Retroperitoneal leiomyosarcoma diagnosis and management in a chronic kidney disease context: A case report

While the treatment approach for sarcomas seems straightforward and well-defined, we often encounter several diagnostic or therapeutic challenges in clinical practice. This article presents a case of retroperitoneal leiomyosarcoma in a patient with chronic kidney disease, highlighting the complexity of managing such cases.

A 63-year-old woman with a history of chronic kidney disease presented with a progressively enlarging mass in her right flank. A CT scan revealed a retroperitoneal mass affecting the muscular layer of the right lumbar ureter, without invading the kidney. Percutaneous biopsies concluded to a smooth muscle tumor with positive anti-caldesmone and anti-desmin antibodies. A 99 m Tc DMSA renal revealed significant impairment of the right kidney function while the left kidney function remained normal. The surgical procedure involved removing the mass, as well as the right kidney and ureter. Histopathological examination confirmed the diagnosis of leiomyosarcoma. No locoregional recurrence or metastases were noted after a 13-month follow-up.

Leiomyosarcomas are malignant tumors that can affect various organs, with retroperitoneum being the second most common location. A CT scan and abdominal MRI are standard imaging technique to evaluate this disease. Percutaneous biopsy and pathology are performed to confirm the nature of the tumor, especially when neoadjuvant treatment is necessary for metastatic tumors. Compartmental resection with clear margins is the only potential curative treatment. Even after R0 resection the risk of recurrence varies between 20 and 75 %.

Managing retroperitoneal leiomyosarcoma, especially in patients with comorbidities like chronic kidney disease, necessitates a multidisciplinary approach.