CT features of primary adrenal leiomyosarcoma_West China Medical Journal

Authors：

ZHONG Huanhuan ¹ , LIANG Yiwen ² ,  ZHANG Lizhi ¹

1. Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;
2. West China School of Medicine, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

ZHANG Lizhi, Email: littche_2000@163.com

Keywords：

Adrenal gland; Leiomyosarcoma; Tomography, X-ray computed

DOI：

10.7507/1002-0179.201908033

Video：

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Objective To investigate the CT and pathological findings of adrenal leiomyosarcoma, so as to improve the accuracy of diagnosis.Methods The clinical data of patients with adrenal leiomyosarcoma who were confirmed with surgery and pathology in West China Hospital, Sichuan University between August 2009 and January 2019 were retrospectively analyzed. Patients without pre-operation CT examination were excluded. The CT imaging features of the disease, including the location, size, shape, enhanced features, surrounding structures and metastasis of adrenal leiomyosarcoma were evaluated on CT images, respectively.Results Finally 5 patients were included. All of them had left single lesion. Enhanced CT features delineated large masses with well-defined but irregular boundaries, multicentric necrosis involving both the center and edge, continuous increased enhancement of the non-necrotic area, and cross-section of neovascularization or needle-tip vessels in the tumors. Among the 5 patients, 2 had postoperative recurrence and 3 lost follow-up.Conclusions Primary adrenal leiomyosarcoma is rare. Adrenal leiomyosarcoma could be correctly diagnosed with CT enhanced examination, which are helpful for making surgical strategies.

Citation： ZHONG Huanhuan, LIANG Yiwen, ZHANG Lizhi. CT features of primary adrenal leiomyosarcoma. West China Medical Journal, 2020, 35(7): 833-838. doi: 10.7507/1002-0179.201908033 Copy

1.	邓文友. 原发性肾上腺平滑肌肉瘤一例. 临床放射学杂志, 2016, 35(7): 1138.
2.	王海, 蒋令. 伴有骨肉瘤成分的肾上腺平滑肌肉瘤一例. 中华放射学杂志, 2007, 41(7): 781.
3.	覃峰, 梁世伟, 邓小强. 肾上腺巨大平滑肌肉瘤1例. 武警后勤学院学报(医学版), 2017, 26(4): 352-353.
4.	张祖豹, 凌建煜, 徐兆平, 等. 肾上腺平滑肌瘤伴肉瘤变1例报告. 肿瘤, 1997, 17(3): 55.
5.	李莉, 赵一平, 刘白鹭, 等. 肾上腺平滑肌肉瘤1例. 实用放射学杂志, 2008, 24(6): 784-809.
6.	尤向辉, 范黎, 任军, 等. 肾上腺平滑肌肉瘤1例. 第四军医大学学报, 2001, 22(18): 1713.
7.	谭智勇, 栾婷, 王海峰, 等. 原发性肾上腺平滑肌肉瘤1例报告. 现代泌尿外科杂志, 2019, 24(4): 325-326.
8.	吴建臣, 杨宇如, 余刚, 等. 肾上腺平滑肌肉瘤1例. 临床泌尿外科杂志, 2003, 18(7): 401.
9.	陈佳. 肾上腺平滑肌肉瘤一例. 放射学实践, 2015, 30(1): 97.
10.	周力, 李翼飞, 陈照彦. 肾上腺平滑肌肉瘤一例报告. 中华泌尿外科杂志, 2006, 27(6): 413.
11.	魏建国, 孙丽萍, 孙爱静, 等. 肾上腺原发性平滑肌肉瘤一例. 中华病理学杂志, 2014, 43(2): 122-123.
12.	李武超, 刘衡, 柏永华, 等. 原发肾上腺平滑肌肉瘤1例. 实用放射学杂志, 2015, 31(12): 2102-2103.
13.	李俊龙, 沈翀, 唐桂良, 等. 原发性肾上腺平滑肌肉瘤1例. 临床泌尿外科杂志, 2012, 27(8): 621.
14.	张双, 郭晓山, 姚灵. 原发性肾上腺平滑肌肉瘤1例. 医学影像学杂志, 2016, 26(12): 2158, 2163.
15.	梁晓超, 王伯胤, 徐利军. 原发性肾上腺平滑肌肉瘤一例. 放射学实践, 2012, 27(12): 1419.
16.	Taniguchi A, Ujike T, Fujita K, et al. A case of adrenal leiomyosarcoma. Hinyokika kiyo, 2017, 63(11): 465-469.
17.	Onishi T, Yanagihara Y, Kikugawa T, et al. Primary adrenal leiomyosarcoma with lymph node metastasis: a case report. World J Surg oncol, 2016, 14(1): 176.
18.	Zhou Y, Tang Y, Tang J, et al. Primary adrenal leiomyosarcoma: a case report and review of literature. Int J Clin Exp Pathol, 2015, 8(4): 4258-4263.
19.	Khan IN, Adlan MA, Stechman MJ, et al. A retroperitoneal leiomyosarcoma presenting as an adrenal incidentaloma in a subject on warfarin. Case Rep Endocrinol, 2015: 830814.
20.	Nagaraj V, Mustafa M, Amin E, et al. Primary adrenal leiomyosarcoma in an arab male: a rare case report with immunohistochemistry study. Case Rep Surg, 2015: 702541.
21.	Lee S, Tanawit GD, Lopez RA, et al. Primary leiomyosarcoma of adrenal gland with tissue eosinophilic infiltration. Korean J Pathol, 2014, 48(6): 423-425.
22.	Oztürk H. Vena cava invasion by adrenal leiomyosarcoma. Rare tumors, 2014, 6(2): 5275.
23.	Gulpinar MT, Yildirim A, Gucluer B, et al. Primary leiomyosarcoma of the adrenal gland: a case report with immunohistochemical study and literature review. Case Rep Urol, 2014: 489630.
24.	Wei J, Sun A, Tao J, et al. Primary Adrenal leiomyosarcoma: case report and review of the literature. Int J Surg Pathol, 2014, 22(8): 722-726.
25.	Deshmukh SD, Babanagare SV, Anand M, et al. Primary adrenal leiomyosarcoma: a case report with immunohistochemical study and review of literature. J Cancer Res Ther, 2013, 9(1): 114-116.
26.	Karaosmanoglu AD, Gee MS. Sonographic findings of an adrenal leiomyosarcoma. J Ultrasound Med, 2010, 29(9): 1369-1373.
27.	Hamada S, Ito K, Tobe M, et al. Bilateral adrenal leiomyosarcoma treated with multiple local therapies. Int J Clin Oncol, 2009, 14(4): 356-360.
28.	Wong C, Von Oppell UO, Scott-Coombes D. Cold feet from adrenal leiomyosarcoma. J R Soc Med, 2005, 98(9): 418-420.
29.	Oda Y, Miyajima K, Kawaguchi K, et al. Pleomorphic leiomyosarcoma: clinicopathologic and immunohistochemical study with special emphasis on its distinction from ordinary leiomyosarcoma and malignant fibrous histiocytoma. Am J Surg Pathol, 2001, 25(8): 1030-1038.
30.	M M, M B, M T, et al. Primary adrenal leiomyosarcoma: a case report and literature review. Clin Med Oncol, 2008, 2: 353-356.
31.	Wang TS, Ocal IT, Salem RR, et al. Leiomyosarcoma of the adrenal vein: a novel approach to surgical resection. World J Surg Oncol, 2007: 109.
32.	Mohanty SK, Balani JP, Parwani AV. Pleomorphic leiomyosarcoma of the adrenal gland: case report and review of the literature. Urology, 2007, 70(3): 591.e5-7.
33.	Lee CW, Tsang YM, Liu KL. Primary adrenal leiomyosarcoma. Abdom Imaging, 2006, 31(1): 123-124.
34.	Etten B, van Ijken MG, Mooi WJ, et al. Primary leiomyosarcoma of the adrenal gland. Sarcoma, 2001, 5(2): 95-99.
35.	Kato T, Kato T, Sakamoto S, et al. Primary adrenal leiomyosarcoma with inferior vena cava thrombosis. Int J Clin Oncol, 2004, 9(3): 189-192.
36.	Lujan MG, Hoang MP. Pleomorphic leiomyosarcoma of the adrenal gland. Arch Pathol Lab Med, 2003, 127(1): e32-e35.
37.	Matsui Y, Fujikawa K, Oka H, et al. Adrenal leiomyosarcoma extending into the right atrium. Int J Urol, 2002, 9(1): 54-56.
38.	Bhalla A, Sandhu F, Sieber S. Primary adrenal leiomyosarcoma: a case report and review of the literature. Conn Med, 2014, 78(7): 403-407.
39.	Shao IH, Lee WC, Chen TD, et al. Leiomyosarcoma of the adrenal vein. Chang Gung Med J, 2012, 35(5): 428-431.
40.	Goto J, Otsuka F, Kodera R, et al. A rare tumor in the adrenal region: neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient. Endocr J, 2008, 55(1): 175-181.
41.	Candanedo-González FA, Vela Chávez T, Cérbulo-Vázquez A. Pleomorphic leiomyosarcoma of the adrenal gland with osteoclast-like giant cells. Endocr Pathol, 2005, 16(1): 75-81.
42.	Thamboo TP, Liew LC, Raju GC. Adrenal leiomyosarcoma: a case report and literature review. Pathology, 2003, 35(1): 47-49.
43.	Zetler PJ, Filipenko JD, Bilbey JH, et al. Primary adrenal leiomyosarcoma in a man with acquired immunodeficiency syndrome (AIDS). Further evidence for an increase in smooth muscle tumors related to Epstein-Barr infection in AIDS. Arch Pathol Lab Med, 1995, 119(12): 1164-1167.
44.	Lack EE, Graham CW, Azumi N, et al. Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study. Am J Surg Pathol, 1991, 15(9): 899-905.
45.	Choi SH, Liu K. Leiomyosarcoma of the adrenal gland and its angiographic features: a case report. J Surg Oncol, 1981, 16(2): 145-148.
46.	Kanthan R, Senger JL, Kanthan S. Three uncommon adrenal incidentalomas: a 13-year surgical pathology review. World J Surg Oncol, 2012, 10: 64.
47.	Linos D, Kiriakopoulos AC, Tsakayannis DE, et al. Laparoscopic excision of bilateral primary adrenal leiomyosarcomas in a 14-year-old girl with acquired immunodeficiency syndrome (AIDS). Surgery, 2004, 136(5): 1098-1100.
48.	Boman F, Gultekin H, Dickman PS. Latent Epstein-Barr virus infection demonstrated in low-grade leiomyosarcomas of adults with acquired immunodeficiency syndrome, but not in adjacent Kaposi’s lesion or smooth muscle tumors in immunocompetent patients. Arch Pathol Lab Med, 1997, 121(8): 834-838.

1. 邓文友. 原发性肾上腺平滑肌肉瘤一例. 临床放射学杂志, 2016, 35(7): 1138.
2. 王海, 蒋令. 伴有骨肉瘤成分的肾上腺平滑肌肉瘤一例. 中华放射学杂志, 2007, 41(7): 781.
3. 覃峰, 梁世伟, 邓小强. 肾上腺巨大平滑肌肉瘤1例. 武警后勤学院学报(医学版), 2017, 26(4): 352-353.
4. 张祖豹, 凌建煜, 徐兆平, 等. 肾上腺平滑肌瘤伴肉瘤变1例报告. 肿瘤, 1997, 17(3): 55.
5. 李莉, 赵一平, 刘白鹭, 等. 肾上腺平滑肌肉瘤1例. 实用放射学杂志, 2008, 24(6): 784-809.
6. 尤向辉, 范黎, 任军, 等. 肾上腺平滑肌肉瘤1例. 第四军医大学学报, 2001, 22(18): 1713.
7. 谭智勇, 栾婷, 王海峰, 等. 原发性肾上腺平滑肌肉瘤1例报告. 现代泌尿外科杂志, 2019, 24(4): 325-326.
8. 吴建臣, 杨宇如, 余刚, 等. 肾上腺平滑肌肉瘤1例. 临床泌尿外科杂志, 2003, 18(7): 401.
9. 陈佳. 肾上腺平滑肌肉瘤一例. 放射学实践, 2015, 30(1): 97.
10. 周力, 李翼飞, 陈照彦. 肾上腺平滑肌肉瘤一例报告. 中华泌尿外科杂志, 2006, 27(6): 413.
11. 魏建国, 孙丽萍, 孙爱静, 等. 肾上腺原发性平滑肌肉瘤一例. 中华病理学杂志, 2014, 43(2): 122-123.
12. 李武超, 刘衡, 柏永华, 等. 原发肾上腺平滑肌肉瘤1例. 实用放射学杂志, 2015, 31(12): 2102-2103.
13. 李俊龙, 沈翀, 唐桂良, 等. 原发性肾上腺平滑肌肉瘤1例. 临床泌尿外科杂志, 2012, 27(8): 621.
14. 张双, 郭晓山, 姚灵. 原发性肾上腺平滑肌肉瘤1例. 医学影像学杂志, 2016, 26(12): 2158, 2163.
15. 梁晓超, 王伯胤, 徐利军. 原发性肾上腺平滑肌肉瘤一例. 放射学实践, 2012, 27(12): 1419.
16. Taniguchi A, Ujike T, Fujita K, et al. A case of adrenal leiomyosarcoma. Hinyokika kiyo, 2017, 63(11): 465-469.
17. Onishi T, Yanagihara Y, Kikugawa T, et al. Primary adrenal leiomyosarcoma with lymph node metastasis: a case report. World J Surg oncol, 2016, 14(1): 176.
18. Zhou Y, Tang Y, Tang J, et al. Primary adrenal leiomyosarcoma: a case report and review of literature. Int J Clin Exp Pathol, 2015, 8(4): 4258-4263.
19. Khan IN, Adlan MA, Stechman MJ, et al. A retroperitoneal leiomyosarcoma presenting as an adrenal incidentaloma in a subject on warfarin. Case Rep Endocrinol, 2015: 830814.
20. Nagaraj V, Mustafa M, Amin E, et al. Primary adrenal leiomyosarcoma in an arab male: a rare case report with immunohistochemistry study. Case Rep Surg, 2015: 702541.
21. Lee S, Tanawit GD, Lopez RA, et al. Primary leiomyosarcoma of adrenal gland with tissue eosinophilic infiltration. Korean J Pathol, 2014, 48(6): 423-425.
22. Oztürk H. Vena cava invasion by adrenal leiomyosarcoma. Rare tumors, 2014, 6(2): 5275.
23. Gulpinar MT, Yildirim A, Gucluer B, et al. Primary leiomyosarcoma of the adrenal gland: a case report with immunohistochemical study and literature review. Case Rep Urol, 2014: 489630.
24. Wei J, Sun A, Tao J, et al. Primary Adrenal leiomyosarcoma: case report and review of the literature. Int J Surg Pathol, 2014, 22(8): 722-726.
25. Deshmukh SD, Babanagare SV, Anand M, et al. Primary adrenal leiomyosarcoma: a case report with immunohistochemical study and review of literature. J Cancer Res Ther, 2013, 9(1): 114-116.
26. Karaosmanoglu AD, Gee MS. Sonographic findings of an adrenal leiomyosarcoma. J Ultrasound Med, 2010, 29(9): 1369-1373.
27. Hamada S, Ito K, Tobe M, et al. Bilateral adrenal leiomyosarcoma treated with multiple local therapies. Int J Clin Oncol, 2009, 14(4): 356-360.
28. Wong C, Von Oppell UO, Scott-Coombes D. Cold feet from adrenal leiomyosarcoma. J R Soc Med, 2005, 98(9): 418-420.
29. Oda Y, Miyajima K, Kawaguchi K, et al. Pleomorphic leiomyosarcoma: clinicopathologic and immunohistochemical study with special emphasis on its distinction from ordinary leiomyosarcoma and malignant fibrous histiocytoma. Am J Surg Pathol, 2001, 25(8): 1030-1038.
30. M M, M B, M T, et al. Primary adrenal leiomyosarcoma: a case report and literature review. Clin Med Oncol, 2008, 2: 353-356.
31. Wang TS, Ocal IT, Salem RR, et al. Leiomyosarcoma of the adrenal vein: a novel approach to surgical resection. World J Surg Oncol, 2007: 109.
32. Mohanty SK, Balani JP, Parwani AV. Pleomorphic leiomyosarcoma of the adrenal gland: case report and review of the literature. Urology, 2007, 70(3): 591.e5-7.
33. Lee CW, Tsang YM, Liu KL. Primary adrenal leiomyosarcoma. Abdom Imaging, 2006, 31(1): 123-124.
34. Etten B, van Ijken MG, Mooi WJ, et al. Primary leiomyosarcoma of the adrenal gland. Sarcoma, 2001, 5(2): 95-99.
35. Kato T, Kato T, Sakamoto S, et al. Primary adrenal leiomyosarcoma with inferior vena cava thrombosis. Int J Clin Oncol, 2004, 9(3): 189-192.
36. Lujan MG, Hoang MP. Pleomorphic leiomyosarcoma of the adrenal gland. Arch Pathol Lab Med, 2003, 127(1): e32-e35.
37. Matsui Y, Fujikawa K, Oka H, et al. Adrenal leiomyosarcoma extending into the right atrium. Int J Urol, 2002, 9(1): 54-56.
38. Bhalla A, Sandhu F, Sieber S. Primary adrenal leiomyosarcoma: a case report and review of the literature. Conn Med, 2014, 78(7): 403-407.
39. Shao IH, Lee WC, Chen TD, et al. Leiomyosarcoma of the adrenal vein. Chang Gung Med J, 2012, 35(5): 428-431.
40. Goto J, Otsuka F, Kodera R, et al. A rare tumor in the adrenal region: neuron-specific enolase (NSE)-producing leiomyosarcoma in an elderly hypertensive patient. Endocr J, 2008, 55(1): 175-181.
41. Candanedo-González FA, Vela Chávez T, Cérbulo-Vázquez A. Pleomorphic leiomyosarcoma of the adrenal gland with osteoclast-like giant cells. Endocr Pathol, 2005, 16(1): 75-81.
42. Thamboo TP, Liew LC, Raju GC. Adrenal leiomyosarcoma: a case report and literature review. Pathology, 2003, 35(1): 47-49.
43. Zetler PJ, Filipenko JD, Bilbey JH, et al. Primary adrenal leiomyosarcoma in a man with acquired immunodeficiency syndrome (AIDS). Further evidence for an increase in smooth muscle tumors related to Epstein-Barr infection in AIDS. Arch Pathol Lab Med, 1995, 119(12): 1164-1167.
44. Lack EE, Graham CW, Azumi N, et al. Primary leiomyosarcoma of adrenal gland. Case report with immunohistochemical and ultrastructural study. Am J Surg Pathol, 1991, 15(9): 899-905.
45. Choi SH, Liu K. Leiomyosarcoma of the adrenal gland and its angiographic features: a case report. J Surg Oncol, 1981, 16(2): 145-148.
46. Kanthan R, Senger JL, Kanthan S. Three uncommon adrenal incidentalomas: a 13-year surgical pathology review. World J Surg Oncol, 2012, 10: 64.
47. Linos D, Kiriakopoulos AC, Tsakayannis DE, et al. Laparoscopic excision of bilateral primary adrenal leiomyosarcomas in a 14-year-old girl with acquired immunodeficiency syndrome (AIDS). Surgery, 2004, 136(5): 1098-1100.
48. Boman F, Gultekin H, Dickman PS. Latent Epstein-Barr virus infection demonstrated in low-grade leiomyosarcomas of adults with acquired immunodeficiency syndrome, but not in adjacent Kaposi’s lesion or smooth muscle tumors in immunocompetent patients. Arch Pathol Lab Med, 1997, 121(8): 834-838.

West China Medical Journal

CT features of primary adrenal leiomyosarcoma

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