Pancreatic Metastasis from Primary Leiomyosarcoma of the Breast

An 84-year-old female presented with a 3-month history of asthenia, weight loss, and diffuse abdominal pain. Her medical history was remarkable for high-grade breast leiomyosarcoma (Ki67 25%, 5.5 × 4 × 3.5 cm) excised 6 years before (R1), with no recurrence during follow-up. Physical examination was significant for pallor and abdominal tenderness, and laboratory workup demonstrated anemia (Hb 5.4 g/dL) and elevated lipase (267 U/L) with normal liver function tests. Ultrasound and a CT scan revealed multiple solid hepatic lesions, the largest measuring 7 × 5 cm, a 3-cm pancreatic cephalic mass lesion, and a 3.1 × 2.5 cm endoluminal mass in the gallbladder (Fig. 1). Differential diagnosis included gallbladder and pancreatic cancer (eventually synchronous, with liver metastases) and late recurrence of the primary leiomyosarcoma of the breast with liver, gallbladder, and pancreatic metastases. Endoscopic ultrasound identified solid liver nodules and multiple pancreatic hypoechogenic, well-defined