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Special Feature
August 2010

Image of the Month—Diagnosis

Arch Surg. 2010;145(8):794. doi:10.1001/archsurg.2010.143-b

Answer: Metastasis From Leiomyosarcoma in the Head of the Pancreas

Secondary tumors of the pancreas are rare and most of these are seen as a part of widely disseminated carcinoma. In a series of 4995 adult autopsies reported by Adsay and colleagues,1 81 cases (1.6%) of secondary pancreatic tumors were detected; the lung (34 cases) and gastrointestinal tract (20 cases) were the most common origins. Adsay and colleagues also reported 38 cases (3.9%) of metastatic tumors in the pancreas among 973 surgical specimens of pancreatic resections, with a predominance of hematopoietic malignancies (11 cases) and gastric (7 cases) and renal (6 cases) carcinomas.

Isolated pancreatic metastases are diagnosed very rarely by clinicians. Z’graggen and colleagues2 reported 10 patients with isolated metastases in the pancreas from carcinoma of the lung (4 cases), renal carcinoma (2 cases), sarcoma (2 cases), breast carcinoma (1 case), and endometrial carcinoma (1 case); in 7 of these patients, the tumor was initially misdiagnosed as primary cancer. So, differential diagnosis between primary and metastatic pancreatic neoplasm seems to be very difficult, despite the use of radiologic imaging. Eight cases of pancreatic resection for metastatic tumors were reported by Sperti and colleagues3: the primary cancers were colonic carcinoma (4 cases), renal carcinoma (2 cases), duodenal leiomyosarcoma (1 case), and malignant fibrous histiocytoma (1 case).

To our knowledge, only 2 cases of metastases in the pancreas from uterine leiomyosarcoma were previously reported in the literature: the first case, by Iwamoto and colleagues,4 was treated by left pancreatectomy; a second case was reported by Falconi and colleagues5 and was treated by Whipple procedure with 3 wedge resections of the liver for metastases.

Uterine leiomyosarcoma is a rare, malignant neoplasm that represents 1% of all uterine malignancies. The common sites of distant metastases are the lung, kidney, and liver. Pulmonary or abdominal resection is considered an acceptable treatment to improve survival.6,7 Pancreatic metastases are very rare, and to our knowledge, this is the third case reported in the literature.

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Article Information

Correspondence: Gennaro Clemente, MD, Department of Surgery, A. Gemelli Hospital, Largo Gemelli 8, 00168 Rome, Italy (gclemente@rm.unicatt.it).

Accepted for Publication: June 22, 2009.

Author Contributions:Study concept and design: Clemente, Giordano, De Rose, and Nuzzo. Acquisition of data: Clemente, Giordano, and De Rose. Analysis and interpretation of data: Clemente, Giordano, and De Rose. Drafting of the manuscript: Clemente, Giordano, and De Rose. Critical revision of the manuscript for important intellectual content: Clemente, Giordano, De Rose, and Nuzzo. Administrative, technical, and material support: Clemente, Giordano, and De Rose. Study supervision: Clemente and Nuzzo.

Financial Disclosure: None reported.

Adsay  NVAndea  ABasturk  OKilinc  NNassar  HCheng  JD Secondary tumors of the pancreas: an analysis of a surgical and autopsy database and review of the literature.  Virchows Arch 2004;444 (6) 527- 535PubMedGoogle ScholarCrossref
Z’graggen  KFernández-del Castillo  CRattner  DWSigala  HWarshaw  AL Metastases to the pancreas and their surgical extirpation.  Arch Surg 1998;133 (4) 413- 419PubMedGoogle ScholarCrossref
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Iwamoto  IFujino  THigashi  Y  et al.  Metastasis of uterine leiomyosarcoma to the pancreas.  J Obstet Gynaecol Res 2005;31 (6) 531- 534PubMedGoogle ScholarCrossref
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Yoshinaga  MTogami  STsuji  T Clinical outcome of metastatic uterine leiomyosarcoma and carcinosarcoma in a single institute.  J Obstet Gynaecol Res 2007;33 (6) 818- 822PubMedGoogle ScholarCrossref
Anraku  MYokoi  KNakagawa  KMetastatic Lung Tumor Study Group of Japan, Pulmonary metastases from uterine malignancies: results of surgical resection in 133 patients.  J Thorac Cardiovasc Surg 2004;127 (4) 1107- 1112PubMedGoogle ScholarCrossref