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Portal vein leiomyosarcoma invading the pancreatic head

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Abstract

We encountered a rare case of a pancreatic head tumor protruding into the portal vein, later diagnosed histopathologically as primary leiomyosarcoma of the portal vein. A 59-year-old woman visited our hospital because of an elevated amylase level during a medical checkup. Computed tomography showed a moderately contrasted, well-defined mass of 35-mm diameter in the pancreatic head with protrusion into the portal vein. Endoscopic ultrasonography revealed a well-defined and hypoechoic mass. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the pancreas head. We performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection. Gross findings of the fixed specimen showed a white solid, multinodular mass in the pancreatic parenchyma with protrusion into the portal vein. Histopathological examination showed proliferation of spindle-shaped eosinophilic cells with intricate bundle-like growth, indicating leiomyosarcoma. Examining the tumor location and invasion suggested portal vein as the origin. Although portal vein primary leiomyosarcoma is rare, leiomyosarcoma should be considered as a differential diagnosis in pancreatic head tumors with protrusion into the portal vein. Precise macroscopic and histopathological examinations can help determine the definitive diagnosis and origin of leiomyosarcoma.

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Funding

This work was supported by the Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital to HI (NFRCH 21-0012). The funder had no role in study design, data collection, data analysis, decision to publish, or preparation of the manuscript.

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Authors and Affiliations

  1. Department of Gastrointestinal Surgery, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, 3-35 Michishita-cho, Nakamura-ku, Nagoya, 453-8511, Japan

    Hiromitsu Imataki, Masataka Okuno, Hideo Miyake, Hidemasa Nagai, Yuichiro Yoshioka & Norihiro Yuasa

  2. Department of Pathology, Japanese Red Cross Aichi Medical Center Nagoya Daiichi Hospital, Nagoya, 453-8511, Japan

    Masahiko Fujino

Authors
  1. Hiromitsu Imataki
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  2. Masataka Okuno
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  3. Hideo Miyake
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  4. Hidemasa Nagai
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  5. Yuichiro Yoshioka
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  6. Norihiro Yuasa
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  7. Masahiko Fujino
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Contributions

HI was responsible for data collection, interpretation, and preparation of the manuscript. NY helped draft the manuscript. MO, HM, HN, and YY performed the diagnosis, surgery, and perioperative management of the patient. MF was responsible for pathological examination and diagnosis. All authors read and approved the final manuscript.

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Correspondence to Hiromitsu Imataki.

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Conflict of interest

Hiromitsu Imataki, Masataka Okuno, Hideo Miyake, Hidemasa Nagai, Yuichiro Yoshioka, Norihiro Yuasa, and Masahiko Fujino declare that they have no conflict of interest.

Ethical approval

All the procedures complied with the ethical standards of the responsible committees on human experimentation (institutional and national) and with the 2008 version of the Declaration of Helsinki.

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All the procedures followed have been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Informed consent for this report was obtained from the patient.

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Imataki, H., Okuno, M., Miyake, H. et al. Portal vein leiomyosarcoma invading the pancreatic head. Clin J Gastroenterol 15, 484–492 (2022). https://doi.org/10.1007/s12328-022-01613-9

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  • DOI: https://doi.org/10.1007/s12328-022-01613-9

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