year survival rates: 83% (early detection) versus 14% (late detection). We present the case of a male patient, aged 66, with an apparently benign jejunal ulcer diagnosed enteroscopically. Clinical presentation: diffuse abdominal pain, fatigability, melena; paraclinical evaluation: anaemia, positive occult gastrointestinal bleeding test, superior and inferior endoscopy without haemorrhagic lesions. The surgical exploration guided by intramucosal dye discovers a 2 cm tumor, 250 cm distal to the angle of Treitz with multiple mesenteric adenopathies. A segmental resection is performed keeping oncological safety margins with the removal of the lymphatic drainage elements. The post-operative evolution is favourable and leads to complete healing. The histopathological assay finds pathological changes consistent for Kaposi's sarcoma and confirms the presence of HHV-8 in the nuclei of the tumor cells by means of immunohistochemistry. At the examination of the skin, multiple purple patches were discovered. The particularity of this case is that the Kaposi's sarcoma manifests itself in the absence of an immunosuppressive treatment or an immunodeficiency state induced by a HIV infection. Although rare, the small intestine tumors should be considered when non-specific abdominal pain is accompanied by positive occult bleeding test, with scarce endoscopic evidence. Since the Kaposi's sarcoma is a highly angiogenic tumor, it is prudent to include it in the differential diagnosis when suspecting a source of gastrointestinal bleeding. [ABSTRACT FROM AUTHOR]