PMC5852304_01
(A) Push enteroscopy revealed an ulcerated jejunal mass with an adherent clot. (B) Biopsies were taken and hemostasis was achieved with epinephrine and bipolar cautery.
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F1
Push enteroscopy revealed an ulcerated jejunal lesion with an adherent clot (Figure 1).
The second push enteroscopy showed a second jejnual polypoid mass and active bleeding. Biopsies were taken and hemostasis was achieved with a detachable snare and hemostatic clips.
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F2
A second push enteroscopy revealed hemostasis of the original jejunal lesion with active bleeding from a second, more distal jejunal polypoid lesion, which was treated with a detachable snare and hemostatic clips (Figure 2).
(A) Segment of the small bowel from surgical resection showing 3 polypoid masses (arrows). (B) Small round cells with abundant eosinophilic cytoplasm, some with rhabdoid features.
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F3
An exploratory laparotomy revealed a large mass in the fourth part of the duodenum as well as two proximal ileal lesions, all of which were resected (Figure 3). Based on these findings, a diagnosis of a high-grade fibroblastic reticular cell sarcoma (FRCS) was rendered (Figure 3).
Video capsule endoscopy. (A) A mass identified in the proximal jejunum (arrow). (B) A bleeding mass identified in the distal jejunum. (C) An additional mass identified in the proximal ileum.
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F4
A capsule endoscopy showed multiple actively bleeding lesions in the small bowel (Figure 4).