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Review
. 2019 Nov 27;12(11):e231529.
doi: 10.1136/bcr-2019-231529.

Pancreatic leiomyosarcoma: a diagnostic challenge and literature review

Neesa Fadaee  1 , Tasmea Sefa  2 , Amitabah Das  2   3 , Kheman Rajkomar  3
Affiliations
Review

Pancreatic leiomyosarcoma: a diagnostic challenge and literature review

Neesa Fadaee et al. BMJ Case Rep. .

Abstract

A 71-year-old woman was referred with abdominal pain and weight loss. An abdominal CT showed a 5-cm heterogeneous mass in the head of the pancreas with involvement of the superior mesenteric vein and artery. Her carcinoembryonic antigen (CEA) and CA 19-9 were normal. Two endoscopic ultrasound/fine needle aspirates (EUS/FNAs) of the mass diagnosed her with a mesenchymal tumour of myogenic origin but did not show features of malignancy. Frozen section analysis of laparoscopic core biopsies also failed to show malignant features, hence requiring an open biopsy which confirmed the diagnosis of pancreatic leiomyosarcoma (PLMS). She was eventually treated with radiotherapy. To our knowledge this is the only case in recent English literature of inoperable locally advanced PLMS that has required an open biopsy to formalise the diagnosis despite prior EUS FNAs. We include a review of the literature, highlighting the deficiencies of various biopsy techniques.

Keywords: general surgery; pancreas and biliary tract; pancreatic cancer; pathology.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Axial CT scan of the abdomen showing head of pancreas mass with peripheral enhancement and central necrosis.
Figure 2
Figure 2
Endoscopic ultrasound of head of pancreas mass with sonographic evidence of invasion into portal vein (PV).
Figure 3
Figure 3
Histopathological specimen from open biopsy of head of pancreas lesion. (A) H&E stain demonstrating fascicles of spindle cells and moderate nuclear pleomorphism. (B) Positive staining for SMA. (C) Positive staining for desmin.
Figure 4
Figure 4
PET scan revealing hypermetabolic mass in pancreatic head/neck. PET; positron emission tomography.
See this image and copyright information in PMC

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