Leiomyosarcoma after Kidney Transplantation in a Patient with Leukocytoclastic Vasculitis, Lobular Panniculitis and History of Hyperthyroidism

Abstract

Leiomyosarcoma is a rare, aggressive malignant connective tissue cancer of mature adults, which increases from smooth muscle and occurs most frequently in the uterus, bowel, vascular tissues, and less commonly in somatic soft tissue or bone. We reported a 35-year-old woman was referred to the gastroenterology service with abdominal pain and vomiting. She was a case of renal transplantation in right side since 5 years ago. An evaluation by ultrasound showed right chest wall soft tissue mass measuring 40x36mm with internal vascularity without rib destruction. The CT Thorax without contrast, showed a solid mass in the right lower thoracic wall measuring 42x32mm with invasion to subcutaneous fat and abdominal wall muscle. The patient had history of hyperthyroidism about two years ago, which was treated and history of cutaneous leukocytoclastic vasculitis (LCV) and lobular panniculitis since last year, which was proven by skin biopsy. Our patient sought surgical advice who asked for a biopsy which showed a malignant spindle cell tumor compatible with leiomyosarcoma extending to peripheral fatty tissue with histological grade 2. In conclusion, treatment of thyroid disorders and LCV in kidney transplanted patients can be caused malignancies. Therefore, evaluation for malignancies like sarcoma is suggested with thyroid disorders and vasculitis in the follow-up of kidney transplanted patient.