Pancreatic Leiomyosarcoma With Multi-organ Metastases: A Rare Case

This case report describes the diagnosis, treatment, and progression of a 50-year-old male patient diagnosed with stage IV pancreatic leiomyosarcoma with metastases to the liver, lungs, and brain, representing the only case involving both the pancreas and brain documented in the hospital registry with a histopathological diagnosis of leiomyosarcoma. The patient initially presented with chronic abdominal pain, constipation, and weight loss, and subsequent CT scans revealed a large pancreatic mass with metastases to the liver, lungs, and brain. A biopsy confirmed the diagnosis of leiomyosarcoma, and the patient underwent eight cycles of palliative chemotherapy with cisplatin and docetaxel, along with palliative radiotherapy targeting the brain metastases. Despite these interventions, the disease progressed, resulting in the patient experiencing altered mental status, generalized weakness, and seizure-like activity, reflecting the impact of the brain metastases and overall disease progression. His management included treatment with dexamethasone, antiseizure medications, and supportive care, while discussions about palliative care options were conducted with the family. This rare case highlights the aggressive nature of pancreatic leiomyosarcoma, characterized by rapid progression and resistance to chemotherapy and radiotherapy, with the involvement of multiple organ systems demonstrating the challenges associated with managing advanced metastatic leiomyosarcoma.