A Case Report of Pancreatic Oligometastasis of Uterine Leiomyosarcoma

Uterine leiomyosarcoma (uLMS) is a rare, aggressive uterine malignancy with poor prognosis due to its early hematogenous spread, typically to the lungs and liver, and high recurrence rate. Pancreatic metastases are exceptionally rare, and isolated involvement of the pancreas is even more uncommon.

An 81-year-old patient was admitted after an unwitnessed fall and new neurologic symptoms, later diagnosed as a cerebellar stroke. Abdominopelvic imaging for urinary retention revealed a 9.9 × 15.1 × 18.8 - cm heterogeneous uterine mass and a 1.9-cm hypoenhancing lesion in the pancreatic head. Pelvic MRI findings suggested uLMS. Endoscopic ultrasound-guided biopsy confirmed the pancreatic lesion as metastatic leiomyosarcoma. No other sites of metastatic disease were found. Due to her extensive comorbidities and limited performance status, the patient ultimately elected for hospice care after being thoroughly counseled on her treatment options and multidisciplinary consultation.

This case illustrates a rare instance of isolated pancreatic metastasis from primary uLMS, a presentation that can mimic primary pancreatic cancer. It emphasizes the need for a broad differential diagnosis, histologic confirmation, and individualized treatment planning in medically complex patients.