Leiomyosarcoma of the pancreas is very rare. [1][2][3] Metastatic cases from the stomach, duodenum, vena cava, and splenic vein resembling a primary pancreatic lesion have been described. 4 We report a case of metastatic leiomyosarcoma involving the pancreas that was diagnosed by fine-needle aspiration (FNA) 5 years after resection of the primary tumor.
A 47-year-old woman underwent resection of a left thigh mass, diagnosed as leiomyosarcoma, and subsequently received four courses of adjuvant chemotherapy. Four years later, she developed metastases to the thoracic spine and was treated with radiation. Over the next year, she experienced biliary obstruction and was found to have a lesion in the head of the pancreas. FNA of the pancreatic mass was performed.
Cytologic material was obtained under computed tomography (CT) guidance. The mass was aspirated three times using a 23-gauge-long needle attached to a plastic catheter and a 10-ml disposable syringe. Subsequent to smearing each time, the needle was rinsed in Hank's Balanced Salt Solution. Smears were air-dried for Diff-Quik and wet-fixed in 95% alcohol for Papanicolaou staining. A cell block was prepared and 4-ยตm sections were cut and stained with hematoxylin and eosin. Immunohistochemical studies were also done using cytokeratins and smooth muscle markers.
Smears were markedly hemorrhagic and showed numerous clusters of bizarre, pleomorphic neoplastic cells with a distinct epithelioid morphology. On Diff-Quik, anisonucleosis was prominent with hyperchromatic naked nuclei disclosing round to oval and bean shapes (Fig. 1). Papanicolaou stains showed numerous cells with a more vesicular chromatin pattern and occasional prominent nucleoli. A few of the cells displayed a vaguely granular, eosinophilic cytoplasm. Also evident was granular debris in the background; however, no distinct necrotic cells were noted. Occasional areas showed fragments of normal pancreatic acinar tissue admixed with the neoplastic cells. The cell block displayed sheets of pleomorphic, epithelioid neoplastic cells with distinctly vesicular chromatin and occasional prominent nucleoli (Fig. 2). Numerous atypical mitotic figures were also noted. The diagnosis of an anaplastic pancreatic carci-