Published online Mar 7, 2017. doi: 10.3748/wjg.v23.i9.1725
Peer-review started: November 5, 2016
First decision: December 19, 2016
Revised: January 16, 2017
Accepted: February 7, 2017
Article in press: February 8, 2017
Published online: March 7, 2017
Processing time: 121 Days and 23 Hours
Multiple liver tumors represent a challenging condition for abdominal surgeons both in the selection of technique and the rarity of diagnosis. There are no case reports on co-existence of liver metastases from both intestinal leiomyosarcoma and adenocarcinoma. The patient described in this report successfully underwent resection of both primary lesions and liver metastases in combination with chemotherapy. As for the leiomyosarcoma, the primary cecal lesion was revealed more than three years after the patient's first visit. Peritoneal, lymph-node, and lung recurrences were observed afterward, and thus surgeries on those regions were performed. Pathologically, the peritoneal and lung recurrences comprised leiomyosarcoma and the lymph-node recurrence was diagnosed as adenocarcinoma. Despite newly discovered multiple lung recurrences and regional lymph-node metastases, the patient lived a normal life for 73 mo after the initial operation based on multidisciplinary therapy. He ultimately died of liver failure due to invasive lymph-node recurrence from the rectal adenocarcinoma, in addition to multiple lung recurrences from the leiomyosarcoma. Hepatic recurrence did not occur in this patient's case, which appears to be one reason for his long-term survival.
Core tip: There have been no case reports on co-existence of liver metastases from intestinal leiomyosarcoma and adenocarcinoma. This patient underwent resection of primary lesions and liver metastases in combination with chemotherapy. As for leiomyosarcoma, liver metastasis was discovered three years prior to discovery of the primary lesion. Peritoneal, lymph-node, and lung recurrences were discovered afterward, and therefore surgeries on those regions were performed. Despite newly discovered multiple lung recurrences and regional lymph-node metastases, the patient lived a normal life for 73 mo after the initial operation. He ultimately died of liver failure due to invasive lymph-node recurrence from the rectal adenocarcinoma.