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154 SOFT TISSUE LEIOMYOSARCOMA WITH GASTRIC AND INTESTINAL METASTASIS: A CASE REPORT AND REVIEW OF LITERATURE O Alharbi, SC Grover, R Abdalian, NE Marcon Soft tissue leiomyosarcoma is a rare, aggressively malignant connective tissue tumour of mature adults that arises from smooth muscle. The gastrointestinal tract is an unusual site for metastasis. We present a case of soft tissue leiomyosarcoma with a gastric and intestinal metastasis.
Division of Gastroenterology, St Michael's Hospital, Toronto, Ontario
A 76-year-old woman presented with a past history of a resection of a right forearm high-grade leiomyosarcoma. One year later she underwent a second resection due to positive margins. She presented four years later with iron deficiency anemia and obscure occult gastrointestinal hemorrhage. There was no history of abdominal pain, weight loss or intestinal obstruction. While colonoscopy was negative, gastroscopy revealed a 5 mm gastric polyp which was resected endoscopically. The pathology showed evidence of a high grade leiomyosarcoma with numerous mitotic figures. Immunohistochemical staining for c-kit and CD34 was negative, but stains for smooth muscle actin and desmin were diffusely positive, consistent with a diagnosis of leiomyosarcoma. CT enterography showed metastatic lesions to the small bowel with jejunojejunal intussusceptions due to small bowel metastasis and metastasis to the left ischium. There was no evidence of liver or lung metastasis. The patient was referred for palliative chemotherapy due to the extent of her disease.
The incidence of gastrointestinal metastasis from soft tissue sarcoma is 1.2%. Patients usually present with abdominal pain, anemia, intestinal obstruction and gastrointestinal bleeding. Metastatic disease is seldom amenable to curative treatment. While metastatic leiomyosarcomas are not usually sensitive to radiation and chemotherapy, patients treated with surgery and adjunctive agents are seen to live longer than those treated with surgery alone. Patients with a history of leiomyosarcoma in the past, who present with iron deficiency anemia, warrant consideration of gastrointestinal metastasis as a diagnostic entity, and appropriate imaging of the small bowel as a potential site of metastasis.