Lee Woo Yong, Lee Hye Kyeong
Department of Surgery, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul 100-032, Republic of Korea.
Department of Pathology, Seoul Paik Hospital, Inje University College of Medicine, 9, Mareunnae-ro, Jung-gu, Seoul 100-032, Republic of Korea.
Int J Surg Case Rep. 2019;65:1-3. doi: 10.1016/j.ijscr.2019.10.028. Epub 2019 Oct 21.
Leiomyosarcoma is a rare soft tissue cancer that arises from smooth muscle cells that form involuntary muscles. Here, we report a rare case of retroperitoneal leiomyosarcoma that mimicked a metastatic tumor arising from a gastric cancer.
A 43-year-old man underwent radical total gastrectomy for gastric cancer. He underwent adjuvant chemotherapy with oral 5-fluorouracil (5-FU) for 2 years and regular follow-up. Twenty-nine months after gastrectomy, computed tomography (CT) was performed and revealed a solitary localized mass measuring 43 mm in diameter among retroperitoneal lymph nodes of the posterior inferior vena cava. This finding indicated that the previous gastric cancer recurred either in the lymph node or retroperitoneum. Second-line chemotherapy, consisting of oxaliplatin and 5-FU (FOLFOX) was administered in four cycles. However, serial CT scans showed increased tumor size. Retroperitoneal tumor did not respond to treatment, surgical resection was performed. Pathological findings led to a diagnosis of pleomorphic and epithelioid leiomyosarcoma without metastatic adenocarcinoma of the stomach.
When a diagnosis of locoregional recurrence of gastric cancer in the retroperitoneum is considered, retroperitoneal leiomyosarcoma should also be considered in the differential diagnosis.
Early diagnosis and concerted therapeutic efforts are important for managing misdiagnosed metastatic gastric cancer.
平滑肌肉瘤是一种罕见的软组织癌，起源于构成非自主肌的平滑肌细胞。在此，我们报告一例罕见的腹膜后平滑肌肉瘤病例，该病例酷似源自胃癌的转移性肿瘤。
一名43岁男性因胃癌接受了根治性全胃切除术。他接受了为期2年的口服5-氟尿嘧啶（5-FU）辅助化疗并定期随访。胃切除术后29个月，进行了计算机断层扫描（CT），结果显示在肾下腔静脉后方的腹膜后淋巴结中有一个直径为43毫米的孤立性局限性肿块。这一发现表明先前的胃癌在淋巴结或腹膜后复发。给予了由奥沙利铂和5-FU组成的二线化疗（FOLFOX），共四个周期。然而，系列CT扫描显示肿瘤大小增加。腹膜后肿瘤对治疗无反应，遂进行了手术切除。病理结果诊断为多形性和上皮样平滑肌肉瘤，无胃转移性腺癌。
当考虑诊断为腹膜后胃癌局部区域复发时，在鉴别诊断中也应考虑腹膜后平滑肌肉瘤。
早期诊断和协同治疗对于处理误诊的转移性胃癌很重要。
