Metachronous Liver Metastasis 13 Years after Surgery for Leiomyosarcoma of the Rectum

Abstract

A 61-year-old man was admitted to our hospital on suspicion of pathological fracture of the right clavicle. Abdominal CT scan revealed a huge tumor in the right lobe of the liver. The patient had undergone a low anterior resection of the rectum for leiomyosarcoma 13 years prior; the liver tumor was diagnosed as a metastatic tumor based on a biopsy examination of the leiomyosarcoma. We curatively performed well-developed inferior right hepatic vein-preserving central bisegmentectomy of the liver with resection of the right and middle hepatic veins. Immunohistochemical findings demonstrated that the tumor cells were negative for c-kit and positive for α-smooth muscle actin; similar results were demonstrated in the primary lesion. He received follow-up examinations after the operation, but a CT performed 6 months later showed remnant liver metastasis and multiple lung metastases. He refused chemotherapy, and received supportive care for 14 months after the operation. Leiomyosarcoma of the colon is likely to spread to the liver; however, liver resection is still the only way to treat liver metastasis. If curative resection is feasible, aggressive liver resection should be performed.