A small leiomyosarcoma of the pancreas treated by local excision

Abstract

Background: Leiomyosarcoma of the pancreas is a very rare tumour; only 33 cases have been reported in the English literature. Because these tumours tend to be large and locally advanced, extended resection such as pancreatoduodenectomy or distal pancreatectomy has been advocated.

Case outline: A 25-year-old woman with left-sided back pain had a small low-density lesion (2 x 2 cm) in the pancreatic body on computed tomography (CT). The tumour was initially diagnosed as a pseudocyst and was managed conservatively. A repeat CT scan 10 months later showed an increase in the size of the lesion (3.5 x 3.5 cm) with contrast enhancement of a high-density area. The diagnosis was therefore changed to papillary-cystic neoplasm. At laparotomy, the tumour seemed to be arising from the mid-body of the pancreas with no invasion into surrounding organs. Local excision of the tumour was performed. Pathological examination revealed a leiomyosarcoma of the pancreas.

Discussion: Complete surgical resection offers the only potential chance of cure for patients with leiomyosarcoma of the pancreas.The lack of evidence of recurrence at three-and-a-half years suggests that the less invasive surgical procedure in the present case has been curative. Careful and intraoperative exploration was important to determine the best surgical procedure.

Figure 1.

Contrast-enhanced axial CT demonstrating a 2 cm low-density pancreatic lesion.

Figure 2.

CT scan showing growth of the tumour, which is heterogeneously enhanced by contrast medium.

Figure 3.

Abdominal angiography shows an approximately 4 cm tumour stain arising from the dorsal pancreatic artery.

Figure 4.

Sagittal section of the tumour.

Figure 5.

Photomicrograph showing the tumour comprises spindle-shaped cells with eosinophilic cytoplasm in an interlacing arrangement (haematoxylin and eosin stain, ×200).