Pancreatic metastasis of leiomyosarcoma in the right thigh: A case report

Abstract

tumors is 1.6%-11% at autopsy [1,2] . The majority of patients with pancreatic metastasis have widespread diseases. Isolated, potentially resectable pancreatic metastasis is detected infrequently. Therefore, resection of metastatic tumors of the pancreas has been occasionally reported, and its role in improving the survival or quality of life is not clearly defined [3,4] . However, some recent studies have reported that surgical resection can be performed in selected patients with isolated pancreatic metastases, achieving long-ter m sur vival and good palliation [1,5] . We report here a case of pancreatic metastatic from leiomyosarcoma of the right anterior thigh, which was treated by surgical resection, and review the literature about pancreatic metastasis. CASE REPORTA 66-year-old woman was referred to our hospital with a mass in the right thigh (Figure 1). In September 2005, she had undergone surgical resection for this mass. Malignant mesenchymoma (70% osteosarcoma and 30% leiomyosarcoma) was diagnosed histologically. In the postoperative period, abdominal computed tomography (CT) identified a pancreatic mass. The patient complained of non-specific abdominal discomfort. Laboratory findings were all within normal limits. The levels of the tumor markers including carcinoembryonic agent and carbohydrate antigen 19-9, were within the normal ranges. Abdominal CT revealed a mass at the head of the pancreas. Magnetic resonance imaging of the abdomen showed a low-intensity mass on T1-weighted images and a non-homogeneous high-intensity mass on T2-weighted images. No evidence of other distant metastases was seen (Figure 1). At laparotomy, a fixed mass of 4 cm or so in length was palpated at the head of the pancreas, displacing the surrounding duodenum. Therefore, pyloruspreserving pancreaticoduodenectomy was performed. Macroscopic examination of the operative specimen showed a 4 cm × 3 cm lobulated solid mass with a thin wall. Microscopic examination revealed a malignant neoplasm with predominance of spindle cells. The tumor cells were immunoreactive for desmin. Metastatic leiomyosarcoma was diagnosed histologically (Figure 2). The postoperative course was uneventful. We recommended systemic chemotherapy to the patient, but she declined. Nine months after the first pancreatic resection, a followup abdominal CT showed development of a new 1-cm mass in the remnant tail of the pancreas (Figure 1). Distal In the postoperative period, a pancreatic mass was identified radiologically by abdominal computed tomography. Pylorus-preserving pancreaticoduodenectomy was performed. The surgical specimen revealed leiomyosarcoma metastasized to the pancreas. A metastatic nodule on the remnant pancreatic tail was discovered 9 mo after the first pancreatic resection, and distal pancreatectomy was performed. Cases of pancreatic metastasis from leiomyosarcoma are extremely rare, especially when the tumor was resectable. We report here a unique case of pancreatic metastasis from a leiomyosarcoma in the right thigh that had been treated su...

Pleomorphic and dedifferentiated leiomyosarcoma: clinicopathologic and immunohistochemical study of 41 cases

“…The first cases of dedifferentiated leiomyosarcoma in the literature were reported by Brooks in 1985 [16]. The pleomorphic component of these tumors is often indistinguishable from MFH, although more specific histologic features recognizable as osteosarcoma, chondrosarcoma, or rhabdomyoblastic differentiation have also been documented [1,[13][14][15]19]. However, none of the tumors we report showed such heterologous differentiation.…”

“…The largest cohort published in the literature to date had 28 cases; the remainder are case reports or series with a small number of patients [1,[7][8][9][10][11][12][13][14][15][16]. In the series of Oda et al [1], pleomorphic leiomyosarcoma accounted for 8.6% of all leiomyosarcomas.…”

Isolated metastasis of uterine leiomyosarcoma to the pancreas: Report of a case and review of the literature

“…However a few cases of leiomyosarcoma with metastases to the pancreas have been reported in the literature. Primary sites of leiomyosarcomas included the uterus, ovary, veins, spermatic cord, intestine, retroperitoneum and soft tissue 2 . Most patients have widespread disease on diagnosis of pancreatic metastases, whereas isolated metastases to the pancreas are rare 1 .…”

“…Most patients with pancreatic metastases have widespread disease. Isolated, potentially resectable pancreatic metastases are detected infrequently 2 . Although surgical resection of metastatic lesions to the liver, brain and lungs improve survival and quality of life, the management of pancreatic metastases has not been clearly defined 2,3 .…”

Pancreatic Metastasis from Primary Leiomyosarcoma of the Breast

“…Only 2% of all pancreatic malignancies are metastases, and the most common primary cancer site responsible for pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma, and sarcoma [2]. Leiomyosarcoma represents an exceedingly rare cause of pancreatic metastasis [3][4][5], with the primary organs being the uterus, ovary, veins, spermatic cord, intestine, retroperitoneum, and soft tissue [4]. Primary leiomyosarcoma of the breast is an extremely rare form of breast cancer (< 0.01% of all cases) with an unpredictable biological behavior [5].…”