Unusual evolution of leiomyosarcoma of the rectum: a case report and review of the literature

• Published in: Journal of medical case reports 2016-09, Vol.10 (1), p.249-249, Article 249
• Main Authors: Sahli, N, Khmou, M, Khalil, J, Elmajjaoui, S, El Khannoussi, B, Kebdani, T, Elkacemi, H, Benjaafar, N
• Format: Article
• Language: English
• Subjects: Adult; Care and treatment; Case Report; Case studies; Colorectal cancer; Defecation; Development and progression; Disease; Follow-Up Studies; Humans; Leiomyosarcoma; Leiomyosarcoma - diagnosis; Leiomyosarcoma - pathology; Leiomyosarcoma - radiotherapy; Magnetic Resonance Imaging; Male; Medical treatment; Radiotherapy Dosage; Radiotherapy, Adjuvant; Rectal Neoplasms - diagnosis; Rectal Neoplasms - pathology; Rectal Neoplasms - radiotherapy; Rectum - pathology; Treatment Outcome
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-016-1047-8

Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment. This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors. The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.