Published online May 27, 2023. doi: 10.4240/wjgs.v15.i5.992
Peer-review started: December 28, 2022
First decision: January 10, 2023
Revised: January 23, 2023
Accepted: April 7, 2023
Article in press: April 7, 2023
Published online: May 27, 2023
Leiomyosarcoma (LMS) has a poor prognosis and rarely originates from the colon. If resection is possible, surgery is the first treatment most commonly considered. Unfortunately, no standard treatment exists for hepatic metastasis of LMS; although, several treatments, such as chemotherapy, radiotherapy, and surgery, have been used. Subsequently, the management of liver metastases remains controversial.
We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon. A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months. Colonoscopy revealed a 4-cm diameter mass in the descending colon, 40 cm from the anal verge. Computed tomography revealed intussusception of the descending colon due to the 4-cm mass. The patient underwent a left hemicolectomy. Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin, and negative for cluster of differentiation 34 (CD34), CD117, and discovered on gastrointestinal stromal tumor (GIST)-1, which are characteristic of gastrointestinal LMS. A single liver metastasis developed 11 mo post-operatively; the patient subsequently underwent curative resection thereof. The patient remained disease-free after six cycles of adjuvant chemotherapy (doxorubicin and ifosfamide), and 40 and 52 mo after liver resection and primary surgery, respectively. Similar cases were obtained from a search of Embase, PubMed, MEDLINE, and Google Scholar.
Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.
Core Tip: Leiomyosarcoma (LMS) rarely originates from the colon; hepatic metastasis of LMS lacks standard treatment. We present a case report of a 38-year-old man who was found to have intussusception in the descending colon due to a 4-cm LMS. The patient underwent a left hemicolectomy, however, a single liver metastasis developed 11 mo after the primary surgery. He underwent curative resection of the metastatic lesion and six cycles of adjuvant chemotherapy. The patient remained disease-free for 52 mo after the primary surgery. An early diagnosis and R0 resection may be the only potential curative approach to liver metastasis of gastrointestinal LMS.