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Swisher AR, Ornelas D, Ornelas D, Namazi G, Theodory B, Chitkara A, Desai A, Sethi P. Venous Thromboembolism in Metastatic Uterine Leiomyosarcoma: A Case Report and Review of the Literature. Case Rep Oncol 2023; 16:900-906. [PMID: 37900811 PMCID: PMC10601721 DOI: 10.1159/000531761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 06/13/2023] [Indexed: 10/31/2023] Open
Abstract
We report an unusual case of extensive deep vein thrombosis (DVT) and pulmonary embolism (PE) in the setting of metastatic uterine leiomyosarcoma. Recognition of the associated sequelae of this condition may improve short- and long-term outcomes. A 56-year-old black female with a history of uterine leiomyosarcoma diagnosed incidentally after total abdominal hysterectomy for fibroid uterus without initiation of chemoradiation treatment presented to the emergency department complaining of generalized weakness and progressively worsening stridor for 2 weeks. The patient was experiencing shortness of breath, dysphagia, and hoarseness. Physical exam was remarkable for rhonchi but was otherwise normal. Diagnostic imaging via CT of the abdomen, pelvis, and chest revealed DVTs of the left common and external iliac veins, the superior mesenteric artery, multiple pulmonary emboli of the right pulmonary artery, several nodular lesions within the lungs, and scattered peritoneal necrotic lesions, which were suspicious for metastatic disease. Additionally, CT of the neck showed an exophytic mass protruding into the airway from the subglottic region and thyromegaly with bilateral thyroid lobe nodules. The patient was subsequently started on Eliquis and chemotherapy. The rarity of this case is rooted in the extent of the patient's DVTs and PEs secondary to hypercoagulability in metastatic cancer. This presentation should be further evaluated to exclude thrombophilias or underlying malignancies. Drawing from the lessons of this case will help guide future clinical management regarding the care of metastatic uterine leiomyosarcoma.
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Affiliation(s)
- Austin R. Swisher
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Denise Ornelas
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Diana Ornelas
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Golnaz Namazi
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Bassam Theodory
- Minimally Invasive Gynecologic Surgery, University of California, Riverside, CA, USA
| | - Akshit Chitkara
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Aditya Desai
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
| | - Prabhdeep Sethi
- Department of Internal Medicine, University of California, Riverside School of Medicine, Riverside, CA, USA
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Badheeb A, Al Gharem N, Al Hammadi S, Elsagheer S, Badheeb M, Ahmed F. Primary pulmonary leiomyosarcoma with coexistent pulmonary aspergillosis: a case report. Pan Afr Med J 2022; 42:135. [PMID: 36060845 PMCID: PMC9429989 DOI: 10.11604/pamj.2022.42.135.34116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 06/10/2022] [Indexed: 11/26/2022] Open
Abstract
Coexisting primary pulmonary leiomyosarcoma (PPL) with pulmonary Aspergillosis in immunocompetent patients is a rare occurrence. Here, we presented a 54-year-old woman presented with a dry cough for two months. Bronchoscopy revealed pulmonary aspergillosis. The patient was treated with antifungal therapy for one month without improvement. To evaluate further, a chest computed tomography (CT) scan showed a large heterogeneous enhancing mass in the lower lobe of the left lung with left atrium thrombosis. Computed tomography-guided biopsy was performed, and histopathology demonstrated the diagnosis of PPL. The metastasis workup staging showed multiple metastases in vertebrae, scapula, rib, and liver. The patient was treated with chemotherapy followed by tumor bed radiotherapy. Unfortunately, her general condition worsened, and she passed away with overall survival of fourteen months. In conclusion, clinicians should be alert to underlying malignant disease if airway Aspergillus infection is suspicious in patients without strong risk factors for invasive fungal infection.
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Affiliation(s)
- Ahmed Badheeb
- Department Oncology, King Khalid Hospital, Najran, Saudi Arabia.,Department of Internal Medicine, Faculty of Medicine, Hadhramout University, Hadhramout, Yemen
| | - Nasser Al Gharem
- Department of Radiology, King Khalid Hospital, Najran, Saudi Arabia
| | | | - Said Elsagheer
- Department of Thoracic Surgery, King Khalid Hospital, Najran, Saudi Arabia
| | - Mohamed Badheeb
- Department of General Medicine, King Khalid Hospital, Najran, Saudi Arabia
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Science, Ibb, Yemen
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