Ultrasound and CT Findings of Primary Leiomyosarcoma in the Gallbladder: A Case Report

Abstract

Leiomyosarcoma is a malignant mesenchymal tumor which is composed of cells showing smooth muscle differentiations.Primary leiomyosarcoma of the gallbladder is a rare malignancy with poor prognosis. The imaging findings of gallbladder leiomyosarcoma are rarely reported. We present the ultrasonography (US), computed tomography (CT), and positron emission tomography-computed tomography (PET-CT) imaging findings of a primary leiomyosarcoma on the gallbladder in an 82-year-old male. CASE REPORTAn 82-year-old male was referred to our institution from a local clinic due to an incidentally detected large gallbladder mass. IU/L; total bilirubin, 1.81 mg/dL; direct bilirubin, 0.69 mg/dL).Tumor markers were within the normal limits (alpha-fetoprotein, 1.52 IU/mL; cancer antigen 19-9, 1.82 IU/mL). Abdominal ultrasound showed a large polypoid intraluminal protruding mass, displaying heterogeneous echogenicity and relatively welldefined margins with displaced thick hypoechoic overlying mucosa. Intratumoral vascularity was remarkably increased on color Doppler ultrasonography. In the lumen of the gallbladder,

Primary Leiomyosarcoma of the Gallbladder

“…Sarcoma of the gallbladder is an extremely rare entity that was reported less than 200 times in the medical literature [5]. Older cases agreed that LMS was the most common subtype of Primary Gallbladder Sarcoma (PGBS).…”

“…Most of the patients in the reported cases are females (ratio 5 : 1) and mainly in their 6 th and 7 th decades of life [4][5][6]8].…”

“…Radiological findings on CT scan and ultrasonography may include a dilated gallbladder, an irregular thickening of the wall, and a necrotizing mass protruding into the lumen [1,5]. The larger size of the gallbladder, the presence of necrosis, and the polypoidal shape of the tumor should increase the preoperative suspicion of malignancy [6].…”

“…The differential diagnosis of a solid polypoidal gallbladder mass is wide and includes adenomas, adenocarcinomas, and neoplastic polyps such as cholesterol polyps, inflammatory polyps, and adenomatous hyperplasia [3,5]. The definitive diagnosis relies on both morphological features on H&E staining and immunostains [8,9].…”

“…The extensive differential diagnosis of spindle cell tumors of the gallbladder includes leiomyosarcoma, rhabdomyosarcoma, fibrosarcoma, neurosarcoma, epithelioid angiosarcoma, gastrointestinal stromal tumors (GIST), carcinosarcoma, and primary or metastatic undifferentiated carcinoma [1,3,5,7].…”