Lee Soo-Hyeon, Bae Sang-Ho, Lee Sang-Cheol, Ahn Tae-Sung, Kim Zisun, Jung Hae-Il
Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea.
Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea.
World J Gastrointest Surg. 2023 May 27;15(5):992-999. doi: 10.4240/wjgs.v15.i5.992.
Leiomyosarcoma (LMS) has a poor prognosis and rarely originates from the colon. If resection is possible, surgery is the first treatment most commonly considered. Unfortunately, no standard treatment exists for hepatic metastasis of LMS; although, several treatments, such as chemotherapy, radiotherapy, and surgery, have been used. Subsequently, the management of liver metastases remains controversial.
We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon. A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months. Colonoscopy revealed a 4-cm diameter mass in the descending colon, 40 cm from the anal verge. Computed tomography revealed intussusception of the descending colon due to the 4-cm mass. The patient underwent a left hemicolectomy. Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin, and negative for cluster of differentiation 34 (CD34), CD117, and discovered on gastrointestinal stromal tumor (GIST)-1, which are characteristic of gastrointestinal LMS. A single liver metastasis developed 11 mo post-operatively; the patient subsequently underwent curative resection thereof. The patient remained disease-free after six cycles of adjuvant chemotherapy (doxorubicin and ifosfamide), and 40 and 52 mo after liver resection and primary surgery, respectively. Similar cases were obtained from a search of Embase, PubMed, MEDLINE, and Google Scholar.
Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.
平滑肌肉瘤（LMS）预后较差，很少起源于结肠。如果可能进行切除，手术是最常考虑的首选治疗方法。不幸的是，对于LMS肝转移尚无标准治疗方案；尽管已采用了几种治疗方法，如化疗、放疗和手术。随后，肝转移的管理仍存在争议。
我们报告一例罕见的来自降结肠的LMS患者发生异时性肝转移的病例。一名38岁男性最初报告在过去两个月出现腹痛和腹泻。结肠镜检查发现距肛缘40 cm的降结肠有一个直径4 cm的肿块。计算机断层扫描显示由于4 cm的肿块导致降结肠套叠。患者接受了左半结肠切除术。对肿瘤进行免疫组织化学分析显示，其平滑肌肌动蛋白和结蛋白呈阳性，而分化簇34（CD34）、CD117以及胃肠道间质瘤（GIST）-1呈阴性，这些是胃肠道LMS的特征。术后11个月出现单个肝转移；患者随后对其进行了根治性切除。在接受六个周期的辅助化疗（阿霉素和异环磷酰胺）后，以及分别在肝切除和初次手术后40个月和52个月，患者保持无病状态。通过检索Embase、PubMed、MEDLINE和谷歌学术获得了类似病例。
早期诊断和手术切除可能是胃肠道LMS肝转移唯一潜在的治愈选择。
