Local recurrence and multi-organ metastasis of primary retroperitoneal leiomyosarcoma in unusual locations after surgical resection

摘要

We report a case of retroperitoneal leiomyosarcoma in a 52-year-old woman, who developed local recurrence, pulmonary, hepatic, peritoneal, pancreatic, subcutaneous and intramuscular metastases two years after surgical resection of the primary tumor. Metastasis to the pancreas, subcutaneous or muscular tissue is very rare; however, presence of a lesion in these locations in a known case of leiomyosarcoma might indicate a metastatic tumor deposit. Keywords: Computed tomography, Leiomyosarcoma, Metastasis, Pancreas, Retroperitoneum, Skeletal muscleCASE REPORTA 52-year-old female underwent surgical resection for a retroperitoneal soft tissue mass 2 years prior to presentation. At laprotomy, a large lobulated soft tissue mass was found arising from the left retroperitoneal area. The tumor was involving the left perirenal space and was infiltrating into the sigmoid mesocolon. An extracapsular excision was done. The postoperative course was uneventful. Gross pathological examination revealed a circumscribed mass measuring 10×14×18 cm. Outer surface of mass was bosselated and congested at places. The cut surface was firm having variegated appearance with solid grayish white areas, foci of hemorrhage, necrosis, mucoid and cystic degeneration. The cysts ranged from 0.3 to 0.5 cm. Microscopic examination demonstrated structure of a tumor consisting of sheets and fascicles of spindle cells having oval to oblong pleomorphic nuclei and moderate amount of eosinophilic cytoplasm (Fig. 1). Foci of necrosis, dilated and congested blood vessels, and frequent mitosis were seen. On immunohistochemistry, the tumor cells showed positivity for desmin and smooth muscle actin (Fig. 2, ?,3),3), and were negative for c-kit and S-100. Based on above findings a diagnosis of retroperitoneal leiomyosarcoma was made. Patient was not offered any chemotherapy or radiotherapy in view of the poor response to these therapeutic options. Open in a separate windowFigure 1 52-year-old woman presenting with recurrent retroperitoneal leiomyosarcoma and multi-organ metastasis in unusual locations. Microscopic appearance of the primary retroperitoneal mass, showing tumor cells consisting of sheets and fascicles of spindle cells having oval to elongated hyperchromatic nuclei, abundant eosinophilic cytoplasm & frequent mitosis (H&E ×200).