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

Abstract

Pancreatic tumors are primary in most of the cases. Pancreatic metastases associated with other primary malignancies, especially pancreatic metastasis of leiomyosarcoma, are uncommon. A 66-year-old woman underwent surgical resection of malignant mesenchymoma (70% osteosarcoma and 30% leiomyosarcoma) in the right thigh. 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 surgically.

Figure 1

Radiological findings. A: Gadolinium-enhanced T1 weighted image showing a soft tissue tumor in the muscle of the anterior thigh; B: Contrast-enhanced abdominal CT scan showing a heterogeneously enhanced mass at the head of the pancreas; C: Gadolinium-enhanced T1 weighted image showing a well-enhanced mass with necrotic foci at the head of the pancreas; D: Follow-up CT obtained after 10 mo showing a low attenuated mass in the tail of the pancreas.

Figure 2

Gross and microscopic findings for metastatic leiomyo-sarcoma. A: The section reveals a whitish solid tumor with a lobulated pattern and a yellowish necrotic portion, abutting duodenal wall on the left side, and compressed pancreatic head tissue on the right side; B: Low-power view displaying eosinophilic intersecting fascicles circumscribed by a fibrous capsule (a) and adjacent normal pancreatic tissue (b) (hematoxylin and eosin stain ×40); C: Cellular proliferation of atypical spindle tumor cells is accompanied by nuclear atypia and hyperchromasia (hematoxylin and eosin stain × 200); D: Tumor cells show immunoreactivity for desmin.