Surgical case report of uterine leiomyosarcoma metastasising to the pancreas resected by enucleation

Abstract

A 64-year old lady presented with worsening abdominal pain, vomiting and constipation. She had diffuse abdominal tenderness with peritonism, requiring an emergency laparotomy as a result of a perforated sigmoid tumour. An incidental hard lump was identified on the anterior surface of the pancreas and was removed by enucleation. It was later diagnosed as metastatic leiomyosarcoma based on histology and from her history of uterine malignancy. No recurrence is reported up to this day. Uterine leiomyosarcomas are aggressive malignant tumours with a high predisposition to metastasis, commonly to the lungs, liver, brain and bone. Metastasis to the pancreas is a rare occurrence and considered highly unusual, which can typically present with non-specific symptoms and signs. Imaging can pick up a pancreatic lesion and a radiologically-guided FNA as a pre-operative attempt is acceptable in order to differentiate the lesion before undertaking any major surgery. However, in view of only a few case reports found in the literature, surgical management of pancreatic metastases is not clearly defined with a questionable long-term prognosis. Most cases are managed by elective radical excision with good result. Review of the literature shows other more radical surgical approaches were used. This is the first report of metastatic uterine leiomyosarcoma to the pancreas being managed by enucleation, with a successful follow-up and no recurrence.