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Retroperitoneal leiomyosarcoma

Case contributed by Safwat Mohammad Almoghazy
Diagnosis certain

Presentation

A case of retroperitoneal Leiomyosarcoma stage IV , with lung metastasis, on follow-up

Patient Data

Age: 70 years
Gender: Female

Numerous bilateral metastatic pulmonary nodules have been progressed in size and number with the largest is still seen at the right lower lobe.

No significant mediastinal, hilar or axillary lymph nodes.

No pleural effusion. Evidence of the previous sternotomy.

Further interval progressive changes are seen in previously noted heterogeneous enhancement hypodense right retroperitoneal mass lesion with calcifications with newly developed extension and circumferential involvement of the right ureter, extending upward to the right renal pelvis, soft tissue thickening with subsequent mild to moderate hydronephrosis and newly developed at least two peritoneal soft tissue nodules are seen one anterior to the lesion and another one lateral to the ascending colon.

Liver is averagely sized with homogenous enhancement. No definite focal lesions. No IHBR dilatation.

Gallbladder stones as before

Unremarkable CT features CBD, Portal vein, Pancreas, Spleen, Adrenals, and kidneys (multiple bilateral Simple cortical cysts) are unremarkable.

No significant mesenteric, para-aortic, pelvic or inguinal lymph nodes.

Unchanged previously noted right pericolic stranding. Rest of the opacified bowel loops is unremarkable. No ascites

Case Discussion

A case of retroperitoneal Leiomyosarcoma is diagnosed pathologically proven tow years back, stage IV  with metastasis to lung and the lesion could be originating from IVC because the long axis of the lesion lying parallel to IVC long axis also a loss of fat planes between the lesion and IVC in certain points.

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