Leiomyosarcoma of the sigmoid colon with multiple liver metastases and gastric cancer: a case report

Abstract

BackgroundLeiomyosarcoma (LMS) of the gastrointestinal tract is an extremely rare high-grade neoplasm with poor prognosis. For advanced LMS with distant metastasis, the decision as to the choice of the most appropriate therapeutic strategy, including chemotherapy and surgery, is difficult. Here, we present an unusual case of LMS of the sigmoid colon with liver metastases and gastric cancer. The survival of this patient was prolonged by a combined modality therapy involving chemotherapy and surgery.Case presentationA 66-year-old woman who had been diagnosed with advanced gastric cancer and multiple liver metastases was referred to our hospital. The initial treatment with docetaxel and S-1 considerably reduced both the gastric cancer and liver tumors; consequently we performed surgical resection. Pathological examination revealed that no viable tumor cells remained in the stomach and chemotherapy resulted in complete remission of the gastric cancer. The liver tumors were immunohistochemically diagnosed as LMS. A tumor of the sigmoid colon was subsequently discovered and the liver tumors were found to have recurred. The surgically resected sigmoid colon and liver tumors were all immunohistochemically diagnosed as LMS. These findings indicated that the multiple liver metastases arose from the LMS in the sigmoid colon, and that they were accompanied by advanced gastric cancer. We performed another surgical resection and administered chemotherapy to treat the recurring liver metastases. The patient survived for 4 years and 10 months after initial presentation at our hospital.ConclusionColonic LMS is rare and its joint occurrence with gastric cancer is extremely unusual. Although LMS is a high-grade neoplasm, a multimodal therapeutic approach can increase patient survival time even when multiple liver metastases are present.

Giant leiomyosarcoma of the rectum with lymph node metastasis: A case report and review of the literature

“…Studies have revealed that the use of imatinib for palliative chemotherapy is also effective because the two-year progression free survival (PFS) was 75% with the use of standard imatinib dose in patients with unresectable or metastatic GIST [20], [21]. In contrast, it is difficult to assess the efficacy of palliative treatments of LMS due to the paucity of published reports [22]. Doxorubicin, ifosfamide, dacarbazine, and gemcitabine are commonly used in first-line chemotherapeutic regimens, although standardized chemotherapy with currently available agents has not yet been established for LMS.…”

Leiomyosarcoma of the colon

“…A specific molecular therapy is currently available for GIST, but not for LMS. Reports indicate that 30-60% of clinical response rates can be achieved in the treatment of LMS using combinations of docetaxel and gemcitabine [2], and in the treatment of advanced soft tissue sarcoma using ifosfamide with anthracycline and/or dacarbazine [2]. According to Hamai et al only first line chemotherapy with docetaxel and S-1 was found to be effective against both the gastric cancer and LMS.…”

“…Leiomyosarcomas (LMS) of GIT are extremely rare mesenchymal neoplasms which account for 0.12% of colon cancers. Only a few reports have been published on GIT mesenchymal tumors [2][3][4].…”

Successful management of renal leiomyosarcoma using radiofrequency ablation: Case report and brief review of literature

“…LMS are known to hematogenously metastasize to the lungs, liver, bones and brain. Other sites of metastasis are relatively rare [21][22][23] . Also, although other soft tissue sarcomas have been reported as metachronous, there no reports of metachronous LMS but there are few series of multicentric (synchronous).…”