Clinical Presentation

A 39-year-old man presents with gastrointestinal bleeding.

(A) Contrast-enhanced computed tomography shows marked, circumferential mural thickening (arrow) of the proximal jejunum and no enlarged lymph nodes. (B) More caudal image shows a large exophytic mass with central low-density areas of necrosis or cavitation (arrow). Minimal lymphadenopathy is noted (arrowhead). (C) More caudal image shows two lobulated components of the mass with an enhancing rim and central low density (arrow).

Differential Diagnosis

• Melanoma: This top diagnostic choice causes cavitary lesions of the small bowel, and metastatic disease is the most common small-bowel neoplasm.

• Leiomyosarcoma: