Diagnosis and treatments of primary hepatic leiomyosarcoma

doi:10.3877/cma.j.issn.2095-3232.2021.06.018

Abstract

Abstract:

Objective

To investigate the diagnosis and treatments of primary hepatic leiomyosarcoma (PHL).

Methods

Clinical data of 1 patient with PHL who was diagnosed and treated in the First Affiliated Hospital of Xi'an Jiaotong University in October 2017 were analyzed retrospectively. The female patient, aged 49 years, was admitted to our hospital due to "space-occupying lesions of the liver detected by ultrasound examination". A hypoechoic region in the caudate lobe of liver was found by ultrasound examination. Multiple nodule-like and lumpy low-density shadows in the right lobe and caudate lobe were observed by abdominal CT scan. The diagnosis of PHL was confirmed by liver biopsy and immunohistochemical staining. TACE combined with chemotherapy was adopted.

Results

The patient received TACE on December 14, 2017, and was given with 6 cycles of adjuvant chemotherapy (gemcitabine+docetaxel) after TACE. The lesion was found slightly enlarged in the reexamination on April 16, 2019 and the chemotherapy regimen was modified to gemcitabine + albumin-bound paclitaxel for 3 cycles. On May 20, 2020, the reexamination found that the lesion was obviously enlarged. After the secondary TACE, the patient recovered well. As of July 1, 2020, the patient had lived a high quality of life, and no tumor recurrence was found during postoperative follow-up. Clinical data of 15 adult patients with PHL were retrieved from PubMed database between 2000 and 2020. 6 cases were male and 9 female, aged from 25 to 77 years, with a median age of 54 years. The primary symptoms were mainly abdominal pain and discomfort, and the tumors were mainly located in the right lobe. No specific manifestations was observed in laboratory and imaging examination. Pathological examination showed that spindle-shaped tissue cells were arranged in bundles. Immunohistochemical staining found positive results for SMA, desmin and vimentin, whereas negative results for S-100 and cytokeratin in the tissue cells. Surgical resection was performed in 9 cases, chemotherapy in 2, including 1 of surgical resection combined with chemotherapy, liver transplantation in 1, TACE in 2 and conservative treatments in 2, respectively. During 3-82 month follow-up, 2 cases were lost to follow-up, 6 cases died and 7 survived.

Conclusions

PHL is a rare disease. Pathological examination is the only effective approach to confirm the diagnosis. Surgical resection can achieve relatively better clinical efficacy.

Key words: Liver neoplasms, Leiomyosarcoma, Diagnosis, Treatment

Yang Wu, Runchen Miao, Xing Zhang, Yuelang Zhang, Xiaohua Ma, Chang Liu. Diagnosis and treatments of primary hepatic leiomyosarcoma[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2021, 10(06): 618-621.

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References 21

[1]	Tsuji M, Takenaka R, Kashihara T, et al. Primary hepatic leiomyosarcoma in a patient with hepatitis C virus-related liver cirrhosis[J]. Pathol Int, 2010, 50(1):41-47.
[2]	Fujita H, Kiriyama M, Kawamura T, et al. Primary hepatic leiomyosarcoma in a woman after renal transplantation: report ofa case[J]. Surg Today, 2002, 32(5):446-449.
[3]	Iordanidis F, Hytiroglou P, Drevelegas A, et al. A 25-year-old man with a large hepatic tumor and multiple nodular lesions[J]. Semin Liver Dis, 2002, 22(1):97-102.
[4]	Lee HJ, Lee JL, Choi WH. A case of primary myxoid leiomyosarcoma of the liver[J]. Korean J Intern Med, 2002, 17(4):278-282.
[5]	Tsiatis AC, Atkinson JB, Wright JK, et al. Primary hepatic myxoid leiomyosarcoma: a case report and review of the literature[J]. Ultrastruct Pathol, 2008, 32(1):25-28.
[6]	Liang X, Shi XM, Xie JP, et al. Liver transplantation for primary hepatic leiomyosarcoma: a case report and review of the literatures[J]. Med Oncol, 2010, 27(4):1269-1272.
[7]	Shivathirthan N, Kita J, Iso Y, et al. Primary hepatic leiomyosarcoma: case report and literature review[J]. World J Gastrointest Oncol, 2011, 3(10):148-152.
[8]	Chelimilla H, Badipatla K, Ihimoyan A, et al. A rare occurrence of primary hepatic leiomyosarcoma associated with epstein barr virus infection in an AIDS patient[J]. Case Rep Gastrointest Med, 2013: 691862.
[9]	Lv WF, Han JK, Cheng DL, et al. Imaging features of primary hepatic leiomyosarcoma: a case report and review of literature[J]. Oncol Lett, 2015, 9(5):2256-2260.
[10]	Giakoustidis D, Giakoustidis A, Goulopoulos T, et al. Primary gigantic leiomyosarcoma of the liver treated with portal vein embolization and liver resection[J]. Ann Hepatobiliary Pancreat Surg, 2017, 21(4):228-231.
[11]	Feretis T, Kostakis ID, Damaskos C, et al. Primary hepatic leiomyosarcoma: a case report and review of the literature[J]. Acta Medica, 2018, 61(4):153-157.
[12]	Liu W, Liang W. Primary hepatic leiomyosarcoma presenting asa thick-walled cystic mass resembling a liver abscess: a case report[J]. Medicine, 2018, 97(51):e13861.
[13]	Mitra S, Rathi S, Debi U, et al. Primary hepatic leiomyosarcoma: histopathologist's perspective of a rare case[J]. J Clin Exp Hepatol, 2018, 8(3):321326.
[14]	Zhu KL, Cai XJ. Primary hepatic leiomyosarcoma successfully treated by transcatheter arterial chemoembolization: a case report[J]. World J Clin Cases, 2019, 7(4):525-531.
[15]	Vella S, Cortis K, Pisani D, et al. Case of primary hepatic leiomyosarcoma successfully treated with laparoscopic right hepatectomy[J]. BMJ Case Rep, 2020, 13(2):e233567.
[16]	Weitz J, Klimstra DS, Cymes K, et al. Management of primary liver sarcomas[J]. Cancer, 2007, 109(7):1391-13960.
[17]	Yamaguchi J, Azuma T, Fujioka H, et al. Leiomyosarcoma occurring in the ligamentum teres of the liver: a case report and a review of seven reported cases[J]. Hepatogastroenterology, 1996, 43(10):1051-1056.
[18]	Pinson CW, Lopez RR, Ivancev K, et al. Resection of primary hepatic malignant fibrous histiocytoma, fibrosarcoma, and leiomyosarcoma[J]. South Med J, 1994, 87(3):384-391.
[19]	Iida T, Maeda T, Amari Y, et al. Primary hepatic leiomyosarcoma ina patient with autosomal dominant polycystic kidney disease[J]. CEN Case Rep, 2017, 6(1):74-78.
[20]	马学真. 软组织肉瘤的诊断和治疗[C]//山东抗癌协会肿瘤化疗分会. 山东省第七届肿瘤化疗会议暨首届"CSCO-山东"肿瘤论坛论文集, 山东潍坊, 2008.
[21]	Husted TL, Neff G, Thomas MJ, et al. Liver transplantation for primary or metastatic sarcoma to the liver[J]. Am J Transplant, 2006, 6(2):392-397.

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