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Laparoscopically Assisted Resection of a Primary Hepatic Leiomyosarcoma: A Safe Approach in a Rare Malignancy
Resección laparoscópica asistida de leiomiosarcoma hepático primario: un abordaje seguro en una tumoración infrecuente
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Their poor prognosis requires R0 resection, which allows us to achieve long-term survival. Here, we present the case of a PHL that was completely resected by hand-assisted laparoscopic surgery (HALS).<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">1</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">A 63-year-old woman with no prior history of interest reported abdominal pain. Upon examination, a mass was palpated in the epigastrium. Abdominal ultrasound and contrast-enhanced CT scan detected a 7<span class="elsevierStyleHsp" style=""></span>cm mass in the left hepatic lobe, with no evidence of metastatic disease. FNA reported a mesenchymal tumor suggestive of leiomyosarcoma. On PET-CT, the mass was seen to have malignant metabolic characteristics with a maximum SUV of 4.5. We performed HALS and found a 7<span class="elsevierStyleHsp" style=""></span>cm mass in segment III of the left hepatic lobe; segment IV and the rest of the liver parenchyma were normal on intraoperative ultrasound. A laparoscopic left lateral sectionectomy was performed without portal occlusion. The surgical time was 120<span class="elsevierStyleHsp" style=""></span>min, and no blood transfusion was required. The patient was discharged 3 days post-op. Microscopically, the hepatic parenchyma was observed to be infiltrated by a malignant mesenchymal neoplasm derived from smooth muscle cells, consisting of bands that crossed in different directions of atypical ovoid or fusiform cells with occasional multinucleated cells (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>). In addition, areas of necrosis and up to 12 mitotic figures were observed. In the wall of an intrahepatic vessel, these malignant cells were observed to be “emerging” from the wall. The neoplastic cells showed intense cytoplasmic positivity for vimentin, smooth muscle actin and desmin, and negativity for cytokeratin AE1/AE3, CD-117 (C-Kit), DOG-1 and S-100. The Ki-67<span class="elsevierStyleHsp" style=""></span>cell proliferation index was 20%-30%. The patient did not receive adjuvant treatment and is disease-free 132 months after the intervention.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0015" class="elsevierStylePara elsevierViewall">Hepatic sarcomas are exceptional; they represent 0.1%–1% of primary hepatic malignancies.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">2</span></a> Although angiosarcoma is most frequent, PHL constitutes around 8%–10%.<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">3</span></a> Leiomyosarcomas can arise from the muscular walls of intrahepatic vascular structures, bile ducts, or the round ligament. Most hepatic leiomyosarcomas are metastases of leiomyosarcomas from other locations (uterus, retroperitoneum, gastrointestinal tract<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">4</span></a>); therefore, their exclusion is essential for an accurate diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Symptoms are non-specific and frequently include pain in the upper hemiabdomen accompanied by weight loss, low-grade fever, asthenia, jaundice, and even acute intra-abdominal bleeding secondary to tumor rupture. Physical examination may reveal hepatomegaly or an abdominal mass, whereas laboratory data (bilirubin, alkaline phosphatase, transaminases, alpha-fetoprotein or other tumor markers) are usually not useful for diagnosis.<a class="elsevierStyleCrossRef" href="#bib0075"><span class="elsevierStyleSup">5</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">CT usually describes a large heterogeneous, hypodense mass with internal and peripheral enhancement with occasional central necrosis, similar to the findings in our patient.<a class="elsevierStyleCrossRef" href="#bib0080"><span class="elsevierStyleSup">6</span></a> MRI showed homogeneous hypointensity in T1 and homogeneous hyperintensity in T2.<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">7</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">Given the non-specific physical, analytical and radiological data, preoperative histology study (by cytology or ultrasound-guided percutaneous biopsy) and postoperative histological study are key factors in the diagnosis. Macroscopically, the surface of the cut is usually whitish-pink and yellow, with areas of necrosis or dark red, caused by hemorrhagic foci, and the neoplasm shows a good delimitation from the adjacent liver parenchyma, separated by a capsule-like fibrocollagenous tissue. Histologically, the tumor usually consists of interconnected fascicles of cells with abundant cytoplasm of elongated or ovoid nuclei, with variable atypia; multinucleated cells and cells with vacuolated or eosinophilic cytoplasm can be observed. Mitotic figures are frequent and there is usually necrosis. The histological finding of presence of these neoplastic cells that emerge from the wall of intrahepatic vessels supports their origin in these structures. They express immunohistochemical markers that support the smooth muscle origin, such as smooth muscle actin, desmin and H-caldesmon, and they are negative for other markers, such as CD-117 (C-Kit), DOG-1, S-100, and CKAE1-AE3, which helps exclude other types of neoplasms with which the differential diagnosis is established.<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">8</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment consists of hepatic resection with intended R0 resection as the most widely accepted indication. There is no survival of more than 3 years with R1 resections.<a class="elsevierStyleCrossRef" href="#bib0095"><span class="elsevierStyleSup">9</span></a> Adjuvant chemotherapy in PHL is not accepted because of the low rate of response, although in advanced stages tumorectomy associated with chemotherapy with doxorubicin and ifosfamide, or especially irinotecan, are the most accepted options.<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">10</span></a> Another alternative is liver transplantation, although it is not recommended because of high rates of recurrence.</p><p id="par0040" class="elsevierStylePara elsevierViewall">HALS and totally laparoscopic surgery are presented as the most appropriate approaches in this type of tumors. In our case, the tumor was 7<span class="elsevierStyleHsp" style=""></span>cm, which is why we were more in favor of using HALS, since the introduction of the left hand allows for manual and ultrasound examination to locate preoperatively undetected lesions in the abdominal cavity, while also providing for the distinction between a primary tumor or the presence of metastatic disease or tumor dissemination throughout the abdominal cavity.</p><p id="par0045" class="elsevierStylePara elsevierViewall">In conclusion, HALS is a safe approach in the treatment of PHL that enables R0 resection with good long-term survival results.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: López-López V, Robles R, Ferri B, Brusadin R, Parrilla P. Resección laparoscópica asistida de leiomiosarcoma hepático primario: un abordaje seguro en una tumoración infrecuente. Cir Esp. 2017;95:478–480.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 1120 "Ancho" => 1500 "Tamanyo" => 431667 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">(a) Solid encapsulated neoplasm that is well outlined from the adjacent liver parenchyma (H-E, 4×); (b) It is constituted by intertwining bundles of spindle cells with marked nuclear atypia, atypical mitotic figures and a focus of necrosis (H-E, 10×); (c) Neoplastic cells emerging from the wall of a small hepatic vessel (H-E, 20×); (d) Intense positivity of tumor cells (desmin 20×).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0015" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0055" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A new approach to hand-assisted laparoscopic liver surgery" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "R. Robles" 1 => "C. Marín" 2 => "B. Abellán" 3 => "A. López" 4 => "P. Pastor" 5 => "P. Parrilla" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s00464-008-9770-x" "Revista" => array:6 [ "tituloSerie" => "Surg Endosc" "fecha" => "2008" "volumen" => "22" "paginaInicial" => "2357" "paginaFinal" => "2364" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/18322747" "web" => "Medline" ] ] ] ] ] ] ] ] 1 => array:3 [ "identificador" => "bib0060" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "A primary leiomyosarcoma of the liver: an autopsy report" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:3 [ 0 => "S. Sato" 1 => "K. Hosoi" 2 => "T. Kagawa" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:4 [ "tituloSerie" => "EJ Pathol" "fecha" => "2000" "volumen" => "6" "paginaInicial" => "8" ] ] ] ] ] ] 2 => array:3 [ "identificador" => "bib0065" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Management of primary liver sarcomas" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "J. Weitz" 1 => "D.S. Klimstra" 2 => "K. Cymes" 3 => "W.R. Jarnagin" 4 => "M. D’Angelica" 5 => "M.P. La Quaglia" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1002/cncr.22530" "Revista" => array:6 [ "tituloSerie" => "Cancer" "fecha" => "2007" "volumen" => "109" "paginaInicial" => "1391" "paginaFinal" => "1396" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17315167" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0070" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary hepatic leiomyosarcoma: case report and literature review" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "N. Shivathirthan" 1 => "J. Kita" 2 => "Y. Iso" 3 => "H. Hachiya" 4 => "P. Kyunghwa" 5 => "T. Sawada" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.4251/wjgo.v3.i10.148" "Revista" => array:6 [ "tituloSerie" => "World J Gastrointest Oncol" "fecha" => "2011" "volumen" => "3" "paginaInicial" => "148" "paginaFinal" => "152" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/22046492" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0075" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary carcinosarcoma of the liver: clinicopathologic features of 5 cases and a review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "X.M. Lao" 1 => "D.Y. Chen" 2 => "Y.Q. Zhang" 3 => "J. Xiang" 4 => "R.P. Guo" 5 => "X.J. Lin" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1097/01.pas.0000213431.07116.e0" "Revista" => array:6 [ "tituloSerie" => "Am J Surg Pathol" "fecha" => "2007" "volumen" => "31" "paginaInicial" => "817" "paginaFinal" => "826" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/17527068" "web" => "Medline" ] ] ] ] ] ] ] ] 5 => array:3 [ "identificador" => "bib0080" "etiqueta" => "6" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Hepatic leiomyosarcoma: CT features with pathologic correlation" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:5 [ 0 => "P. Soyer" 1 => "D.A. Bluemke" 2 => "M. Riopel" 3 => "R.H. Hruban" 4 => "E.K. Fishman" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Eur J Radiol" "fecha" => "1995" "volumen" => "19" "paginaInicial" => "177" "paginaFinal" => "182" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/7601167" "web" => "Medline" ] ] ] ] ] ] ] ] 6 => array:3 [ "identificador" => "bib0085" "etiqueta" => "7" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary liver leiomyosarcoma: CT appearance" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "F. Ferrozzi" 1 => "D. Bova" 2 => "A. Zangrandi" 3 => "G. Garlaschi" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "Abdom Imaging" "fecha" => "1996" "volumen" => "21" "paginaInicial" => "157" "paginaFinal" => "160" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/8661764" "web" => "Medline" ] ] ] ] ] ] ] ] 7 => array:3 [ "identificador" => "bib0090" "etiqueta" => "8" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Primary hepatic leiomyosarcoma. A case report with immunohistochemical studies and review of the literature" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "S. Korbi" 1 => "M.T. Aouini" 2 => "S. Remadi" 3 => "S. el Ajmi" 4 => "M. Mokni" 5 => "F. Ben Ayed" ] ] ] ] ] "host" => array:1 [ 0 => array:1 [ "Revista" => array:6 [ "tituloSerie" => "J Submicrosc Cytol Pathol" "fecha" => "1991" "volumen" => "23" "paginaInicial" => "643" "paginaFinal" => "647" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/1764691" "web" => "Medline" ] ] ] ] ] ] ] ] 8 => array:3 [ "identificador" => "bib0095" "etiqueta" => "9" "referencia" => array:1 [ 0 => array:3 [ "comentario" => "[discussion 344]" "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Long-term survival after surgery for primary hepatic sarcoma in adults" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "H. Matthaei" 1 => "A. Krieg" 2 => "M. Schmelzle" 3 => "E. Boelke" 4 => "C. Poremba" 5 => "X. Rogiers" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1001/archsurg.2009.30" "Revista" => array:6 [ "tituloSerie" => "Arch Surg" "fecha" => "2009" "volumen" => "144" "paginaInicial" => "339" "paginaFinal" => "344" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19380647" "web" => "Medline" ] ] ] ] ] ] ] ] 9 => array:3 [ "identificador" => "bib0100" "etiqueta" => "10" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Outcomes of first-line chemotherapy in patients with advanced or metastatic leiomyosarcoma of uterine and non-uterine origin" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:6 [ 0 => "A.W. Oosten" 1 => "C. Seynaeve" 2 => "P.I. Schmitz" 3 => "M.A. den Bakker" 4 => "J. Verweij" 5 => "S. Sleijfer" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1155/2009/348910" "Revista" => array:5 [ "tituloSerie" => "Sarcoma" "fecha" => "2009" "volumen" => "2009" "paginaInicial" => "348910" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/20066161" "web" => "Medline" ] ] ] ] ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/21735077/0000009500000008/v1_201711201938/S2173507717301680/v1_201711201938/en/main.assets" "Apartado" => array:4 [ "identificador" => "15076" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Scientific letters" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/21735077/0000009500000008/v1_201711201938/S2173507717301680/v1_201711201938/en/main.pdf?idApp=UINPBA00004N&text.app=https://www.elsevier.es/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/S2173507717301680?idApp=UINPBA00004N" ]
| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 4 | 3 | 7 |
| 2024 September | 12 | 8 | 20 |
| 2024 August | 9 | 5 | 14 |
| 2024 July | 7 | 1 | 8 |
| 2024 June | 12 | 3 | 15 |
| 2024 May | 29 | 7 | 36 |
| 2024 April | 34 | 6 | 40 |
| 2024 March | 10 | 7 | 17 |
| 2024 February | 7 | 7 | 14 |
| 2024 January | 5 | 10 | 15 |
| 2023 December | 26 | 3 | 29 |
| 2023 November | 18 | 4 | 22 |
| 2023 October | 20 | 3 | 23 |
| 2023 September | 13 | 0 | 13 |
| 2023 August | 11 | 3 | 14 |
| 2023 July | 33 | 2 | 35 |
| 2023 June | 23 | 3 | 26 |
| 2023 May | 34 | 1 | 35 |
| 2023 April | 30 | 0 | 30 |
| 2023 March | 14 | 11 | 25 |
| 2023 February | 13 | 4 | 17 |
| 2023 January | 15 | 2 | 17 |
| 2022 December | 15 | 6 | 21 |
| 2022 November | 13 | 7 | 20 |
| 2022 October | 21 | 6 | 27 |
| 2022 September | 27 | 12 | 39 |
| 2022 August | 19 | 9 | 28 |
| 2022 July | 18 | 13 | 31 |
| 2022 June | 28 | 5 | 33 |
| 2022 May | 26 | 7 | 33 |
| 2022 April | 12 | 8 | 20 |
| 2022 March | 20 | 11 | 31 |
| 2022 February | 30 | 3 | 33 |
| 2022 January | 48 | 7 | 55 |
| 2021 December | 29 | 9 | 38 |
| 2021 November | 19 | 8 | 27 |
| 2021 October | 18 | 9 | 27 |
| 2021 September | 20 | 11 | 31 |
| 2021 August | 17 | 9 | 26 |
| 2021 July | 12 | 7 | 19 |
| 2021 June | 19 | 16 | 35 |
| 2021 May | 17 | 12 | 29 |
| 2021 April | 35 | 9 | 44 |
| 2021 March | 36 | 11 | 47 |
| 2021 February | 22 | 7 | 29 |
| 2021 January | 15 | 11 | 26 |
| 2020 December | 25 | 7 | 32 |
| 2020 November | 23 | 9 | 32 |
| 2020 October | 13 | 8 | 21 |
| 2020 September | 19 | 6 | 25 |
| 2020 August | 17 | 8 | 25 |
| 2020 July | 10 | 10 | 20 |
| 2020 June | 11 | 7 | 18 |
| 2020 May | 12 | 13 | 25 |
| 2020 April | 6 | 7 | 13 |
| 2020 March | 4 | 1 | 5 |
| 2020 February | 7 | 3 | 10 |
| 2020 January | 10 | 3 | 13 |
| 2019 December | 18 | 12 | 30 |
| 2019 November | 9 | 7 | 16 |
| 2019 October | 8 | 2 | 10 |
| 2019 September | 5 | 0 | 5 |
| 2019 August | 6 | 1 | 7 |
| 2019 July | 27 | 14 | 41 |
| 2019 June | 32 | 7 | 39 |
| 2019 May | 71 | 26 | 97 |
| 2019 April | 21 | 12 | 33 |
| 2019 March | 3 | 1 | 4 |
| 2019 February | 7 | 8 | 15 |
| 2019 January | 1 | 1 | 2 |
| 2018 December | 2 | 2 | 4 |
| 2018 November | 5 | 3 | 8 |
| 2018 October | 12 | 6 | 18 |
| 2018 September | 4 | 3 | 7 |
| 2018 August | 2 | 2 | 4 |
| 2018 July | 1 | 0 | 1 |
| 2018 June | 4 | 0 | 4 |
| 2018 April | 3 | 0 | 3 |
| 2018 March | 1 | 0 | 1 |
| 2018 February | 6 | 0 | 6 |
| 2018 January | 2 | 0 | 2 |
| 2017 November | 1 | 1 | 2 |
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