Leiomyosarcoma with Hepatic Secondaries- CT

This is a case of 70 yr old male who came to us with abdominal distension, pain and weakness and was diagnosed as CA pancreas, elsewhere. Whole cancer work up was advised and USG abdomen was performed. There was an irregular illdefined heteroechoic conglomerate mass seen in the region of lesser sac, extending into right anterior pararenal space and infrahepatic space. Multiple large nodular peritoneal and retroperitoneal deposits were also present along with complex ascites and multiple necrotic liver secondaries. Case contributed by Dr Rishu Sangal, MD Radiology.

Pancreatic tail region appear clear of the mass. CECT upper abdomen was advised again to r/o pancreas as the primary site and thin section were taken in the region of pancreas. Again a conglomerate, heterogeneous necrotic mass diffusely infiltrating the peritoneal and retroperitoneal spaces was noted.  Though aorta and IVC appear uninvolved, however branches from upper abdominal aorta were encased within the mass lesion. Pancreas had intact fat planes with the mass lesion. Our differentials were retroperitoneal sarcoma with peritoneal and omental involvement, lymphoma, peritoneal disseminated, metastases from unknown primary

USG guided FNAC was advised from the epigastric mass, but a significant volume of foul smelling aspirate was obtained which showed nothing else than inflammatory cells. Repeat USG guided FNAC was advised, but due to necrotic nature of liver secondaries, sample was taken from the solid surface deposit from the liver. This time FNAC was positive, and it came out to be mesenchymal tumour more related to leiomyosarcoma.