Division of Gastroenterology, Department of Medicine, Shiga University of Medical Science, Seta Tsukinowa, Otsu, Shiga, 520-2192, Japan.
Department of Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
Clin J Gastroenterol. 2024 Dec;17(6):1111-1117. doi: 10.1007/s12328-024-02033-7. Epub 2024 Sep 6.
Renal leiomyosarcoma metastasis to the pancreas is exceptionally rare. Here, we present a case of metastatic recurrence in the pancreas seven years after renal leiomyosarcoma resection. A 73-year-old female with a history of renal leiomyosarcoma surgery seven years prior presented with a well-defined 40 × 30 mm pancreatic tail tumor detected by a computed tomography (CT) scan. The tumor exhibited hypo-enhancement in the arterial phase and a progressive enhancement pattern toward the equilibrium phase, similar to pancreatic cancer. Endoscopic ultrasound-guided fine-needle biopsy (EUS-FNB) revealed bundles of spindle cells that matched those in the previously resected renal sample. Immunohistochemistry showed positive staining for desmin, confirming the diagnosis of pancreatic metastasis from renal leiomyosarcoma. The patient underwent a distal pancreatectomy to remove the metastatic lesion. The extended interval of seven years before the detection of metastasis underscores the challenges in monitoring and diagnosing metastatic patterns of renal leiomyosarcoma. EUS-FNB can assist in distinguishing metastatic pancreatic leiomyosarcoma from primary pancreatic cancer, thus influencing treatment decisions.
肾脏平滑肌肉瘤转移至胰腺极为罕见。在此，我们报告一例肾平滑肌肉瘤切除 7 年后胰腺转移复发的病例。一名 73 岁女性，7 年前因肾平滑肌肉瘤接受手术治疗，在 CT 扫描中发现一个边界清楚的 40×30mm 胰尾肿瘤。肿瘤在动脉期呈低增强，向平衡期呈渐进性增强模式，类似于胰腺癌。超声内镜引导下细针活检（EUS-FNB）显示出与先前切除的肾样本相匹配的梭形细胞束。免疫组化显示结蛋白阳性，证实了胰腺转移来自肾平滑肌肉瘤的诊断。患者接受了胰尾切除术以切除转移病灶。在检测到转移之前，间隔长达 7 年，这突显了监测和诊断肾平滑肌肉瘤转移模式的挑战。EUS-FNB 有助于将胰腺转移性平滑肌肉瘤与原发性胰腺癌区分开来，从而影响治疗决策。
