An unusual hypoechoic solid mass in the pancreatic head

Abstract

Solid pancreatic lesions found on imaging procedures are suspicious for malignancy and, therefore, demand immediate diagnostic evaluation and therapy. In the case of indeterminate histology, a primary resection should be considered in order to preserve the possibility of curative surgery, although rare entities may be initially disregarded. We present here the case of a 48-year-old female patient with a hypoechoic lesion of the pancreatic head, which was clearly delineated from the surrounding pancreatic tissue. The challenging diagnosis of metastatic leiomyosarcoma could only be established by considering the long-term clinical history and former histology specimens.

Zusammenfassung

Solitäre Pankreasraumforderungen sind malignitätsverdächtig und erfordern eine schnelle diagnostische Abklärung mit unverzüglichem Therapiebeginn. Bei unklarem histologischen Befund sollte die primäre Resektion in Betracht gezogen werden, um die Chance einer kurativen Behandlung zu erhöhen. Seltene Entitäten können dabei zunächst übersehen werden. Wir berichten über den Fall einer 48-jährigen Patientin mit einer sonografisch echoarmen Pankreaskopfläsion. Die Diagnose eines metastasierten Leiomyosarkoms konnte in diesem Fall erst unter Berücksichtigung der Langzeitanamnese und Nachbegutachtung früherer histologischer Schnittpräparate geklärt werden.

Schlüsselwörter

Leiomyosarkom - Leiomyom - Ultraschall - Pankreasraumforderung

Key words

leiomyosarcoma - leiomyoma - ultrasound - pancreatic lesion

• References

• 1 Klimstra DS. Fukushima N. Hruban RH. Diagnostic algorithms for tumours of the pancreas. In: Bosman FT. Carneiro F. Hruban RH. eds WHO Classification of Tumours of the Digestive System. Lyon, France: International Agency for Research on Cancer; 2010: 334-337
• 2 Seufferlein T. Porzner M. Becker T. et al. S3-guideline exocrine pancreatic cancer. Z Gastroenterol 2013; 51: 1395-1440
• 3 Miller DL. Allen MS. Rare pulmonary neoplasms. Mayo Clin Proc 1993; 68: 492-498
• 4 Bartosch C. Afonso M. Pires-Luis AS. et al. Distant Metastases in Uterine Leiomyosarcomas: The Wide Variety of Body Sites and Time Intervals to Metastatic Relapse. Int J Gynecol Pathol 2016; DOI: 10.1097/PGP.0000000000000284.
• 5 Minni F. Casadei R. Perenze B. et al. Pancreatic metastases: observations of three cases and review of the literature. Pancreatology 2004; 4: 509-520
• 6 Ogura T. Masuda D. Kurisu Y. et al. Multiple Metastatic Leiomyosarcoma of the Pancreas: A First Case Report and Review of the Literature. Inter Med 2013; 52: 561-566
• 7 Baylor SM. Berg JW. Cross-classification and survival characteristics of 5000 cases of cancer of the pancreas. J Surg Oncol 1973; 5: 335-358
• 8 Zhang QY. Shen QY. Yan S. et al. Primary pancreatic pleomorphic leiomyosarcoma. J Int Med Res 2011; 39: 1555-1562
• 9 Si M. Jia L. Song K. et al. Role of Lymphadenectomy for Uterine Sarcoma: A Meta-Analysis. I Int J Gynecol Cancer 2017; 27: 109-116
• 10 Izumi H. Okada K. Imaizumi T. et al. Leiomyosarcoma of the pancreas: report of a case. Surg Today 2011; 41: 1556-1561
• 11 Ferlan-Marolt V. Vladislav P. Alojz P. Pancreatic leiomyosarcoma: clinicopathohistological presentation of a rare tumor. Hepatogastroenterology 2000; 47: 556-559
• 12 Sarcoma of the Uterus. Guideline of German Society of Gynecology and Obstetrics (S2k-Level, AWMF Registry No. 015/074, August 2015). http://www.awmf.org/leitlinien/detail/ll/015-074.html
• 13 Maki RG. Wathen JK. Patel SR. et al. Randomized phase II study of gemcitabine and docetaxel compared with gemcitabine alone in patients with metastatic soft tissue sarcomas: results of sarcoma alliance for research through collaboration study 002 [corrected]. J Clin Oncol 2007; 25: 2755-2763
• 14 Suh CH. Keraliya A. Shinagare AB. et al. Multidetector computed tomography features of pancreatic metastases from leiomyosarcoma: experience at a tertiary cancer center. World J Radiol 2016; 8: 316-321
• 15 Dima SO. Bacalbasa N. Eftimie MA. et al. Pancreatic metastases originating from uterine leiomyosarcoma: a case report. World J Surg Oncol 2014; 12: 405
• 16 Andrade C. Finan J. Kulkarni P. Metastatic leiomyosarcoma to the pancreas presenting as a massive upper gastrointestinal hemorrhage. J Gastrointest Cancer 2014; 45 (Suppl. 01) 230-232
• 17 Ozturk S. Unver M. Ozturk BK. et al. Isolated metastasis of uterine leiomyosarcoma to the pancreas: report of a case and review of the literature. Int J Surg Case Rep 2014; 5: 350-353
• 18 Gomez AJ. Sanchez AA. Martinez CD. et al. Uterine leiomyosarcoma metastasis to the pancreas: report of a case and review of the literature. J Gastrointest Cancer 2012; 43: 361-363
• 19 Koh YS. Chul J. Cho CK. et al. Pancreatic metastasis of leiomyosarcoma in the right thigh: a case report. World J Gastroenterol 2007; 13: 1135-1137
• 20 Milanetto AC. Lico V. Blandamura S. et al. Primary leiomyosarcoma of the pancreas: report of a case treated by local excision and review of the literature. Surg Case Rep 2015; 1: 98
• 21 Hebert-Magee S. Varadarajulu S. Frost AR. et al. Primary pancreatic leiomyosarcoma: a rare diagnosis obtained by EUS-FNA cytology. Gastrointest Endosc 2014; 80: 361-362
• 22 Kocakoc E. Havan N. Bilgin M. et al. Primary pancreatic leiomyosarcoma. Iran J Radiol 2014; 11: e4880
• 23 Hur YH. Kim HH. Park EK. et al. Primary leiomyosarcoma of the pancreas. J Korean Surg Soc 2011; 81 (Suppl. 01) S69-S73