Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: Experience at a tertiary cancer center

Abstract

AIM:To describe the multidetector computed tomography features of pancreatic metastasis from leiomyosarcoma (LMS). METHODS:Between January 1995 and December 2012, 13 consecutive patients (11 women, 2 men; mean age of 57 years; range, 38-78 years) with pancreatic metastases from LMS were included in our study. Imaging features including location, number, largest dimension, tumor attenuation and enhancement characteristics, presence of necrosis, pancreatic ductal dilatation, common bile duct (CBD) dilatation, presence of pancreatitis, and atrophy were documented. RESULTS:The most common site of origin of the pancreatic metastases from LMS was uterus (38.5%), followed by retroperitoneum (30.8%) and extremity (23.1%). None of the patients in our study had pancreas as the first site of metastasis. All patients developed pancreatic metastases at a median interval of 24 mo. Pancreatic metastases from LMS were solitary in 8/13 patients and multiple in 5/13 patients, had no predilection for any part of the pancreas, were hypovascular on arterial phase in 10/13 patients and associated with pancreatic duct dilatation in 3/13 patients. None had CBD dilatation. None of the pancreatic metastases in LMS cohort caused pancreatitis, and atrophy. Median duration of follow-up was 19 mo for LMS cohort during which two patients underwent resection of metastasis (median survival 45 mo) while the remaining underwent systemic therapy (median survival 13 mo). ORIGINAL ARTICLE CONCLUSION:Pancreatic metastases from LMS are often solitary and hypovascular masses and less commonly associated with pancreatic ductal dilatation, CBD dilatation, pancreatitis or pancreatic atrophy. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients. Core tip: Pancreatic metastases from leiomyosarcoma (LMS) commonly arise in the uterus and are characterized by a long latency period after the diagnosis of primary tumor. Although the imaging features of the pancreatic metastases from LMS are nonspecific, pancreatic metastases from LMS should be considered in the differential diagnosis of solitary or multiple hypovascular masses without pancreatic ductal dilatation, common bile duct dilatation, pancreatitis, atrophy in the pancreas in patients with history of LMS. Surgical resection of solitary LMS pancreatic metastasis can be considered due to the long survival of these patients after detection of pancreatic metastasis.Suh CH, Keraliya A, Shinagare AB, Kim KW, Ramaiya NH, Tirumani SH. Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: Experience at a tertiary cancer center.

Recurrent broad ligament leiomyosarcoma with pancreatic and thigh metastasis: a case report

“…A literature review of LMS metastasis to the pancreas is presented in Table 1 [6][7][8][9][10][11][12][13]. A retrospective study of 13 patients with metastatic pancreatic LMS showed that the median interval between diagnosis of metastases and primary LMS was 24 moths (range, 1-77 moths), and all patients were associated with metastases to other organs [14]. In this case, pancreatic and thigh metastasis were found 3 years after resection of the broad ligament LMS, showing a long interval between the treatment of primary LMS and the appearance of pancreatic metastasis.…”

“…Metastatic pancreatic LMS has no specificity in clinical and image findings, so it is difficult to make an exact diagnosis preoperatively. In contrast-enhanced CT scan, most of metastatic pancreatic LMSs are hypovascular [14], which need to be carefully differentiated from pancreatic ductal adenocarcinoma. In this case, the pancreatic lesion showed heterogeneous enhancement that was lower than the surrounding normal pancreas in arterial phase, and the same enhancement degree with the surrounding tissue in venous phase.…”

Metastatic leiomyosarcoma to the pancreas diagnosed on endoscopic ultrasound‐guided fine needle aspiration – A report of two cases with review of spindle cell lesions of pancreas

“…Pancreatic adenocarcinoma generally remains hypoechoic, but an almost black echo texture, round appearance with sharply defined borders should raise a possibility of some other lesion as seen in these two cases. According to a study by Suh et al 4…”

Preoperative contrast-enhanced computed tomographic characterisation of pancreatic cystic lesions: A prospective study

“…Johnson et al 22 reported that on ultrasound, SCAs usually have more than six loculi that are less than 2 cm in diameter. Bhatt and Vaishnav 23 found that SCAs were approximately 5 cm–6 cm in size with small internal cysts < 2cm, with septations. However, Curry et al 24 reported that the largest cyst in each tumour was smaller than 2 cm in only 14 (64%) out of the 22 patients.…”