IMAGES IN GASTROENTEROLOGY AND HEPATOLOGY

 

Pancreatic Metastasis from Primary Leiomyosarcoma of the Breast

Metástases pancreáticas de leiomiossarcoma primário da mama

 

Catarina Félix, Miguel Bispo, Cristina Chagas

Gastroenterology Department, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal

^* Corresponding author.

 

Keywords: Pancreatic metastasis, Gallbladder metastasis,  Breast leiomyosarcoma

Palavras-Chave: Metástases pancreáticas, Metástases da vesícula biliar, Leiomiossarcoma da mama

 

An 84-year-old female presented with a 3-month history of asthenia, weight loss, and diffuse abdominal pain. Her medical history was remarkable for high-grade breast leiomyosarcoma (Ki67 25%, 5.5 × 4 × 3.5 cm) excised 6 years before (R1), with no recurrence during follow-up. Physical examination was significant for pallor and abdominal tenderness, and laboratory workup demonstrated anemia (Hb 5.4 g/dL) and elevated lipase (267 U/L) with normal liver function tests. Ultrasound and a CT scan revealed multiple solid hepatic lesions, the largest measuring 7 × 5 cm, a 3-cm pancreatic cephalic mass lesion, and a 3.1 × 2.5 cm endoluminal mass in the gallbladder (Fig. 1). Differential diagnosis included gallbladder and pancreatic cancer (eventually synchronous, with liver metastases) and late recurrence of the primary leiomyosarcoma of the breast with liver, gallbladder, and pancreatic metastases.

 

 

Endoscopic ultrasound identified solid liver nodules and multiple pancreatic hypoechogenic, well-defined nodules, the largest measuring 35 mm in the cephalic region, consistent with multifocal pancreatic metastization, and a heterogeneous hypoechoic gallbladder mass (Fig. 2). Endoscopic ultrasound-guided fine-needle biopsy of the largest pancreatic lesion using a 22-G needle (AcquireTM; Boston Scientific) was performed. Pathology documented fusiform neoplastic cells with numerous mitosis, and immunohistochemical staining was positive for actine, desmine, vimentin, and caldesmon and negative for CK AE1AE3, Cam 5.2, S-100, and CD99, consistent with pancreatic metastasis from leiomyosarcoma (Fig. 3). The patient was referred to a palliative care unit.

 

 

 

Metastatic gallbladder and pancreatic disease are extremely uncommon in clinical practice [1, 2]. Melanoma, renal, and cervix cancer are the most common primary cancers associated with gallbladder metastases [1]. Metastatic lesions of the gallbladder from primary breast tumors are rarely described, and most of those have been associated with a lobular histology [1]. Only 2% of all pancreatic malignancies are metastases, and the most common primary cancer site responsible for pancreatic metastasis is the kidney, followed by colorectal cancer, melanoma, breast cancer, lung carcinoma, and sarcoma [2]. Leiomyosarcoma represents an exceedingly rare cause of pancreatic metastasis [3–5], with the primary organs being the uterus, ovary, veins, spermatic cord, intestine, retroperitoneum, and soft tissue [4]. Primary leiomyosarcoma of the breast is an extremely rare form of breast cancer (< 0.01% of all cases) with an unpredictable biological behavior [5]. To the best of our knowledge, synchronous pancreatic and gallbladder metastasis from breast leiomyosarcoma has never been reported.

 

References

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2 Sperti C, Molleta L, Patané G: Metastatic tumors to the pancreas: the role of surgery. World J Gastrointest Oncol 2014;6:381–392.         [ Links ]

3 Falconi M, Crippa S, Sargenti M, Capelli P, Pederzoli P: Pancreatic metastasis from leiomyosarcoma of the broad ligament of the uterus. Lancet Oncol 2006;7:94–95.         [ Links ]

4 Koh Y, Chul J, Cho C, Kim H: Pancreatic metastasis of leiomyosarcoma in the right thigh: a case report. World J Gastroenterol 2007;13:1135–1137.         [ Links ]

5 Amaadour L, Benbrahim Z, Moumna K, Boudahna L, Amarti A, Arifi S, et al: Primary breast leiomyosarcoma. Case Rep Oncol Med 2013;2013:732730.         [ Links ]

 

Statement of Ethics

This study did not require informed consent or review/approval by the appropriate ethics committee.

Disclosure Statement

The authors have no conflicts of interest to declare.

 

^* Corresponding author.

Dr. Catarina Félix

Gastroenterology Department, Hospital de Egas Moniz

Centro Hospitalar Lisboa Ocidental, Rua da Junqueira nº 126

PT–1349-019 Lisbon (Portugal)

E-Mail sfelixcatarina@gmail.com

 

Received: March 16, 2018; Accepted after revision: May 7, 2018