Laparoscopic resection of retroperitoneal metastasis originating from sternal leiomyosarcoma - a case report

Leiomyosarcomas are malignancies of smooth muscle differentiation that can metastasize early through hematogenous spread. Leiomyosarcoma of the sternum is extremely rare, with an incidence of < 0.7% among malignant bone tumors.

We report the case of a 66-year-old male with a retroperitoneal metastasis located in the right pararenal space, originating from a sternal leiomyosarcoma. Three years earlier, the patient had undergone partial excision of the sternum and costal cartilages, followed by thoracic wall osteosynthesis, for the primary tumor. Follow-up imaging with CT and PET-CT revealed a mass in the right perirenal space, situated between the upper pole of the right kidney and the right adrenal gland. In the absence of other metastatic lesions and following multidisciplinary oncology team discussion, the patient underwent laparoscopic en bloc metastasectomy and right adrenalectomy.

Histopathological examination confirmed the metastatic nature of the tumor with negative resection margins. Postoperatively, the patient experienced fever due to atelectasis, which resolved with intravenous antibiotics. He was discharged on the 6th postoperative day and remains free of recurrence at a two-year follow-up.

Minimally invasive surgical techniques allow for oncological resection of retroperitoneal metastatic lesions with low perioperative morbidity and mortality. Resection of isolated lymph node metastases has been shown to improve overall survival and disease control.