Curative resection for leiomyosarcoma of the descending mesocolon with metachronous liver metastasis: A case report and literature review

Abstract

Mesenteric leiomyosarcoma is a rare disease with poor prognosis. Previously, mesenteric leiomyosarcoma was not differentiated from gastrointestinal stromal tumor (GIST), which is the most common mesenchymal tumor of the gastrointestinal tract, and several cases of GIST may have been misclassified as mesenteric leiomyosarcoma. Thus, the actual clinicopathological characteristics of mesenteric leiomyosarcomas remain unclear. We herein describe a case of leiomyosarcoma arising in the descending mesocolon in a patient who developed metachronous liver metastasis. A 76-year-old woman reported a mass in her left upper abdomen. Computed tomography imaging revealed a low-density tumor adjacent to the descending colon. The patient underwent surgery and the tumor was resected along with part of the descending colon. Immunohistochemical differential diagnosis revealed that the tumor was positive for smooth muscle actin and desmin, and negative for CD117 (c-KIT) and S-100, which are characteristic of gastrointestinal leiomyosarcoma. A single liver metastasis developed 24 months after the operation. The patient underwent curative resection of the metastatic lesion. Sixteen months following surgery for the liver metastasis and 40 months after the initial removal of the primary lesion, the patient remains disease-free. The prognosis of leiomyosarcoma remains poor and standardized chemotherapy for this rare disease has not yet been established. Early diagnosis and surgical removal of the tumor is the only potentially curative option for liver metastasis of mesenteric leiomyosarcoma.

Primary Leiomyosarcoma of the Mesentery: A Case Report With Review of Literature

“…The median follow-up time for the cases presented (n = 17) was 22.6 months (range: 3-59), and consistent with the findings of Kato et al [5], no patient was reported to survive 59 months ( Table 1) [11].…”

“…Given that LMSs originate from smooth muscle cells, confirming the diagnosis with IHC is necessary for accurate diagnosis [5]. SMA (n = 17) was positive in 100% of the reported cases.…”

“…Hamed et al [11] n/a + n/a n/a + n/a n/a -Hamed et al [11] n/a + n/a n/a + n/a n/a -Dasgupta et al [18] n/a + n/a n/a + n/a n/a -Kato et al [5] n/a + n/a n/a + -n/a -Varghese et al [9] n/a + + n/a + n/a n/a n/a Ilias et al [6] n/a + + n/a + -+ -Dalal et al [1] n/a + n/a + + ---Schoucair et al [3] n/a + + n/a + n/a n/a n/a Yoon et al [14] n/a + n/a n/a + n/a n/a n/a Our reported case + + + + + -n/a n/a All patients were managed with surgical resection, apart from two cases where modality of treatment was not reported. The extent of resection was dependent on whether there is an invasion of adjacent structures.…”

“…Prior to the development of immunohistochemical (IHC) staining, LMS was frequently misdiagnosed as a gastrointestinal stromal tumor (GIST), given the histological similarities as both entities are under the umbrella of gastrointestinal mesenchymal tumors. IHC is currently considered essential for the accurate diagnosis of LMS [1,5,6]. Similar to most soft tissue sarcomas, LMS tends to grow along the tissue planes and thus can compress surrounding structures, leading to the formation of a pseudo-capsule with fingerlike projections that can infiltrate adjacent tissues [7].…”

Rare case of primary leiomyosarcoma of sigmoid mesocolon

“…Five-year survival rate is only 20%–30% and the complete surgical resection will favour the outcome. Case series and literature review by Kato et al in 2016 stated that since 1998, it was 13 cases which have been reported so far by proper immunohistochemistry 13. Kato et al added that the recurrence can occur within 5 years, and periodic monitoring is recommended using imaging modality to monitor the progression following the surgical resection.…”