Pleomorphic Leiomyosarcoma of the Adrenal Gland in a Young Woman: A Case Report and Review of the Literature

Pleomorphic leiomyosarcoma of the maxilla with metastasis to the colon: A case report

BACKGROUND

Pleomorphic leiomyosarcomas make up around 8.6% of all leiomyosarcomas. They behave aggressively and often have poor prognoses. They can affect the gastrointestinal tract and retroperitoneum. To date, pleomorphic leiomyosarcoma involving the mesocolon have been reported in nine patients.

CASE SUMMARY

The patient was a 44-year-old man with a history of pleomorphic leiomyosarcoma of the left maxilla with metastasis to the lung and liver. His most recent positron emission tomography-computed tomography (PET-CT) scan showed uptake in the ascending and transverse colons. A colonoscopy revealed a 5.0 cm × 3.5 cm × 3.0 cm pedunculated polyp in the ascending colon. The polyp was removed using hot snare polypectomy technique and retrieved with Rothnet. Histopathologic examination of the polyp showed a metastatic pleomorphic leiomyosarcoma.

CONCLUSION

Uptake(s) on PET-CT in a patient with pleomorphic leiomyosarcoma should raise suspicion for metastasis.

Challenges in the diagnosis of the enigmatic primary adrenal leiomyosarcoma: two case reports and review of the literature

BACKGROUND

Primary adrenal leiomyosarcoma is a rare and aggressive mesenchymal tumor derived from the smooth muscle wall of a central adrenal vein or its tributaries; therefore, tumors tend to invade the inferior vena cava and cause thrombosis. The great majority of tumors grow rapidly, which makes the disease difficult to diagnose in its early clinical stages and needs differentiation from adrenocortical carcinomas for the selection of chemotherapy including mitotane which causes adrenal insufficiency.

CASE PRESENTATION

We presented two patients with adrenal leiomyosarcoma who were referred to our hospital with abdominal pain and harboring large adrenal tumors and inferior vena cava thrombosis. The endocrine findings, including serum catecholamine levels, were unremarkable. These two patients were considered clinically inoperable, and CT-guided core needle biopsy was performed to obtain the definitive histopathological diagnosis and determine the modes of therapy. The masses were subsequently diagnosed as primary adrenal leiomyosarcoma based on the histological features and positive immunoreactivity for SMA (smooth muscle actin), desmin, and vimentin.

CONCLUSIONS

Adrenal leiomyosarcoma derived from the smooth muscle wall of a central adrenal vein or its tributaries is rare but should be considered a differential diagnosis in the case of nonfunctioning adrenal tumors extending directly to the inferior vena cava. CT-guided biopsy is considered useful for histopathological diagnosis and clinical management of patients with inoperable advanced adrenal tumors without any hormone excess.

Primary leiomyosarcoma of the adrenal; a case report

Introduction and importance

Primary adrenal leiomyosarcoma (PAL) is an extremely rare neoplasm that usually arises from the smooth muscle cells of the adrenal or adjacent vascular structures. The tumor is asymptomatic until it grows up and develops a mass effect in the retroperitoneal region. Although there are about 50 reported valid cases, surgical intervention is mandatory in the majority of patients.

Case presentation

Herein, we report the case of a 32-year-old healthy woman with a chief complaint of vague abdominal pain. After initial clinical and radiological examinations, we found a large retroperitoneal mass located around the right adrenal gland. Due to the patient's pain, a laparotomy was performed, and a large mass was resected with free margins. Immunohistochemical examination was positive for vimentin, smooth muscle actin (SMA), and desmin. Therefore, the diagnosis of PAL was confirmed.

Conclusion

Although PAL is an uncommon malignancy, its diagnostic and therapeutic approaches are almost straightforward. A computed tomography scan can show the characteristics of the tumor and direct the management. Surgical resection is the mainstay of treatment, and the effects of adjuvant therapies have not been apparent yet.

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A 32-year-old woman presented to us complaining of vague abdominal pain without any specific signs and symptoms.

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After imaging studies, a large retroperitoneal mass was found around the right adrenal gland.

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The patient was operated with a midline laparotomy and the mass was resected with free margins.

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Immunohistochemical examination was positive for pathological markers of leiomyosarcoma.

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The surgery was performed successfully, and the patient was discharged in a good condition.