Bleeding duodenal tumor

Bleeding mass and ulcer in the duodenal bulb found in a patient presented with melena (figure 1). The same lesion after eleven-day PPI therapy (figure 2). Biopsy revealed a cellular lesion composed of spindle shaped cells. The tumor exhibited positivity for dezmin, actin and vimentin. Staining for CD34 and CD117 was negative. The tumor was interpreted as an leiomyosarcoma. CT scan showed 20 cm diameter mass in the subhepatal region with infiltration into the duodenal wall. Hyperechogenic mass in the gall bladder was seen on ultrasound and so we could not rule out gallbladder sarcoma infiltrating into the duodenal wall. Patient refused further treatment.