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Case report
Pancreatic leiomyosarcoma: a diagnostic challenge and literature review
  1. Neesa Fadaee1,
  2. Tasmea Sefa1,
  3. Amitabah Das1,2 and
  4. Kheman Rajkomar2
  1. 1General Surgery, Liverpool Hospital, Liverpool, New South Wales, Australia
  2. 2General Surgery, Bankstown Hospital, Bankstown, New South Wales, Australia
  1. Correspondence to Dr Neesa Fadaee; neesafadaee{at}gmail.com

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.

  • pancreas and biliary tract
  • pancreatic cancer
  • pathology
  • general surgery
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Footnotes

  • Contributors NF: conception of the work including the design, acquisition and analysis of data. Drafting and revision of the manuscript. Final approval of the submitted version. Accountable for all aspects of the work. TS: conception of the work including the design, acquisition and analysis of data. Final approval of the submitted version. Accountable for all aspects of the work. AD: Final approval of the submitted version. Accountable for all aspects of the work. KR: conception of the work including the design, acquisition and analysis of data. Final approval of the submitted version. Accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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