The Imaging and Pathological Features of Metastatic Leiomyosarcoma in the Gallbladder

Abstract

Uterine leiomyosarcoma is a rare and aggressive malignancy with poor overall prognosis. There have been few reports of metastatic leiomyosarcoma in the gallbladder. We report a case of a 41-year-old female who underwent total abdominal hysterectomy due to presumed uterine fibroids. The postoperative pathology revealed high-grade pleomorphic leiomyosarcoma, with involvement of the uterine serosal surface. She subsequently underwent exploratory laparotomy, followed by pelvic radiation and chemotherapy. Since initial management she has developed metastatic disease and has been under treatment and surveillance for 11 years. She has undergone multiple surgical procedures and numerous lines of systemic therapy for metastatic leiomyosarcoma, including cholecystectomy for a metastatic lesion in the gallbladder. There have been no previous reports of metastatic leiomyosarcoma in the gallbladder. Despite extensive metastatic disease this patient has had prolonged survival with multi-modality management.

Leiomyosarcoma of the gallbladder—A case report and a review of literature

“…The LMS of the GB has a very poor prognosis, particularly in a metastatic stage [1,17]. By removing the LMS in an early tumor stage, a long term survival for several years, as shown in our case report, has been described [8,14].…”

“…To reveal further knowledge on epidemiology, therapy and outcome of patients with LMS of the GB, we reviewed the literature using the search terms “Sarcoma,” “Leiomyosarcoma,” and “Gallbladder”, with Google Scholar and PubMed. The search yielded 30 relevant publications [1,2,4,[6], [7], [8], [9], [10], [11], [12], [13], [14], [15], [16], [17], [18], [19], [20], [21], [22], [23], [24], [25], [26]]. We excluded publications without available abstracts or insufficient information regarding the patient’s medical history.…”

“…Contrarily, Guo et al and Perez-Montiel et al treated a LMS of the GB by performing a solely cholecystectomy. Their patients survival rate was about 2 years [8,14]. Our review revealed that an extensive surgery was performed in cases of a local tumor invasion [1,10,13].…”