Computed tomography‐guided cryoablation of pelvic metastasis from uterine leiomyosarcoma

Owing to its ability to place and use multiple cryoprobes simultaneously, cryoablation enables the treatment of tumors of any shape [1]. Cryoablation causes ice crystals to form within cells, inducing membrane rupture and cell death via cellular dehydration and local tissue ischemia. Ultrasound, computed tomography (CT), and magnetic resonance imaging (MRI) enable clear visualization of the margins of low-density and solid ice [2]. A case of breast cancer with axillary lymphnode metastasis treated with CT-guided cryoablation has been reported previously [3]. In 2005, a 72-year-old Caucasian woman underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy at the Gynecologic and Obstetric Clinic of Sassari University, Sassari, Italy, owing to recurrent metrorrhagia. Histology demonstrated a grade 1 uterine leiomyosarcoma and the woman underwent follow-up. In 2007, bone scintigraphy demonstrated metastasis of the pubic bone and ischium. Computed tomography-guided biopsy showed leiomyosarcoma metastasis. The woman underwent 18 cycles of radiotherapy at 4500 cGy, resulting in destruction of the metastasis. In 2009, a total-body CT scan showed a pelvic nodule measuring 28× 15 mm; biopsy revealed this to be a new metastatic tumor (b5. 0% of the tumor cells were positive for antigen KI-67). The woman refused chemotherapy but consented to cryoablation. Before CT-guided cryoablation was performed, the woman underwent total-body scintigraphy to rule out further metastasis. For local anesthesia, 2–5 mL of lidocaine (1.0%) was injected into the deep tissues proximal to the mass, along the expected course …