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ABDOMINAL IMAGING Table of Contents   
Year : 2003  |  Volume : 13  |  Issue : 4  |  Page : 405-408
Leiomyosarcoma of pancreas: MR findings: A rare case report


Department of Radiology and Imaging and Pathology, G.B.Superspeciality, Hospital and Maulana Azad Medical College (Delhi University), New Delhi-2, India

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   Abstract 

Mesenchymal tumors represent 1% to 2% of pancreatic neoplasms. These unusual tumors arise from the connective, vascular and neuronal tissue in pancreas. They are classified according to their main histological component. In selected instances, cross sectional imaging can offer a specific diagnosis of histological type [1]. In present case we documented imaging findings in leiomyosarcoma arising from the head of pancreas in 28-year- old patient

Keywords: Leiomyosarcoma, Pancreas, Imaging Findings

How to cite this article:
Sharma A K, Siddhartha, Sakhija P. Leiomyosarcoma of pancreas: MR findings: A rare case report. Indian J Radiol Imaging 2003;13:405-8

How to cite this URL:
Sharma A K, Siddhartha, Sakhija P. Leiomyosarcoma of pancreas: MR findings: A rare case report. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Jul 20];13:405-8. Available from: http://www.ijri.org/text.asp?2003/13/4/405/28720
A28-year-old patient presented with a history of swelling in the epigastrium. There was no history of weight loss or loss of appetite or jaundice. Physical examination showed an evidence of lump in the epigastrium with its extension to right hypochondrium. Routine blood investigations were normal SGOT, PT, Alkaline phosphatase and alpha feto proteins were normal. Clinical diagnosis of hemangioma was thought of. US examination showed an evidence of very vascular big echogenic mass lesion in the epigastrium.The origin of mass could not be definitely ascertained. The patient was subjected to a plain and contrast spiral CT. On scanogram there was an evidence of a well-defined mass with an impression on transverse colon [Figure - 1]. Plain CT showed an evidence of well circumscribed mass in relation to right lobe of liver/head region of pancreas with an evidence of air inside it [Figure - 2]. On questioning, it was revealed that FNAC of the lesion had showed it to be hemangioma. Patient underwent CECT, which showed patchy enhancement of the mass lesion. These findings were not consistent with hemangioma even on delayed scan. The origin of lesion was either from liver or head of pancreas. Pancreatic body and tail was normal. Partial pancreatic head was visualized. Pancreatic duct was prominent in body and tail region [Figure - 3]. The adjoining structures were not encased by tumor mass. No evidence suggestive of lymphadenopathy was seen. To know better planes of tumor mass, patient underwent MR on 1.5 T unit. On T2/SSH/60,there was well-defined heterogeneous mass lesion with very hyper- intense areas inside it [Figure - 4].Duodenum was displaced anteriorly by this mass lesion. On T 1 and Thrive sequences, mass was hypo intense with minimal dilation of pancreatic duct [Figure - 5] and [Figure - 6]. On GD-enhanced images i.e. Dynamic-GD and T1 W Fat Sat, there was patchy enhancement of the lesion [Figure - 7],[Figure - 8]. MRCP sequence showed mild dilation of PD in body and tail region and in head region, there was kinking/cut off of PD. Big heterogeneous mass lesion was seen in duodenal loop and GB was displaced anteriorly [Figure - 9]. On barium meal examination, there was duodenal loop widening and inverted 3 sign [Figure - 10].Since patient was young, asymptomatic, had no evidence of jaundice and previous FNAC was suggestive of hemangioma; we could only define the nature and origin of mass on all radiological investigations. Surgeons did not agree for biopsy. They went for laprotomy and found it to be highly vascular lesion probably originating from pancreatic head. The lesion was exophytic.Biopsy report showed it as leiomyoma of pancreas [Figure - 11]. Embolization of tumor was done and it was completely excised. The final diagnosis was leiomyosarcoma on histopathology.


   Discussion Top


Primary sarcomas of the pancreas are very rare, accounting for a small fraction of pancreatic malignancies. In fact, most malignant tumours of the pancreas with a sarcomatous appearance are represented by anaplastic carcinomas with sarcomatoid differentiation of pancreatic extension of retroperitoneal sarcomas. However, primary undifferentiated sarcomas, fibrosarcomas, malignant fibrous histiocytoma, Kaposi sarcomas and leiomyosarcomas have been described. Leiomyosarcoma is the histiotype least commonly described. It has been postulated that this tumor either arises from the pancreatic duct or blood vessels within the pancreas. Sarcomas are highly malignant neoplasms, frequently showing hypervascularity and metastases. Findings can range from a finely heterogeneous solid mass to a highly homogenous enhancing lesion with peripheral vascularisation and necrotic component [1],[2],[3],[4]. In present case, we have a well-defined heterogeneous mass lesion with marked enhancement on CECT.Similarly on MR it has enhanced markedly both on dynamic sequence as well as on T1 and thrive sequence. MR findings in leiomyosarcoma has been described first time to the best of our knowledge. It is also concluded that no significant CT or MR findings permit the differential diagnosis from an adeno carcinoma and conclusive diagnosis can be made only on histo-pathology.

 
   References Top

1.Zalatnai A,kovacs M,Flautner,et al.Pancreatic leiomyosarcoma. Case report with immunohistochemical and flow cytometric studies.Virchows Arch 1998;432:469-472.  Back to cited text no. 1    
2.Paciorek ML, Ross GJ.MR imaging of primary pancreatic leiomyosarcoma.Br Jr Radiol 1998; 71:561-563.  Back to cited text no. 2    
3.Francesco F, Giulio Z, Davide B, etal.Mesenchymal tumours of the pancreas- CT findings: Journal of, computer Assisted Tomography 24(4):622-627.  Back to cited text no. 3    
4.Sheila S, Elliot F.Imaging of uncommon tumors of pancreas.Radiol Clin N Am 40(2002) 1273-1287.  Back to cited text no. 4    

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Correspondence Address:
A K Sharma
C10 Kendriya Vihar, Sector 51 Noida, 201307
India
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Source of Support: None, Conflict of Interest: None


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    Figures

  [Figure - 1], [Figure - 2], [Figure - 3], [Figure - 4], [Figure - 5], [Figure - 6], [Figure - 7], [Figure - 8], [Figure - 9], [Figure - 10], [Figure - 11]

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