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Primary Pancreatic Leiomyosarcoma: Laparoscopic Distal Pancreatosplenectomy/Review of Literature
10.5005/jp-journals-10033-1226
CaSe RepORt

Primary Pancreatic Leiomyosarcoma: Laparoscopic Distal

Pancreatosplenectomy

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1 Jitendra H Mistry, Alankar Gupta, Harshad Soni, Atul Shah, KS Patel, Sanjiv Haribhakti
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AbStrAct contrast enhanced computed tomography (Fig. 1A) of abdomen
Leiomyosarcoma of the pancreas is an extremely rare mesen­ revealed heterogeneously enhancing soft tissue lesion in
chymal tumor, less than 50 cases have been reported till now. distal body and tail of pancreas with solid and cystic com­
It accounts for 0.1% of pancreatic malignancy. Prognosis of ponents. Splenic vessels were encased within the tumor.
this tumor is very poor, fewer are in resectable state. Surgical
resection is the best possible option if feasible. We are reporting Fat planes with surrounding organs were preserved. He
a case of leiomyosarcoma of pancreas underwent laparoscopic underwent laparoscopic distal pancreatectosplenectomy,
distal pancreatosplenectomy. the specimen was retrieved within the Endobag from the
Keywords: Laparoscopic distal pancreatectomy, Pancreato­ Pfannenstiel incision (Figs 1B and C). The procedure took
splenectomy, Pancreatic leiomyosarcoma, mesenchymal tumor. 177 minutes with around 100 cc of blood loss. Postoperative
How to cite this article: mistry JH, Gupta A, Soni H, Shah A, recovery was uneventful and was discharged on post­
Patel KS, Haribhakti S. Primary Pancreatic Leiomyosarcoma: operative day 6. Histopathological examination of specimen
Laparoscopic Distal Pancreatosplenectomy. World J Lap Surg
2014;7(2):101­102. revealed intermediate grade leiomyosarcoma. All the
Source of support: Nil margins and lymphnodes were free of tumor and there was
no lymphovascular involvement (Figs 2A to C). Immuno­
Conflict of interest: None
histochemistry examination showed tumor cells positive for
IntroDuctIon smooth muscle actin (SMA) and h-Caldesmon. Now with
6 months of follow­up, patient is doing well without any
Leiomyosarcoma of pancreas is an extremely rare mesen­ recurrence or complications.
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chymal tumor, less than 50 cases have been reported till now.
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It accounts for 0.1% of pancreatic malignancy. Prognosis DIScuSSIon
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of this tumor is very poor, fewer are in resectable state. Mesenchymal tumor of pancreas are extremely rare, as of
Surgical resection is the best possible option if feasible. We now less than 50 cases of pancreatic leiomyosarcoma have
are reporting a case of leiomyosarcoma of pancreas under­ been reported in literature, many of them had metastatic
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went laparoscopic distal pancreatosplenectomy.
tumor. Literature suggests that it usually occurs in patients
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cASe rePort over 50 years of age, as it was in our case. Origin of these
mesenchymal tumor is usually pancreatic duct or blood
A 78­year­old gentleman visited our institution with com­ vessels within the pancreas. These tumors more commonly
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plaint of pain at left upper quadrant of abdomen for 2 years arise in the body and tail of the pancreas which was seen
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with significant weight loss of 10 kg over a period of last in our patient also. It usually metastatize via hematogenous
6 months and occasional vomiting. Examination revealed route and common site of metastasis are lung, liver, brain
deep tenderness in left hypochondrium, no palpable mass and spine. Surgery is the preferred treatment for pancreatic
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or any other findings noted. Further evaluation in form of leiomyosarcoma which offers the best survival. There are
very few cases of laparoscopic distal pancreatosplenectomy
reported for leiomyosarcoma in literature. Due to the mag­
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1 Consultant HPB and GI Oncosurgeon, DNB trainee
3 Consultant GI and Laparoscopic Surgeon nification of vision we feel that oncological clearance is
4,5 Consultant GI Surgeon, Chairman better with the laparoscopic approach. We did not find any
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1 Department of Surgical Gastroenterology, Baroda Laparoscopic difficulty while laparoscopic resection. Literature support
Hospital, Vadodara, Gujarat, India laparoscopic distal pancreatectomy over open distal pan­
2­6 Kaizen Hospital, Institute of Gastroenterology and research createctomy for benign and low grade malignant tumors but
Centre, Ahmedabad, Gujarat, India the experience for high grade malignant is limited and needs
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Corresponding Author: Jitendra H mistry, Consultant HPB long­term data. Histopathological examination revealed
and GI Oncosurgeon, Department of Surgical Gastroenterology pancreatic leiomyosarcoma. Most leiomyosarcomas are
Baroda Laparoscopic Hospital, Vadodara, Gujarat, India, e­mail: positive for SMA, desmin, cadesmon and vimentin. In our
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jitlap@gmail.com
case, the tumor was positive for SMA and h-Caldesmon.
World Journal of Laparoscopic Surgery, May-August 2014;7(2):101-102 101