Stromal tumors of the rectum: a case report and review of the literature

This paper describes a case of epithelioid leiomyosarcoma of the rectum in a patient admitted for constipation and rectal bleeding. After an initial biopsy diagnosis of leiomyoma, a local excision was performed, showing the malignant nature of the tumour. Consequently, the patient underwent an abdomino-perineal amputation, adjuvant radiation (50 Gy) and a 24-month follow-up, which revealed no signs of local or distant recurrence. Sarcomas of the rectum are rare and therefore poorly documented neoplasms. They belong to the wider group of gastrointestinal stromal tumours, which are classified in 4 histological types: (i) smooth muscle, (ii) neural, (iii) mixed and (iv) undifferentiated. Since they grow within the intestinal wall, the symptoms are usually few or late, leading to delays in diagnosis. The diagnostic and staging protocol of stromal tumours of the rectum includes CT and MRI. The treatment is primarily surgical, where possible, and should guarantee complete clearance of the tumour, which often requires an aggressive approach. Non-curative resection, high tumour grade and size > 10 cm, are considered unfavourable prognostic factors. Further trials are needed to establish the exact role of adjuvant therapy. Though it prolongs the disease-free interval, there is no clear evidence that it influences the overall survival.