Korean J Gastroenterol.  2019 Jul;74(1):57-62. 10.4166/kjg.2019.74.1.57.

Synchronous Primary Leiomyosarcoma in the Thoracic Vertebra and the Liver

• Kim YK
• Kim JA
• Ryu SH
• Choi JH
• Tsung PC
• Park JH
• Moon JS
• Shim JC
• Lee HK
• Loutzenhiser JM

• KMID: 2453260
• DOI: http://doi.org/10.4166/kjg.2019.74.1.57

Abstract

This is a case report of simultaneous primary leiomyosarcomas in the spine and liver. A 64-year-old woman presented to the Seoul Paik Hospital with epigastric discomfort and constipation that she had experienced for two months. A physical examination revealed severe tenderness around the thoraco-lumbar junction. Esophagogastroduodenoscopy showed an ulceroinfiltrative lesion on the gastric angle. An abdominopelvic CT scan revealed two low attenuated lesions in the S4 and S8 regions of the liver, as well as a soft tissue mass at the T10 vertebra. Percutaneous ultrasonography-guided needle biopsy of the hepatic nodules revealed a leiomyosarcoma. The tumor at the T10 vertebra was removed to avoid spinal cord compression. The histology of this tumor was compatible with that of leiomyosarcoma. The potential primary sites for leiomyosarcoma, including the lung, thyroid, breast, kidney, genitourinary organs, and gastrointestinal tract, were subsequently investigated. No detectable abnormal findings that would suggest the origin of the tumor were found. Synchronous primary leiomyosarcomas in the spine and liver are quite rare and have a poor prognosis.

Keyword

Leiomyosarcoma; Bone and bones; Spine; Liver; Neoplasms, multiple primary

MeSH Terms

Biopsy, Needle
Bone and Bones
Breast
Constipation
Endoscopy, Digestive System
Female
Gastrointestinal Tract
Humans
Kidney
Leiomyosarcoma*
Liver*
Lung
Middle Aged
Neoplasms, Multiple Primary
Physical Examination
Prognosis
Seoul
Spinal Cord Compression
Spine*
Thyroid Gland
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Esophagogastroduodenoscopy shows an ulceroinfiltrative lesion (arrow) on the gastric angle.

• 

  Fig. 2 Abdominopelvic computed tomography scan shows an oval low attenuation nodule with rim enhancement (arrow) at S4 in the liver.

• 

  Fig. 3 Computed tomography scan shows a lobulated heterogeneous low attenuation mass (arrow) involving the left pedicle and both laminae extending into the spinal canal.

• 

  Fig. 4 (A) Microscopic view of the hepatic lesion shows an interlacing bundle of atypical spindle cells (H&E, ×200). (B) Immunohistochemical staining of the hepatic lesion shows a positive reaction for desmin (×200). (C) Microscopic view of the spinal lesion showing an interlacing bundle of atypical spindle cells (H&E, ×400). (D) Immunohistochemical staining of the spinal lesion showing a positive reaction for smooth muscle actin (×200).

• 

  Fig. 5 Magnetic resonance imaging shows a heterogeneous low-signal intensity mass compressing the dural sac at the T10 level (arrow) on a sagittal T2-weighted image.

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