Preoperative diagnosis of pancreatic leiomyosarcoma.
BACKGROUND
The low incidence of pancreatic leiomyosarcoma is responsible for the small number of cases correctly diagnosed preoperatively, the tumor being frequently confused with benign pancreatic lesions.


RESULTS
We describe a symptom free 52-yr-old male bearing an abdominal mass incidentally found at physical examination. Imaging techniques revealed a nonhomogenous large mass at the head of the pancreas that dislodged the portal vein and the superior mesenteric vein. Increased metabolic activity in the tumor area demonstrated by 18F-fluorodeoxyglicose positron emission tomography scan allowed the diagnosis of a malignant lesion. The patient was operated on and a pylorus preserving pancreatoduodenectomy performed. The pathology diagnosis was a low grade leiomyosarcoma. Immunohistochemistry revealed positivity for vimentin and smooth muscle specific actin. The clinical course was uneventful after 2 yr follow-up.


CONCLUSIONS
Pancreatic leiomyosarcoma may be preoperatively diagnosed by image techniques and differentiated from benign lesions by means of fluorodeoxyglicose positron emission tomography scanning (FDGPET).
Machado
M C
MC
Department of Gastroenterology, School of Medicine, University of São Paulo, Brazil. mccm37@vol.com.br
Cunha
J E
JE
Penteado
S
S
Bacchella
T
T
Jukemura
J
J
Costa
A C
AC
Halpern-Salomon
I
I
D000199:Actins / Q000378:metabolism; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009130:Muscle, Smooth / Q000378:metabolism; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000378:metabolism / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D014055:Tomography, Emission-Computed; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography; D014746:Vimentin / Q000378:metabolism
D000199:Actins; D014746:Vimentin; D019788:Fluorodeoxyglucose F18