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Papalampros A, Vailas MG, Deladetsima I, Moris D, Sotiropoulou M, Syllaios A, Petrou A, Felekouras E. Irreversible electroporation in a case of pancreatic leiomyosarcoma: a novel weapon versus a rare malignancy? World J Surg Oncol 2019; 17:6. [PMID: 30611280 PMCID: PMC6320590 DOI: 10.1186/s12957-018-1553-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Accepted: 12/23/2018] [Indexed: 12/28/2022] Open
Abstract
Background Primary pancreatic leiomyosarcoma is an extremely rare entity that needs high clinical suspicion in order to diagnose it at an early stage. Clinical characteristics, diagnosis, and management still remain challenging and controversial, especially in advanced stages, when tumor invades adjacent vessels and organs or gives distant metastases. Case presentation Herein, we describe a case of a 57-year-old woman suffering from advanced pancreatic leiomyosarcoma with thrombosis of the superior mesenteric vein, as well as liver lesions which were suspicious for metastasis. Multidisciplinary team decided for upfront chemotherapy to assess tumor response. Follow-up imaging after the completion of chemotherapy led tumor board to decide for subsequent surgical exploration. The patient underwent exploratory laparotomy and irreversible electroporation ablation of the pancreatic tumor. Postoperative course was uneventful, and she was discharged 10 days later with a plan to receive adjuvant therapy. To the best of our knowledge, this is the first case of pancreatic leiomyosarcoma ever reported, treated with this novel technique of irreversible electroporation that could be an alternative and feasible way for the management of these rare malignancies. Conclusions In conclusion, primary pancreatic leiomyosarcoma is a rare and highly malignant tumor associated with poor prognosis. Nowadays, R0 surgical resection remains the cornerstone treatment, combined with adjuvant and/or neoadjuvant chemotherapy prior to resection. In the advanced setting, when major vessel invasion and distant metastases occur, chemotherapy along with irreversible electroporation ablation could be a helpful and possibly effective modality for the management of this highly aggressive tumor.
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Affiliation(s)
- Alexandros Papalampros
- 1st Surgical Department, Athens University School of Medicine,"Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Michail G Vailas
- 1st Surgical Department, Athens University School of Medicine,"Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece.
| | - Ioanna Deladetsima
- Pathology Department, Athens University School of Medicine,"Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Demetrios Moris
- Department of Surgery, Duke University Medical Center
- DUMC, Durham, USA
| | - Maria Sotiropoulou
- 3rd Surgical Department, Evangelismos General Hospital, Ypsilantou 47, 10676, Athens, Greece
| | - Athanasios Syllaios
- 1st Surgical Department, Athens University School of Medicine,"Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
| | - Athanasios Petrou
- Nicosia Department of Surgery/Div. HPB, 93 Agiou Nikolaou Street, Engomi, 2408, Nicosia, Cyprus
| | - Evangelos Felekouras
- 1st Surgical Department, Athens University School of Medicine,"Laiko" General Hospital, Agiou Thoma 17, 11527, Athens, Greece
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A case report of primary pancreatic leiomyosarcoma requiring six additional resections for recurrences. Int J Surg Case Rep 2017; 41:272-276. [PMID: 29121584 PMCID: PMC5681329 DOI: 10.1016/j.ijscr.2017.10.039] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 10/24/2017] [Indexed: 12/27/2022] Open
Abstract
Primary pancreatic leiomyosarcoma is extremely rare, and is considered to be a highly aggressive malignancy. We performed distal pancreatectomy, splenectomy, and wide resection of the transverse mesocolon. Due to treat recurrent tumors, six additional resections were needed over a 5-year period. Even if a primary pancreatic tumor recurs, long-term survival is achievable by repeated resection of recurrent tumors.
Introduction Primary pancreatic leiomyosarcoma is extremely rare. We report a case in which six additional resections were required to treat recurrent tumors in a 5-year period following the primary operation. Presentation of case A 69-year-old man presented with a pancreatic tumor. Abdominal computed tomography scan showed a large heterogeneous mass with a necrotic area arising from the pancreatic body. We performed distal pancreatectomy, splenectomy, and wide resection of the transverse mesocolon. Histopathological examination confirmed the diagnosis of a pancreatic leiomyosarcoma. We repeatedly performed surgery on recurrent tumors. Discussion Primary pancreatic leiomyosarcoma is considered to be a highly aggressive malignancy. The most effective treatment is complete surgical resection with tumor-free margins. Even when tumors recur, it is possible to improve the prognosis by further resection. Conclusion Long-term survival is achievable by repeated resection of recurrent tumors.
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Lin C, Wang L, Sheng J, Zhang D, Guan L, Zhao K, Zhang X. Transdifferentiation of pancreatic stromal tumor into leiomyosarcoma with metastases to liver and peritoneum: a case report. BMC Cancer 2016; 16:947. [PMID: 27955634 PMCID: PMC5154023 DOI: 10.1186/s12885-016-2976-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 11/28/2016] [Indexed: 12/19/2022] Open
Abstract
Background Primary pancreatic leiomyosarcoma is a rare pancreatic malignancy; the clinical presentation and treatment is not well-characterized. Further, the molecular mechanisms underlying its pathogenesis are not known. We report a patient with pancreatic stromal tumor that progressed to primary pancreatic leiomyosarcoma with hepatic and peritoneal metastases. Case presentation A 54-year-old woman was found to have pancreatic and hepatic tumor masses on routine health checkup. Owing to the difficulty in performing biopsy, this patient underwent open operation. Histopathological examination of pancreatic and liver biopsy specimen demonstrated spindle cells with nuclear mitoses. Immunohistochemical examination showed positive staining for Cluster of Differentiation117 (+) and negative staining for S-100 (-) and Smooth Muscle Actin (-). Thus, the patient was diagnosed as a case of advanced pancreatic stromal tumor with liver metastases. After surgery, treatment with oral imatinib mesylate combined with thymosin injection therapy was prescribed. Follow-up examination at 13-months revealed multiple nodular masses in liver and right peritoneum. The patient underwent a second surgery. Liver biopsy and the resected peritoneal specimen showed positive staining for Discovered On Gastrointestinal tumor-1(weak +), Actin (+), Smooth Muscle Actin (+) and negative staining for Cluster of Differentiation117 (-) Cluster of Differentiation34 (-) and S-100 (-). Histopathological examination showed spindle cells with nuclear mitoses. The final diagnosis was primary pancreatic leiomyosarcoma, transdifferentiating from pancreatic stromal tumor, with liver and peritoneal metastases. Conclusions Surgery is the first line treatment for primary pancreatic leiomyosarcoma and extra-gastrointestinal stromal tumors. In the present case, radical resection was not performed owing to hepatic metastases. Palliative treatment with radioactive 125I ion implantation and microwave coagulation therapy was administered. However, the long-term therapeutic effect needs to be assessed in future. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-2976-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chao Lin
- Department of Hepatobiliary and Pancreas Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Liping Wang
- Department of Pathology, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Jiyao Sheng
- The Second Hospital of Jilin University, Ziqiang Street no. 218, Changchun, 130033, China
| | - Dan Zhang
- The Second Hospital of Jilin University, Ziqiang Street no. 218, Changchun, 130033, China
| | - Lianyue Guan
- Department of Hepatobiliary and Pancreas Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Kai Zhao
- Department of Hepatobiliary and Pancreas Surgery, China-Japan Union Hospital of Jilin University, Changchun, 130033, China
| | - Xuewen Zhang
- The Second Hospital of Jilin University, Ziqiang Street no. 218, Changchun, 130033, China.
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4
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Moletta L, Sperti C, Beltrame V, Gruppo M, Blandamura S, Pasquali C, Pedrazzoli S. Leiomyosarcoma of the Pancreas with Liver Metastases as a Paradigm of Multimodality Treatment: Case Report and Review of the Literature. J Gastrointest Cancer 2016; 43 Suppl 1:S246-50. [PMID: 22733567 DOI: 10.1007/s12029-012-9405-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Affiliation(s)
- Lucia Moletta
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Cosimo Sperti
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy.
| | - Valentina Beltrame
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Mario Gruppo
- Clinica Chirurgica Geriatrica, University of Padua, Padova, Italy
| | | | - Claudio Pasquali
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
| | - Sergio Pedrazzoli
- Department of Surgical, Oncological, and Gastroenterological Sciences, 4th Surgical Clinic, University of Padua, via Giustiniani 2, 35128, Padova, Italy
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5
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Milanetto AC, Liço V, Blandamura S, Pasquali C. Primary leiomyosarcoma of the pancreas: report of a case treated by local excision and review of the literature. Surg Case Rep 2015; 1:98. [PMID: 26943422 PMCID: PMC4595416 DOI: 10.1186/s40792-015-0097-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Accepted: 10/01/2015] [Indexed: 12/14/2022] Open
Abstract
Background First described by Ross in 1951, primary pancreatic leiomyosarcoma is a rare mesenchymal tumour of the pancreas, with nonspecific clinical and radiological features and a poor prognosis, if unresectable. Case report A 60-year-old woman presented with abdominal pain. Magnetic resonance imaging (MRI) and computed tomography (CT) scan detected a dishomogeneous egg-shaped 8-cm mass, arising from the pancreatic head, with duodenal compression, without dilation of the Wirsung duct. 18F-FDG positron-emission tomography (PET)-CT showed a moderate tracer uptake, and the endoscopic ultrasound (US) showed a hypoechoic lesion, arising from the duodenal wall, suspected to be a gastrointestinal stromal tumour (GIST). CEA, CA19-9, NSE, and chromogranin A were normal. At the surgical exploration, a 10-cm mass, adherent to the anterior aspect of the pancreatic head, was found. The lesion was easily separable from the duodenal wall and was totally excised. The frozen intraoperative examination showed a mesenchymal tumour, with spindle-shaped cells, suggesting that a GIST diagnosis was likely. Postoperative course was uneventful. Histology and immunohistochemistry demonstrated a well-differentiated leiomyosarcoma, with five to six mitotic counts per 10 high-power field (HPF) and proliferative index (MIB-1) 10 % (grade 2 according to Federation Nationale des Centres de Lutte Contre le Cancer (FNCLCC)), with positive smooth muscle actin, desmin, and caldesmon but negative CD117 (c-kit) and S-100. The patient is alive and asymptomatic 19 months after surgery, without evidences of disease. Conclusions In the English literature, only 44 cases of primary pancreatic leiomyosarcoma have been reported. If a pancreatic mass suspected for primary pancreatic leiomyosarcoma has no adjacent organ/vessel invasion or distant metastases, surgical resection is the therapy of choice.
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Affiliation(s)
- Anna Caterina Milanetto
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
| | - Valbona Liço
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
| | - Stella Blandamura
- Pathology-Department of Medicine, University of Padua, Via Gabelli, 61-35128, Padua, Italy.
| | - Claudio Pasquali
- Pancreatic and Digestive Endocrine Surgical Unit-Department of Surgery, Gastroenterology and Oncology, University of Padua, Via Giustiniani, 2-35128, Padua, Italy.
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6
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Primary angiosarcoma of the pancreas mimicking severe acute pancreatitis--case report. Pancreatology 2014; 15:84-7. [PMID: 25541144 DOI: 10.1016/j.pan.2014.11.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Revised: 11/09/2014] [Accepted: 11/26/2014] [Indexed: 12/11/2022]
Abstract
Primary angiosarcoma of the pancreas is an extremely rare neoplasm that often mimicks severe acute pancreatitis. A 58-year-old man was admitted with clinical and laboratory signs of severe acute pancreatitis. Contrast enhanced CT scan demonstrated haemorrhagic necrotizing inflammation of the pancreas involving the pancreatic tail, splenic hilum and small bowels with multiple peripancreatic and free abdominal fluid collection. Percutaneous drainage was performed. After 13 days, laparotomy was indicated because of persistent intra-abdominal bleeding, fever and a palpable, rapidly growing mass in the left upper quadrant of the abdomen. During the operation a necrotic, haemorrhagic mass was found in the pancreatic tail; a frozen section showed malignancy, although the tumour was unresectable. Despite all conservative and surgical therapeutic attempts, the patient died within four weeks after diagnosis. Final histology justified primary angiosarcoma of the pancreas. If a patient with signs of severe acute pancreatitis has fever without elevated PCT, the presence of a malignant tumour of the pancreas should be considered.
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7
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Kocakoc E, Havan N, Bilgin M, Atay M. Primary pancreatic leiomyosarcoma. IRANIAN JOURNAL OF RADIOLOGY 2014; 11:e4880. [PMID: 25035704 PMCID: PMC4090645 DOI: 10.5812/iranjradiol.4880] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2012] [Revised: 03/22/2013] [Accepted: 04/06/2013] [Indexed: 11/16/2022]
Abstract
Primary pancreatic leiomyosarcomas are rare malignant neoplasms with an aggressive course and a large size. A 56-year-old woman presented with an 8-year history of abdominal pain. Multislice computed tomography revealed a large heterogeneous mass with necrotic, calcified and macroscopic fatty areas. The tumor was excised. Histopathological evaluation revealed leiomyosarcoma of the pancreas. If a patient has a large size mass with a cystic-necrotic component, pancreatic leiomyosarcoma should be considered in the differential diagnosis list after excluding other common differential diagnoses.
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Affiliation(s)
- Ercan Kocakoc
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
- Corresponding author: Ercan Kocakoc, Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey. Tel: +90-2124531700, Fax: +90-2126217580, E-mail:
| | - Nuri Havan
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Mehmet Bilgin
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Musa Atay
- Department of Radiology, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
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8
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Xu J, Zhang T, Wang T, You L, Zhao Y. Clinical characteristics and prognosis of primary leiomyosarcoma of the pancreas: a systematic review. World J Surg Oncol 2013; 11:290. [PMID: 24219646 PMCID: PMC3874640 DOI: 10.1186/1477-7819-11-290] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 09/02/2013] [Indexed: 12/12/2022] Open
Abstract
Background Primary pancreatic leiomyosarcoma (PLMS) is rare. The clinical characteristics and prognosis is still not completely understood. The aim of the present study is to identify the clinical characteristics and long-term outcomes of PLMS from the existing reported cases in different scientific literature. Methods PLMS cases reported in Chinese and English journals were collected and reviewed. Clinical features and long-term outcomes of these cases were summarized and analyzed statistically. Results A total of 69 cases reported from both Chinese and English journals were included in the present study. An equal incidence in gender was observed. The mean age was 53.9 ± 14.7 years. The most common symptoms were abdominal mass, abdominal pain, and weight loss. The mean size of the tumor was 11.4 ± 7.1 cm. The incidence of PLMS between the head and body-tail of the pancreas had a similar pattern. Twenty-five percent of patients had distant metastasis and 19% of patients had adjacent organs/vessels invasion at the time of diagnosis. But lymph node metastasis was documented in only one (1.5%) patient. The median survival time was 48 months. The overall 1-, 3-, 5-, and 10-year survival rates were 66.6%, 51.2%, 43.9%, and 29.3%, respectively. Results from the multivariate analysis showed that non-radical resection (P = 0.000; hazard ratio (HR) 5.128; 95% confidence interval (CI) 2.041-12.987) was the independent adverse prognostic factor. Adjacent organs/vessels invasion (yes) may be considered as an another potential independent adverse prognostic factor (P = 0.071; HR 2.708; 95% CI 0.981-7.474). Conclusions PLMS is rare without specific clinical features. PLMS is an aggressive tumor and has a poor prognosis. Radical resection can prolong survival time of the patients.
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Affiliation(s)
| | | | | | | | - Yupei Zhao
- Department of General Surgery, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No1 Shuaifuyuan, Wangfujing Street, Beijing 100730, China.
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9
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Zhang QY, Shen QY, Yan S, Zheng SS. Primary pancreatic pleomorphic leiomyosarcoma. J Int Med Res 2012; 39:1555-62. [PMID: 21986161 DOI: 10.1177/147323001103900447] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Primary pancreatic leiomyosarcoma is a rare mesenchymal tumour that is believed to arise from the walls of the pancreatic blood vessels or the pancreatic duct. A 56-year-old female was referred with epigastric pain and abdominal mass. Preoperative computed tomography showed a large soft tissue mass in the pancreatic body and tail. Fine needle aspiration biopsy indicated a spindle cell type tumour. The patient received distal pancreatectomy with no adjuvant treatment. Histology revealed a pleomorphic spindle cell neoplasm with an immunoprofile suggestive of smooth muscle origin. The absence of other lesions in the body was consistent with the diagnosis of primary pleomorphic leiomyosarcoma. The patient was well and tumour-free 14 months after surgery. Detailed immunohistochemical analyses are necessary in the diagnosis of this highly malignant tumour. Radical resection offers the only chance of long-term survival.
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Affiliation(s)
- Q-Y Zhang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Key Laboratory of Combined Multi-organ Transplantation, Ministry of Public Health, The First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
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10
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Leiomyosarcoma of the pancreas: Report of a case. Surg Today 2011; 41:1556-61. [DOI: 10.1007/s00595-010-4536-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2010] [Accepted: 11/01/2010] [Indexed: 10/17/2022]
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11
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Varghese L, Ngae MY, Wilson AP, Crowder CD, Gulbahce HE, Pambuccian SE. Diagnosis of metastatic pancreatic mesenchymal tumors by endoscopic ultrasound-guided fine-needle aspiration. Diagn Cytopathol 2009; 37:792-802. [DOI: 10.1002/dc.21104] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
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12
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Rifki Jai S, Bensardi F, Hizaz A, Chehab F, Khaiz D, Bouzidi A. [Primary leiomyosarcoma of the pancreas]. ACTA ACUST UNITED AC 2009; 146:195-8. [PMID: 19524241 DOI: 10.1016/j.jchir.2009.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Primary leiomyosarcoma (LMS) of the pancreas is a rare mesenchymal neoplasm (0.1% of pancreatic tumors) with only 35 cases reported in the world literature. We describe a 36th case. This tumor affects adults in the fifth decade of life, especially men. Its diagnosis is difficult and is based on immunohistochemical analyses that reveal smooth muscle cell markers. We report the case of a patient with primary LMS in the head of the pancreas. He underwent a pancreaticoduodenectomy for both diagnosis and treatment after imaging was unable to provide a precise diagnosis. The discussion covers the clinical, diagnostic, immunohistochemical, and therapeutic characteristics of this neoplasm.
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Affiliation(s)
- S Rifki Jai
- Service de chirurgie viscérale III, CHU Ibn Rochd, Casablanca, Maroc.
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13
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Chetty R, Jain R, Serra S. Solitary fibrous tumor of the pancreas. Ann Diagn Pathol 2009; 13:339-43. [PMID: 19751911 DOI: 10.1016/j.anndiagpath.2009.02.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2009] [Revised: 01/27/2009] [Accepted: 02/05/2009] [Indexed: 01/01/2023]
Abstract
A 67-year-old woman was found to have an incidental pancreatic mass on computed tomographic examination of her abdomen in the course of investigation of hematuria. The radiologic features were of a hypervascular mass in the uncinate process of the head of the pancreas, and a preoperative diagnosis of a neuroendocrine tumor was favored. A Whipple procedure was performed. The uncinate process contained a 2.6-cm well-circumscribed mass. Histologic evaluation showed a lesion composed of alternating hypercellular areas made up of spindle-shaped cells and hypocellular areas with hyalinized, keloidal-like fibrous tissue. Occasional dilated vascular channels and entrapped pancreatic tissue were present within the lesion. Immunohistochemistry showed the lesion to be CD34, CD99, and bcl-2 positive. No evidence of atypia was noted, and the overall impression was of a benign solitary fibrous tumor of the pancreas. This is an unusual primary spindle cell neoplasm of the pancreas and should be considered in the differential diagnosis of all spindle cell lesions that occur in the pancreas.
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Affiliation(s)
- Runjan Chetty
- Department of Pathology, University Health Network/University of Toronto, Toronto, Ontario, Canada.
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14
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Muhammad SUI, Azam F, Zuzana S. Primary pancreatic leiomyosarcoma: a case report. CASES JOURNAL 2008; 1:280. [PMID: 18957130 PMCID: PMC2584078 DOI: 10.1186/1757-1626-1-280] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2008] [Accepted: 10/28/2008] [Indexed: 11/13/2022]
Abstract
Background Leiomyosarcoma are malignant tumours of the soft tissues. It is most commonly found in the stomach, small intestine and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare and only 22 cases have been reported in the literature since 1951. Its prognosis is poor and the palliative treatment is only aimed at symptomatic improvement. Case presentation We report case of primary pancreatic leiomyosarcoma with liver metastases in a 73 year old man who presented with weight loss, epigastric pain, anorexia, abdominal fullness and obstructive jaundice. Histological examination and Immunohistochemical analysis of liver biopsy specimen confirmed the diagnosis of metastatic leiomyosarcoma. The patient died of disease 3 months after the initial diagnosis. Conclusion Leiomyosarcoma of the pancreas is an extremely rare malignancy with a poor prognosis. Treatment is aimed at symptomatic improvement and pain management.
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15
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Maarouf A, Scoazec JY, Berger F, Partensky C. Cystic leiomyosarcoma of the pancreas successfully treated by splenopancreatectomy: a 20-year follow-up. Pancreas 2007; 35:95-8. [PMID: 17575551 DOI: 10.1097/01.mpa.0000278689.86306.70] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
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16
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Iwamoto I, Fujino T, Higashi Y, Tsuji T, Nakamura N, Komokata T, Douchi T. Metastasis of uterine leiomyosarcoma to the pancreas. J Obstet Gynaecol Res 2006; 31:531-4. [PMID: 16343254 DOI: 10.1111/j.1447-0756.2005.00344.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Metastasis of uterine leiomyosarcoma to the pancreas is extremely rare. CASE A 46-year-old woman presented with hypermenorrhea and dysmenorrhea and underwent surgery. The histologic and immunohistochemical diagnosis was uterine leiomyosarcoma stage I with no metastasis to the ovaries or the pelvic lymph nodes. The mitotic count was very high. Thereafter, recurrences in the lung and subsequently in the pancreas were detected. The lesions in the lung and pancreas were resected and diagnosed as metastases of uterine leiomyosarcoma based on histology and immunohistochemistry. CONCLUSION We report an extraordinarily rare case of uterine leiomyosarcoma with metastasis to the pancreas following initial metastasis to the lung, both of which were diagnosed using histology and immunohistochemistry of the specimens obtained at surgery.
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Affiliation(s)
- Ichiro Iwamoto
- Department of Obstetrics and Gynecology, Faculty of Medicine, Kagoshima University, Kagoshima, Japan.
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17
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Daum O, Klecka J, Ferda J, Treska V, Vanecek T, Sima R, Mukensnabl P, Michal M. Gastrointestinal stromal tumor of the pancreas: case report with documentation of KIT gene mutation. Virchows Arch 2005; 446:470-2. [PMID: 15756592 DOI: 10.1007/s00428-004-1200-4] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2004] [Accepted: 12/12/2004] [Indexed: 12/16/2022]
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18
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Demos TC, Posniak HV, Harmath C, Olson MC, Aranha G. Cystic lesions of the pancreas. AJR Am J Roentgenol 2002; 179:1375-88. [PMID: 12438020 DOI: 10.2214/ajr.179.6.1791375] [Citation(s) in RCA: 84] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Terrence C Demos
- Department of Radiology, Loyola University Medical Center, 2160 S. First Ave., Maywood, IL 60153, USA
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19
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Komoda H, Nishida T, Yumiba T, Nishikawa K, Kitagawa T, Hirota SI, Ito T, Matsuda H. Primary leiomyosarcoma of the pancreas--a case report and case review. Virchows Arch 2002; 440:334-7. [PMID: 11889607 DOI: 10.1007/s00428-001-0557-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2001] [Accepted: 09/24/2001] [Indexed: 10/27/2022]
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20
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Aihara H, Kawamura YJ, Toyama N, Mori Y, Konishi F, Yamada S. A small leiomyosarcoma of the pancreas treated by local excision. HPB (Oxford) 2002; 4:145-8. [PMID: 18332943 PMCID: PMC2020541 DOI: 10.1080/136518202760388064] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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.
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Affiliation(s)
- H Aihara
- Department of Surgery, Jichi Medical SchoolSaitama-shi SaitamaJapan
| | - YJ Kawamura
- Department of Surgery, Jichi Medical SchoolSaitama-shi SaitamaJapan
| | - N Toyama
- Department of Surgery, Jichi Medical SchoolSaitama-shi SaitamaJapan
| | - Y Mori
- Department of Surgery, Jichi Medical SchoolSaitama-shi SaitamaJapan
| | - F Konishi
- Department of Surgery, Jichi Medical SchoolSaitama-shi SaitamaJapan
| | - S Yamada
- Department of Pathology, Omiya Medical Center, Jichi Medical SchoolSaitama-shi SaitamaJapan
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