Preoperative diagnosis of pancreatic leiomyosarcoma

Background: The low incidence of pancreatic leiomyosarcoma is responsible f or 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 mas s incidentally found at physical examination. Imaging techniques revealed a nonhomogenous large mass at the head of the pancreas that dislodged the po rtal vein and the superior mesenteric vein. Increased metabolic activity in the tumor area demonstrated by F-18-fluorodeoxyglicose positron emission t omography 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 re vealed positivity for vimentin and smooth muscle specific actin. The clinic al course was uneventful after 2 yr follow-up. Conclusion: Pancreatic leiomyosarcoma may be preoperatively diagnosed by im age techniques and differentiated front benign lesions by means of fluorode oxyglicose positron emission tomography scanning (FDGPET).