Primary Retrovesical Leiomyosarcoma: A Case Report

Soft tissue sarcomas (STS) are a rare group of malignant tumors in adults. This group of tumors contains a variety of subtypes, each with distinct clinical features and presentations. Leiomyosarcoma is among the most common subtypes, which typically occur within the uterus, retroperitoneum, abdomen, and large blood vessels. At presentation, tumors are often large and may have metastasized to the lungs, liver, or peritoneum. Given the rarity and variability of the disease, a multidisciplinary treatment approach is essential for management, however, further research is needed to develop histologic-specific guidelines and targeted treatments. Here, we present a case of a 69-year-old male who was found to have a large pelvic mass of unknown etiology after presenting to the emergency department with generalized weakness, decreased appetite, and an inability to ambulate. On examination, he was found to have testicular swelling and trace edema of bilateral lower extremities. Labs significant for lactic acidosis and CT chest/abdomen/pelvis showed a large heterogeneously enhancing mass within the pelvis measuring up to 15 cm x 12 cm x 15 cm, of uncertain origin, but highly concerning for malignancy. Biopsy with immunohistochemical stains of the mass revealed a grade 2 leiomyosarcoma. Due to the size and location of the mass, transfer to a tertiary care center was recommended. Computed tomography angiography (CTA) abdomen/pelvis and magnetic resonance imaging (MRI) abdomen/pelvis performed at the tertiary care hospital revealed a 16.6 cm heterogeneously enhancing, necrotic mass within the retrovesical pelvic space and three liver lesions, which were concerning for metastases. Due to the patient's deconditioning and poor functional status, surgical resection and radiation were not offered. The patient expired soon after his code status was changed to comfort care.