title: Muscular metastasis from mesocolic and duodenal leiomyosarcoma. A case report and a review of the literature.
abstract: BACKGROUND
  Mesenteric and duodenal leiomyosarcomas are very rare malignancies. Muscular metastases from leiomyosarcoma are even more rare. Surgery is the only chance of cure and should be attempted whenever possible. The relief of symptoms and the prevention of recurrences are ultimately the aims of surgery. We present a unique case of mesocolic and duodenal leiomyosarcoma with muscular metastases.
  
  
  METHODS
  A 61 year old woman was treated by radical resection including left neftectomy and left hemicolectomy for a leiomyosarcoma of the left mesocolon. Three years after the first surgery a leiomyosarcoma of the duodenal wall was diagnosed. Following a careful evaluation that ruled out the presence of other secondary locations, she underwent pancreatoduodenectomy. Three months later she observed a small, mildly painful swelling in the left thigh, rapidly growing to a diameter of 4 cm over a month period. The MRI showed a low-signal intensity malignancy in T2-weighted images whereas the lesion was homogeneously enhanced by Gadolinium on T1-weighted imaging. The histological examination after excision confirmed the clinical suspicion of a metastasis from high grade leiomyosarcoma. Successively the patient underwent a palliative chemotherapy treatment with epirubicin and ifosfamide for three cycles. The patient experienced a progression of disease with multiple pulmonary and encephalic metastases five months later.
  
  
  CONCLUSIONS
  Muscular metastases from leiomyosarcoma are occasionally described in the literature. The apparition of muscular metastases is considered a negative prognostic factor and shortly precedes massive distant diffusion of the malignancy. Denervation syndrome can be a risk factor for muscular metastases. To our knowledge, this is the first report of a skeletal-muscle metastasis following mesenteric and duodenal leiomyosarcoma.
authors: Department of Surgery, University of Catania Medical School, Catania, Italy.
authors: Alessandro
authors: A
authors: Cappellani
authors: Maria
authors: M
authors: Di Vita
authors: Emanuele
authors: E
authors: Lo Menzo
authors: Antonio
authors: A
authors: Zanghì
authors: Salvatore
authors: S
authors: Lanzafame
authors: PierFrancesco
authors: P
authors: Veroux
authors: Ernesto
authors: E
authors: Zanet
authors: Andrea
authors: A
authors: Cavallaro
authors: Massimiliano
authors: M
authors: Berretta
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D004379:Duodenal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D005260:Female; D006801:Humans; D007890:Leiomyosarcoma / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D008646:Mesocolon / Q000473:pathology*; D008875:Middle Aged; D019042:Muscle Neoplasms / Q000188:drug therapy / Q000556:secondary* / Q000601:surgery; D009361:Neoplasm Invasiveness; D009378:Neoplasms, Multiple Primary / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D010166:Palliative Care; D010534:Peritoneal Neoplasms / Q000188:drug therapy / Q000473:pathology* / Q000601:surgery; D011379:Prognosis; D013848:Thigh / Q000473:pathology