Post written by Philippe Willems, MD, from the Center for Advanced Endoscopy, Research & Education, Orlando Health Digestive Health Institute, Orlando, Florida, USA.

A 46-year-old woman was evaluated in the endoscopy unit for intermittent epigastric pain. On EUS examination, a large, hypoechoic, and irregular mass was found in the pancreas, and a similar 6-cm lesion was seen in the splenic parenchyma.

Biopsy of the pancreatic mass was performed using a 22-gauge Franseen-tip needle. The lesion in the spleen also was sampled to rule out a concomitant lymphoproliferative neoplasm using a different 22-gauge needle. Results of both biopsies returned positive for leiomyosarcoma, which is a rare but aggressive mesenchymal tumor.

Leiomyosarcoma can metastasize both by direct invasion of adjacent organs or to distant sites via hematogenous spread. There is no effective treatment other than complete surgical resection for small localized lesions. Thus, rapid evaluation and timely diagnosis are pivotal for treatment.

To our knowledge, this is the first video case report of leiomyosarcoma in the literature. It highlights the EUS features of this tumor and can serve as guidance for endoscopists. We showcase a rare form of pancreatic cancer and review a proper approach to an unknown pancreatic mass found during EUS examination as well as fine-needle biopsy technique.

Moreover, despite the caveats, performing a biopsy on a lesion within the spleen can be done safely, which has mainly been reported in lymphoproliferative disease so far.

A, CT scan of the abdomen revealing a 4.2-cm mass in the pancreas and periaortic lymphadenopathy. B, CT scan showing a 6.7-cm mass in the splenic parenchyma.

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