Imaging characteristics of hepatic metastases from abdominal leiomyosarcoma: A case report

Hepatic metastases from abdominal leiomyosarcoma are an extremely rare clinical condition. The multimodal imaging features of this condition have not been systematically described in the current literature, which may lead to delayed diagnosis or misdiagnosis and adversely affect patient prognosis. We herein report a case of hepatic metastases from abdominal leiomyosarcoma that occurred 5 years after surgical resection, and describe in detail its imaging features on ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI). Through literature review, we aim to enhance clinicians' ability to diagnose hepatic metastasis from abdominal leiomyosarcoma.

A 78-year-old woman presented to our hospital in January 2025 with bilateral lower limb edema. She had undergone abdominal tumor resection 5 years prior. Postoperative pathology confirmed the primary tumor as abdominal leiomyosarcoma.

Ultrasonography identified multifocal large masses within the hepatic parenchyma. Abdominal CT demonstrated hepatomegaly with multiple heterogeneously hypodense lesions. MRI revealed multiple hypervascular masses in the liver. In conjunction with the patient's history, these findings suggested hepatic metastases from abdominal leiomyosarcoma, which was subsequently confirmed by ultrasound-guided core needle biopsy of the hepatic mass.

Due to advanced age and poor performance status, surgery was contraindicated. Liposomal doxorubicin plus anlotinib was administered as first-line treatment.

The patient completed 6 treatment cycles stably without severe adverse events leading to discontinuation.

Hepatic metastases from abdominal leiomyosarcoma are rare but clinically significant. Comprehensive multimodal imaging (ultrasonography, CT, MRI) plays a pivotal role in characterizing these lesions: ultrasound serves as a noninvasive screening tool, while CT and MRI provide detailed anatomical, morphological and vascular information. Histopathological confirmation via ultrasound-guided core needle biopsy is the gold standard for diagnosis. Early detection of hepatic metastases through comprehensive imaging and timely intervention is critical to improving patient outcomes. This case highlights the need for increased awareness of the imaging features of hepatic metastases from abdominal leiomyosarcoma to facilitate early diagnosis and personalized treatment.