Pancreatic leiomyosarcoma: EUS findings of an uncommon pancreatic mass (with video).

Abstract

Stromal pancreatic neoplasms are extremely rare, perhaps due to the poor representation of this tissue in the normal parenchyma. [1] Although leiomyosarcoma is the most common primary malignant mesenchymal pancreatic tumor, it represents only 0.1% of malignant pancreatic tumors and 0.5% of all adult soft tissue sarcomas. [2] This neoplasm mainly affects females (70% – 80%), occurs predominantly between the fifth and sixth decades of life, and has significant metastatic potential with poor prognosis. [3,4] We present a case of an 83-year-old woman referred to our center for dysgeusia and weight loss. In the diagnostic workup, an abdominal computed tomographic scan was performed in December 2021; a 28-mm-diameter mass in the pancreatic body, with sharp margin and bulging on the splenic vein, was found. Successively an abdominal magnetic resonance imaging described a nodular lesion at the passage between body and tail hyperintense in diffusion-weighted imaging (DWI), hypointense in T1, and isointense in T2 sequences. Contrast enhancement was slight and progressive, and all the features were not typical for adenocarcinoma. Biochemical analysis and oncological markers were all within the reference range, except chromogranin A (402 ng/mL, upper normal value <98 ng/mL). Because of this positivity, a PET-Ga-68-DOTATOC positron emission tomography (PET)/ computerized tomography (CT)wasprescribedinFebruary2022,whichdemonstratesanabnor-maltracer uptake in the pancreatic tail.To characterize the mass, EUS with fine needle aspiration was