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Retroperitoneal Leiomyosarcoma with Elevated CA 19-9.

Brendan Wechsler1, Bogdan Anton1, Douglas Yim1,2

  • 1University of South Dakota Sanford School of Medicine, Sioux Falls, South Dakota.

South Dakota Medicine : the Journal of the South Dakota State Medical Association
|June 16, 2022
PubMed
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Retroperitoneal leiomyosarcomas are rare soft tissue tumors. A massively elevated CA 19-9 level in leiomyosarcoma is exceptionally rare, posing diagnostic challenges, especially with metastatic disease, often necessitating core needle biopsy for diagnosis.

Area of Science:

  • Oncology
  • Pathology

Background:

  • Leiomyosarcomas are malignant tumors originating from smooth muscle cells.
  • They can occur in various body locations, including the retroperitoneum.
  • Retroperitoneal tumors may present incidentally or with non-specific symptoms due to mass effect.

Purpose of the Study:

  • To report an exceedingly rare case of retroperitoneal leiomyosarcoma presenting with a massively elevated CA 19-9 level.
  • To highlight the diagnostic challenges associated with this rare presentation, particularly in the context of metastatic disease.

Main Methods:

  • Case report review.
  • Diagnostic imaging (e.g., CT, MRI).
  • Core needle biopsy for histopathological confirmation.

Main Results:

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  • The patient presented with a retroperitoneal mass and a significantly elevated cancer antigen 19-9 (CA 19-9) level.
  • The elevated CA 19-9 was an unusual finding for leiomyosarcoma, complicating the differential diagnosis.
  • Metastatic disease to adjacent organs was present, further increasing diagnostic complexity.

Conclusions:

  • Massively elevated CA 19-9 levels are an exceedingly rare presentation of retroperitoneal leiomyosarcoma.
  • This presentation poses a significant diagnostic challenge, requiring a high index of suspicion.
  • Core needle biopsy is crucial for definitive diagnosis in such complex cases, especially with metastatic spread.