Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents. 1. Introduction Uterine leiomyosarcoma accounts for 3% of all uterine malignancies and it metastasize through hematogenous dissemination to the lungs, liver, bones, and the brain [1]. Small bowel is an extremely rare site of metastasis from uterine leiomyosarcoma [2, 3]. Leiomyosarcoma of the small bowel can either be primary or secondary. Primary leiomyosarcomas arise from the muscularis propria layer of the intestinal wall and show immunopositivity DC117, CD34, and CK AE1/AE3. In contrary, secondary leiomyosarcomas arise from the mucosal layer of the intestinal wall and are negative for DC117, CD34, and CK AE1/AE3 [4]. Uterine leiomyosarcoma can invade small bowel by direct extension, hematogenous route, implantation, or via lymphatic route [5]. Acute abdomen (small bowel obstruction or perforation) secondary to metastatic uterine leiomyosarcoma to small bowel is not well known and has been documented by only four case reports till date [6]. Small bowel metastasis in uterine leiomyosarcoma is usually a sign of extensive disease and poor prognosis. Herein we report a case of a 55-year-old Saudi women who presented in emergency room with acute abdomen secondary to small bowel metastasis from uterine leiomyosarcoma. 2. Case Presentation A 55-year-old Saudi woman was admitted to the Emergency Department with a chief complaint of episodes of paroxysmal