title: Duodenal plexiform fibromyxoma as a cause of obscure upper gastrointestinal bleeding: A case report.
abstract: BACKGROUND
  We are reporting the first-to our knowledge-case of duodenal Plexiform Fibromyxoma causing obscure upper gastrointestinal bleeding.
  
  
  METHODS
  Plexiform fibromyxoma triggered recurrent upper gastrointestinal bleeding episodes in a 63-year-old man who remained undiagnosed, despite multiple hospitalizations, extensive diagnostic workups and surgical interventions (including gastrectomies), for almost 17 years.
  During hospitalization for the last bleeding episode, an upper gastrointestinal endoscopy revealed an intestinal hemorrhagic nodule. The lesion was deemed unresectable by endoscopic means. An abdominal computerized tomography disclosed no further lesions and surgery was decided. The lesion at operation was found near the edge of the duodenal stump and treated with pancreas-preserving duodenectomy (1st and 2nd portion).
  
  
  RESULTS
  Postoperative recovery was mainly uneventful and a 20-month follow-up finds the patient in good health with no need for blood transfusions.Plexiform fibromyxomas stand for a rare and widely unknown mesenchymal entity. Despite the fact that they closely resemble other gastrointestinal tumors, they distinctly vary in clinical management as well as the histopathology. Clinical awareness and further research are compulsory to elucidate its clinical course and prognosis.
authors.affiliation: First Department of Surgery Department of Pathophysiology, "Laikon" General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece Department of Immunology, Lerner Research Institute, Cleveland Clinic, Cleveland, OH Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece.
authors.forename: Demetrios
authors.initials: D
authors.lastname: Moris
authors.forename: Evangelia
authors.initials: E
authors.lastname: Spanou
authors.forename: Stavros
authors.initials: S
authors.lastname: Sougioultzis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Dimitrokallis
authors.forename: Polyxeni
authors.initials: P
authors.lastname: Kalisperati
authors.forename: Ioanna
authors.initials: I
authors.lastname: Delladetsima
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
mesh_terms: D013505:Digestive System Surgical Procedures / Q000379:methods*; D004379:Duodenal Neoplasms / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D004386:Duodenum / Q000000981:diagnostic imaging / Q000473:pathology; D016145:Endoscopy, Digestive System / Q000379:methods; D005350:Fibroma / Q000150:complications / Q000473:pathology / Q000503:physiopathology / Q000601:surgery; D006471:Gastrointestinal Hemorrhage / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome