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Borghese O, Pisani A, Dubrez J, Di Centa I. Treatment outlines for the management of primary leiomyosarcoma of the inferior vena cava. J Med Vasc 2022; 47:65-70. [PMID: 35691665 DOI: 10.1016/j.jdmv.2022.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Accepted: 03/26/2022] [Indexed: 06/15/2023]
Abstract
Primary venous Leiomyosarcoma (LMSs) are extremely rare tumours with poor survival rates. Surgery is currently the only potentially curative therapy in non-metastatic disease, but it consists in challenging interventions. The authors report the experience of one single centre in the treatment of LMS and a literature overview focusing on the diverse methods of vessels repair. Outcomes achieved are also outlined.
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Affiliation(s)
- Ottavia Borghese
- Sapienza University, Rome, Italy; Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France.
| | - Angelo Pisani
- Sapienza University, Rome, Italy; Department of Cardiovascular Surgery, Azienda Ospedaliera Santa Maria della Misericordia, Perugia, Italy
| | - Julien Dubrez
- Department of Gastrointestinal Surgery, Foch Hospital, Suresnes, France
| | - Isabelle Di Centa
- Department of Vascular and Endovascular Surgery, Foch Hospital, Suresnes, France
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Kasper B, D'Ambrosio L, Davis EJ, Ingham M, Broto JM, Trent JC, van Houdt WJ, Van Tine BA. What Clinical Trials Are Needed for Treatment of Leiomyosarcoma? Curr Treat Options Oncol 2022; 23:439-449. [PMID: 35275323 PMCID: PMC8930904 DOI: 10.1007/s11864-021-00928-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2021] [Indexed: 11/27/2022]
Abstract
OPINION STATEMENT Leiomyosarcoma is one of the most common subtypes of soft tissue sarcomas accounting for approximately 20% of sarcomas. As leiomyosarcoma patients frequently develop metastatic disease, effective systemic therapies are needed to improve clinical outcomes. The overall activity of the currently available conventional systemic therapies and the prognosis of patients with advanced and/or metastatic disease are poor. As such, the treatment of this patient population remains challenging. As a result, there is a clear unmet medical need, and designing and performing meaningful clinical studies are of utmost importance to improve the prognosis of this patient group. Therefore, the aim of this review is to briefly summarize state-of-the-art treatments for leiomyosarcoma patients and to describe trial characteristics needed for informative clinical studies.
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Affiliation(s)
- Bernd Kasper
- Mannheim University Medical Center, University of Heidelberg, Theodor-Kutzer-Ufer 1-3, D-68167, Mannheim, Germany.
| | | | - Elizabeth J Davis
- Department of Internal Medicine, Division of Hematology/Oncology, Vanderbilt University Medical Center, Nashville, USA
| | | | - Javier Martin Broto
- Medical Oncology Department, University Hospital Fundacion Jimenez Diaz, Madrid, Spain
| | - Jonathan C Trent
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, USA
| | - Winan J van Houdt
- Department of Surgical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Brian A Van Tine
- Siteman Cancer Center, Washington University in St. Louis, St. Louis, USA
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Imataki H, Okuno M, Miyake H, Nagai H, Yoshioka Y, Yuasa N, Fujino M. Portal vein leiomyosarcoma invading the pancreatic head. Clin J Gastroenterol 2022. [PMID: 35230653 DOI: 10.1007/s12328-022-01613-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Accepted: 02/14/2022] [Indexed: 10/19/2022]
Abstract
We encountered a rare case of a pancreatic head tumor protruding into the portal vein, later diagnosed histopathologically as primary leiomyosarcoma of the portal vein. A 59-year-old woman visited our hospital because of an elevated amylase level during a medical checkup. Computed tomography showed a moderately contrasted, well-defined mass of 35-mm diameter in the pancreatic head with protrusion into the portal vein. Endoscopic ultrasonography revealed a well-defined and hypoechoic mass. Fluorodeoxyglucose-positron emission tomography showed a high accumulation of fluorodeoxyglucose in the pancreas head. We performed a subtotal stomach-preserving pancreaticoduodenectomy with portal vein resection. Gross findings of the fixed specimen showed a white solid, multinodular mass in the pancreatic parenchyma with protrusion into the portal vein. Histopathological examination showed proliferation of spindle-shaped eosinophilic cells with intricate bundle-like growth, indicating leiomyosarcoma. Examining the tumor location and invasion suggested portal vein as the origin. Although portal vein primary leiomyosarcoma is rare, leiomyosarcoma should be considered as a differential diagnosis in pancreatic head tumors with protrusion into the portal vein. Precise macroscopic and histopathological examinations can help determine the definitive diagnosis and origin of leiomyosarcoma.
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104
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Wen CY, Lee HS, Lin JT, Yu CC. Disseminated peritoneal leiomyomatosis with malignant transformation involving right ureter: A case report. World J Clin Cases 2022; 10:1639-1644. [PMID: 35211604 PMCID: PMC8855271 DOI: 10.12998/wjcc.v10.i5.1639] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 11/14/2021] [Accepted: 01/10/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Disseminated peritoneal leiomyomatosis (DPL) with myxoid leiomyosarcoma is a rare variant of leiomysosarcoma, and hematuria as a presenting symptom has never been reported. Through this case report, we emphasize the investigation of the etiology, clinical presentation, diagnosis, treatment, and prognosis of DPL with malignant changes mimicking metastatic urinary tract cancer and to help develop further clinical management.
CASE SUMMARY We describe a case of DPL with malignant transformation involving the right ureter after laparoscopic hysterectomy. An exploratory laparotomy was performed and all visible nodules were surgically removed. DPL with focal malignant transformation to myxoid leiomyosarcoma was confirmed based on pathology results.
CONCLUSION Professionals who preoperatively diagnose DPL with malignant change to myxoid leiomyosarcoma involving the genitourinary tract should consider symptoms of abdominal pain, hematuria, and imaging of disseminated pelvic tumors in women, especially those with prior history of laparoscopic hysterectomy. Early complete removal of all tumors is the cornerstone to prevent DPL from malignant changes.
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Affiliation(s)
- Chen-Yueh Wen
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
| | - Herng-Sheng Lee
- Department of Pathology and Laboratory Medicine, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
| | - Jen-Tai Lin
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
| | - Chia-Cheng Yu
- Division of Urology, Department of Surgery, Kaohsiung Veterans General Hospital, Kaohsiung 81346, Taiwan
- School of Medicine, National Yang-Ming University, Taipei 814, Taiwan
- Department of Pharmacy, Tajen University, Pingtung 900, Taiwan
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105
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Sam SS, Stewart B, Nasri E, Leon ME, Martinez Duarte E. Leiomyosarcoma of the Nasal Cavity and Paranasal Sinuses: A Case Report and Comprehensive Review of the Literature. Head Neck Pathol 2022; 16:918-927. [PMID: 35157212 PMCID: PMC9424462 DOI: 10.1007/s12105-022-01427-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Accepted: 02/06/2022] [Indexed: 11/28/2022]
Abstract
Sinonasal leiomyosarcoma (LMS) is a rare and aggressive mesenchymal tumor with smooth muscle differentiation. The sinonasal tract is an unusual primary site for LMS, as scant smooth muscle exists in this location, with only 75 cases reported in the English literature including the case presented herein. Sinonasal LMS is considered an aggressive head and neck tumor with significant potential for recurrence and metastasis. Since recurrence is high and the potential for late metastasis exists, lifelong follow-up in these patients would be beneficial, especially among those with previous history of RB.
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Affiliation(s)
- Sumita S. Sam
- Department of Oral and Maxillofacial Diagnostic Sciences, College of Dentistry, University of Florida, Gainesville, FL USA
| | - Brian Stewart
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32010 USA
| | - Elham Nasri
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32010 USA
| | - Marino E. Leon
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL 32010 USA
| | - Ernesto Martinez Duarte
- Department of Pathology, Immunology and Laboratory Medicine, College of Medicine, University of Florida, 1600 SW Archer Rd, Gainesville, FL, 32010, USA.
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Kamitani R, Matsumoto K, Takeda T, Mizuno R, Oya M. Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases. BMC Cancer 2022; 22:15. [PMID: 34980039 PMCID: PMC8722180 DOI: 10.1186/s12885-021-09122-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 12/16/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Paratesticular leiomyosarcoma (LMS) is a rare tumor. Conventionally, tumor resection by high inguinal orchiectomy is performed as the preferred treatment approach for paratesticular sarcoma. On the other hand, testis-sparing surgery has recently attracted attention as a less-invasive treatment option for paratesticular sarcoma. However, the prognostic predictors and optimal treatment strategy for paratesticular LMS remain unclear because of its rarity. In this study, we systematically reviewed previously reported cases of paratesticular LMS to evaluate the prognostic factors and establish the optimal treatment strategy. METHODS A systematic search of Medline, Web of Science, Embase, and Google was performed to find articles describing localized paratesticular LMS published between 1971 and 2020 in English. The final cohort included 217 patients in 167 articles. The starting point of this study was the time of definitive surgical treatment, and the end point was the time of local recurrence (LR), distant metastasis (DM), and disease-specific mortality. RESULTS Patients with cutaneous LMS had a slightly better LR-free survival, DM-free survival, and disease-specific survival than those with subcutaneous LMS (p = 0.745, p = 0.033, and p = 0.126, respectively). Patients with higher grade tumors had a significantly higher risk of DM and disease-specific mortality (Grade 3 vs Grade 1 p < 0.001, and Grade 3 vs Grade 1 p < 0.001, respectively). In addition, those with a microscopic positive margin had a significantly higher risk of LR and DM than those with a negative margin (p < 0.001, and p = 0.018, respectively). Patients who underwent simple tumorectomy had a slightly higher risk of LR than those who underwent high inguinal orchiectomy (p = 0.067). Subgroup analysis of cutaneous LMS demonstrated that the difference in LR between simple tumorectomy and high inguinal orchiectomy was limited (p = 0.212). On the other hand, subgroup analysis of subcutaneous LMS revealed a significant difference in LR (p = 0.039). CONCLUSIONS Our study demonstrated that subcutaneous LMS and high-grade tumors are prognostic factors for paratesticular LMS. For subcutaneous LMS, tumorectomy with high inguinal orchiectomy should be the optimal treatment strategy to achieve a negative surgical margin.
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Affiliation(s)
- Rei Kamitani
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Kazuhiro Matsumoto
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan.
| | - Toshikazu Takeda
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Shinanomachi 35, Shinjuku-ku, Tokyo, 160-8582, Japan
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Kho RM, Desai VB, Schwartz PE, Wright JD, Gross CP, Hutchison LM, Boscoe FP, Lin H, Xu X. Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma. J Minim Invasive Gynecol 2022; 29:119-127. [PMID: 34265441 PMCID: PMC8752465 DOI: 10.1016/j.jmig.2021.07.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 07/07/2021] [Accepted: 07/07/2021] [Indexed: 01/03/2023]
Abstract
STUDY OBJECTIVES To examine the effectiveness of endometrial sampling for preoperative detection of uterine leiomyosarcoma in women undergoing hysterectomy, identify factors associated with missed diagnosis, and compare the outcomes of patients who had a preoperative diagnosis with those of patients who had a missed diagnosis. DESIGN Retrospective cohort study using linked data from the New York Statewide Planning and Research Cooperative System and New York State Cancer Registry from 2003 to 2015. SETTING Inpatient and outpatient encounters at civilian hospitals and ambulatory surgery centers in New York State. PATIENTS Women with uterine leiomyosarcoma who underwent a hysterectomy and a preoperative endometrial sampling within 90 days before the hysterectomy. INTERVENTIONS Endometrial sampling. MEASUREMENTS AND MAIN RESULTS A total of 79 patients with uterine leiomyosarcoma met the sample eligibility criteria. Of these patients, 46 (58.2%) were diagnosed preoperatively, and 33 (41.8%) were diagnosed postoperatively. Patients in the 2 groups did not differ significantly in age, race/ethnicity, bleeding symptoms, or comorbidities assessed. In multivariable regression analysis, women who had endometrial sampling performed with hysteroscopy (compared with women who had endeometrial sampling performed without hysteroscopy) had a higher likelihood of preoperative diagnosis (adjusted risk ratio [aRR] 3.03; 95% confidence interval [CI], 1.43-6.42). Patients with localized stage (vs distant stage) or tumor size >11 cm (vs <8 cm) were less likely to be diagnosed preoperatively (aRR 0.50; 95% CI, 0.28-0.89, and aRR 0.54; 95% CI, 0.30-0.99, respectively). Supracervical hysterectomy was not performed in any of the patients whose leiomyosarcoma was diagnosed preoperatively compared with 21.2% of the patients who were diagnosed postoperatively (p = .002). CONCLUSION Endometrial sampling detected leiomyosarcoma preoperatively in 58.2% of the patients. The use of hysteroscopy with endometrial sampling improved preoperative detection of leiomyosarcoma by threefold. Patients with a missed diagnosis had a higher risk of undergoing suboptimal surgical management at the time of their index surgery.
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Affiliation(s)
- Rosanne M. Kho
- Women’s Health Institute, Department of Obstetrics
and Gynecology, Cleveland Clinic, Cleveland, OH
| | - Vrunda B. Desai
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT,CooperSurgical Inc, Trumbull, CT
| | - Peter E. Schwartz
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT
| | - Jason D. Wright
- Department of Obstetrics and Gynecology, Columbia
University College of Physicians and Surgeons, New York, NY
| | - Cary P. Gross
- Department of Internal Medicine, Yale School of Medicine,
New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness
Research (COPPER) Center, New Haven, CT
| | | | - Francis P. Boscoe
- New York State Cancer Registry, New York State Department
of Health, Albany, NY
| | - Haiqun Lin
- Division of Nursing Science, Rutgers University School of
Nursing, Newark, NJ,Department of Biostatistics and Epidemiology, Rutgers
School of Public Health, Newark, NJ
| | - Xiao Xu
- Department of Obstetrics, Gynecology and Reproductive
Sciences, Yale School of Medicine, New Haven, CT,Yale Cancer Outcomes, Public Policy and Effectiveness
Research (COPPER) Center, New Haven, CT,Corresponding Author: Xiao Xu, PhD,
Yale University School of Medicine, LSOG 205B, 310 Cedar Street, New Haven, CT
06520; Phone: (203) 737-1655; Fax: (203) 785-6586;
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Ciarrocchi AP, Aramini B, Sanna S, Rossi G, Argnani D, Stella F. A large and late mediastinal metastasis from a uterine smooth muscle tumour of uncertain malignant potential: A case report. Int J Surg Case Rep 2021; 90:106734. [PMID: 34972012 DOI: 10.1016/j.ijscr.2021.106734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Revised: 12/22/2021] [Accepted: 12/22/2021] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Smooth muscle tumours of uncertain malignant potential (STUMP) are mesenchymal uterine tumours with a malignant potential found somewhere between that of benign leiomyomas and leiomyosarcomas. Only three cases of STUMP pulmonary metastasis exist in the literature. CASE PRESENTATION We report the case of a 63 year-old female patient presenting with dysphonia secondary to recurrent laryngeal nerve paralysis due to an enormous mediastinal STUMP metastasis, 14 years after having undergone a total hysterectomy with bilateral salpingo-oophorectomy. A successful left pneumonectomy was performed and the mass weighing 1570 g was histologically confirmed as a STUMP metastasis. DISCUSSION Only three cases of pulmonary metastasis from STUMP have been reported in the recent literature and no robust information exists about the metastatic nature of STUMP. No cases exist in the literature of a successful pneumonectomy performed for a STUMP metastasis of such large dimensions presenting after many years from the diagnosis of the primary uterine lesion. Physicians should keep in mind that the finding of a smooth muscle tumour in the lung of a woman should promptly raise the suspicion of a metastatic uterine malignancy, even several years after diagnosis of the primary lesion. CONCLUSION Despite the size, invasiveness and late presentation of the STUMP metastasis, the surgery was successful and the patient no longer requires oxygen therapy.
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109
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Vias P, Goyal S, Periasamy K, Madan R, Devana SK, Bal A, Kundu R. Leiomyosarcoma of urinary bladder with unusual recurrence in intestinal mucosa and peritoneum: a case report. J Egypt Natl Canc Inst 2021; 33:38. [PMID: 34897558 DOI: 10.1186/s43046-021-00095-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 11/14/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Leiomyosarcomas of urinary bladder constitute rare malignant sarcomas with very few cases reported in literature. CASE PRESENTATION Here, we present a case of bladder leiomyosarcoma in a well-preserved female. She failed to respond to standard chemotherapy and had a rapidly downhill course with unusual metastases in anastomotic site and peritoneum soon after surgery. Despite multimodality management including resection of primary and metastatic site, systemic therapy and pelvic radiotherapy, our patient had dismal prognosis with an overall survival of 1.7 years. CONCLUSION Leiomyosarcomas of bladder are aggressive tumors and have a very poor prognosis; thus, future research should focus on optimizing more effective treatment regimes.
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Affiliation(s)
- Poorva Vias
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Shikha Goyal
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - Kannan Periasamy
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Renu Madan
- Department of Radiotherapy, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Sudheer Kumar Devana
- Department of Urology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Amanjit Bal
- Department of Histopathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Reetu Kundu
- Department of Cytology and Gynaecological Pathology, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India
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Falkenhorst J, Hamacher R, Bauer S. [Medicinal treatment of retroperitoneal soft tissue sarcomas]. Chirurg 2021. [PMID: 34874461 DOI: 10.1007/s00104-021-01539-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2021] [Indexed: 10/19/2022]
Abstract
Retroperitoneal soft tissue sarcomas represent extreme challenges for interdisciplinary treatment teams. The sarcoma-specific experience of surgeons has the greatest impact on the survival of patients; however, too many patients still die despite optimal local treatment. The role of chemotherapy is undisputed only for patients with highly malignant bone sarcomas or rhabdomyosarcomas. For soft tissue sarcomas in adult patients, especially liposarcomas and leiomyosarcomas, the evidence situation is very unsatisfactory. This overview article discusses the complex data situation and controversial aspects that are relevant for current treatment decisions in interdisciplinary treatment teams.
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111
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Jun H. Mesenteric and myocardial ischemia revealing lower limb sarcoma. Int J Surg Case Rep 2021; 89:106616. [PMID: 34856441 PMCID: PMC8640440 DOI: 10.1016/j.ijscr.2021.106616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 10/19/2021] [Accepted: 11/16/2021] [Indexed: 11/22/2022] Open
Abstract
Introduction and importance Although most of the causes of acute superior mesenteric artery (SMA) embolism with a poor clinical course originate from the heart, we report a case of SMA embolism secondary to advanced sarcoma of the lower extremities. Case presentation A 66-year-old man presented with chest and epigastric discomfort that lasted for 1 day. Coronary angioplasty was performed, followed by laparotomy with an embolectomy of the SMA, small bowel resection, and ileostomy. After surgery, leiomyosarcoma was diagnosed on a biopsy performed in the left thigh, and lung metastasis was confirmed. He had recurrent peritonitis for 2 months and died of multiple organ failure. Clinical discussion The common etiologies of SMA embolism include cardioembolic sources with atrial fibrillation and recent myocardial infarction. Rare etiologies include atherosclerotic plaque, mural thrombus of the aneurysm, and cardiac sarcoma. Conclusion Efforts are required for the systemic evaluation of various etiologies in patients with SMA embolism who require rapid diagnosis and intervention. Mesenteric ischemia and myocardial ischemia caused by advanced sarcoma of lower extremities are rare. When evaluating patients with SMA embolism, systemic evaluation of various etiologies is required. We present a case of SMA embolism secondary to advanced sarcoma of the lower extremities.
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Affiliation(s)
- Heungman Jun
- Department of Surgery, Inje University College of Medicine, Ilsan-Paik Hospital, Goyang, Republic of Korea.
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112
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Sousa FAE, Ferreira J, Cunha TM. MR Imaging of uterine sarcomas: a comprehensive review with radiologic-pathologic correlation. Abdom Radiol (NY) 2021; 46:5687-5706. [PMID: 34468798 DOI: 10.1007/s00261-021-03263-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 08/22/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023]
Abstract
The aim of this article is to summarize the MRI features of each sarcoma subtype and to correlate them with its pathological findings. Literature review through PubMed/Medline database to identify relevant articles on uterine sarcomas, with a special emphasis on their MRI findings and pathological features. While several, more generalistic, MRI findings of a uterine tumour should raise suspicion for malignancy (including irregular contour, intra-tumoral necrosis/hemorrhage and low ADC values), some particular features may suggest their specific histological subtype such as the gross lymphovascular invasion associated with endometrial stromal sarcomas, the "bag of worms" appearance of the low-grade endometrial stromal sarcoma and the "lattice-like" aspect of adenosarcomas which results from the mixed composition of solid and multiseptated cystic components. Knowledge of the different histological uterine sarcoma subtypes, their specific MRI features and comprehension of their pathological background allows for a more confident diagnosis and may indicate the correct histological subtype.
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Affiliation(s)
- Filipa Alves E Sousa
- Department of Radiology, Centro Hospitalar Universitário de Lisboa Central, Alameda Santo António dos Capuchos, 1169-050, Lisbon, Portugal.
| | - Joana Ferreira
- Department of Pathology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
- Nova Medical School, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Teresa Margarida Cunha
- Department of Radiology, Instituto Português de Oncologia de Lisboa Francisco Gentil, R. Prof. Lima Basto, 1099-023, Lisbon, Portugal
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Antakle M, Alshaghel MM, Ghannam G, Al-Ibraheem M, Shehade L, Agha S, Etr A. Primary cutaneous Leiomyosarcoma on the left iliac region: A rare case report from Syria. Ann Med Surg (Lond) 2021; 71:102992. [PMID: 34840749 PMCID: PMC8606708 DOI: 10.1016/j.amsu.2021.102992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Revised: 10/26/2021] [Accepted: 10/28/2021] [Indexed: 12/03/2022] Open
Abstract
Introduction and importance: Leiomyosarcoma is a rare aggressive soft-tissue malignancy typically originating from embryonic mesoderm or mesenchymal cell lines in smooth muscles. Leiomyosarcoma of the skin is termed as “Dermal Leiomyosarcoma”, and is categorized into two subdivisions; superficial cutaneous and deep subcutaneous. Both types begin either as primary lesions or metastatic lesions from distant sites. Case presentation We report the case of a 60-year-old male patient with Primary Cutaneous Leiomyosarcoma (PCL) located in the left iliac region. His history is insignificant and he has no family or genetic history of leiomyosarcoma. The lesion was itchy without any other symptoms and existed 20 years before our evaluation. A biopsy from the nodule was performed and sent to the pathology department, where the section was stained with smooth muscle actin stain (SMA) and the result was positive. We referred the patient to a surgeon to excise the nodule. The lesion was excised with a 3cm safety margin, the eradication includes also the of the major iliac muscle. After one year of follow-up there was no metastasis nor recurrence. Conclusion Primary Cutaneous Leiomyosarcoma is a very rare malignancy and it is hard to diagnose without biopsy and pathological examination. Primary cutaneous Leiomyosarcoma is a very rare tumor. Accurate diagnosis cannot be made without histological and immunohistochemical examination. Surgery is the only guaranteed treatment and other methods are still controversial.
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Affiliation(s)
| | | | - Ghina Ghannam
- Faculty of Medicine, Aleppo University, Aleppo, Syria
| | | | - Linda Shehade
- Department of Pathology, Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Sarab Agha
- Department of Pathology, Faculty of Medicine, Aleppo University, Aleppo, Syria
| | - Aladdin Etr
- Department of Plastic Surgery, Faculty of Medicine, Aleppo University, Aleppo, Syria
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Futagawa M, Yamamoto H, Kochi M, Urakawa Y, Sogawa R, Kato F, Okazawa-Sakai M, Ennishi D, Shinozaki K, Inoue H, Yanai H, Hirasawa A. Retroperitoneal leiomyosarcoma in a female patient with a germline splicing variant RAD51D c.904-2A > T: a case report. Hered Cancer Clin Pract 2021; 19:48. [PMID: 34838098 PMCID: PMC8627011 DOI: 10.1186/s13053-021-00205-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Accepted: 11/03/2021] [Indexed: 11/10/2022] Open
Abstract
Background RAD51D (RAD51 paralog D) is an intermediate cancer susceptibility gene for primary ovarian cancer, including fallopian tube and peritoneal carcinomas and breast cancer. Although gynecological non-epithelial tumors such as uterine sarcomas are associated with genomic instability, including BRCA impairment, there is no clear evidence of the relationship between RAD51D variants and the risk of sarcoma development. Case presentation A Japanese woman in her 50s underwent multiple surgical resections and several regimens of chemotherapy for tumors that originated in the retroperitoneum and recurred in the peritoneum over a clinical course of approximately 4 years. The peritoneal tumor was histologically diagnosed as a leiomyosarcoma and was genetically identified to show a splice variant of RAD51D c.904-2A > T [NM_002878] through tumor profiling performed as a part of cancer precision medicine. The confirmatory genetic test performed after genetic counseling revealed that the RAD51D splicing variant detected in her tumor was of germline origin. In silico analyses supported the possible pathogenicity of the detected splice variant of RAD51D with a predicted attenuation in mRNA transcription and truncated protein production due to frameshifting, which was attributed to a single-nucleotide alteration in the splicing acceptor site at the 3′-end of intron 9 of RAD51D. Considering her unfavorable clinical outcome, which showed a highly aggressive phenotype of leiomyosarcoma with altered RAD51D, this case provided novel evidence for the relationship of a RAD51D splicing variant with malignant tumor development or progression. We report the findings of this rare case with possible involvement of the germline variant of RAD51D c.904-2A > T as a potential predisposing factor for malignant tumors, including leiomyosarcoma. Conclusions We present the findings of a case of leiomyosarcoma in the peritoneum of a female patient with a novel germline splicing variant of RAD51D as potential evidence for the pathogenicity of the variant and its involvement in the risk of sarcoma etiology and/or development. To the best of our knowledge, this is the first case report describing a leiomyosarcoma carrying a germline RAD51D splicing variant and elucidating its pathogenicity on the basis of computational prediction of the impairment of normal transcription and the presumed loss of functional protein production. Supplementary Information The online version contains supplementary material available at 10.1186/s13053-021-00205-x.
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Affiliation(s)
- Mashu Futagawa
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan.,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Hideki Yamamoto
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan. .,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan.
| | - Mariko Kochi
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan.,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Yusaku Urakawa
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan.,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Reimi Sogawa
- Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Fumino Kato
- Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Mika Okazawa-Sakai
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan
| | - Daisuke Ennishi
- Center for Comprehensive Genomic Medicine, Okayama University Hospital, Okayama, Japan
| | - Katsunori Shinozaki
- Division of Clinical Oncology, Hiroshima Prefecture Hospital, Hiroshima, Japan
| | - Hirofumi Inoue
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Hiroyuki Yanai
- Department of Pathology, Okayama University Hospital, Okayama, Japan
| | - Akira Hirasawa
- Department of Clinical Genomic Medicine, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University, 2-5-1 Shikata-cho, Kita-ku, Okayama, 700-8551, Japan.,Department of Clinical Genomic Medicine, Okayama University Hospital, Okayama, Japan
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Li Y, Zhang H, Wang Z, Shi H, Nie L, Zhao R. A brief review and case report of urothelial carcinoma and metachronous leiomyosarcoma of the bladder at the same anatomic region. Urol Case Rep 2021; 40:101931. [PMID: 34820286 PMCID: PMC8601975 DOI: 10.1016/j.eucr.2021.101931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 11/06/2021] [Indexed: 11/18/2022] Open
Abstract
One patient with bladder leiomyosarcoma and urothelial carcinoma is very rare. Only 10 cases have been reported in the literature. A 70-year-old patient was admitted due to bladder tumor. Two TURBTs were performed confirming the patient was free of tumor, and pathology reported low-grade urothelial carcinoma. Three years later, a tumor was also found on the right anterolateral wall of urinary bladder and was diagnosed as leiomyosarcoma by pathological examination. Radical cystectomy was performed. With 45 months follow-up, the patient has no recurrence. Two malignancies in the same anatomic region at different time has never been reported to date.
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Affiliation(s)
- Yajie Li
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
| | - Hang Zhang
- Department of Surgery, Bazhong Central Hospital, Bazhong, Sichuan, 636000, PR China
| | - Zhenwei Wang
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
| | - Hongbin Shi
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
| | - Lihong Nie
- School of Basic Medical Sciences, Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
- Corresponding author. Department of Physiology.
| | - Ruining Zhao
- Department of Urology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia, 750004, PR China
- Corresponding author.
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Aichouni N, Ziani H, Karich N, Bennani A, Kamaoui I, Nasri S, Skiker I. Primary leiomyosarcoma of the sigmoid colon: Case report and review of literature. Radiol Case Rep 2021; 17:35-40. [PMID: 34765056 PMCID: PMC8569432 DOI: 10.1016/j.radcr.2021.09.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2021] [Revised: 09/23/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022] Open
Abstract
Leiomyosarcomas of the sigmoid colon are aggressive and extremely rare tumors representing less than 0.1% of all colorectal malignancies. Few cases have been reported in the literature and their imaging features need to be more detailed. We report the case of a 70 year old male patient, smoker, with a history of arterial hypertension, admitted for abdominal pain and hypogastric mass. Computed tomography has shown a voluminous heterogeneously enhancing tumor process with a necrotic center, attached to the sigmoid wall, with multiple secondary peritoneal and hepatic masses. The anatomopathological examination of the biopsy sample with immunohistochemistry allowed the diagnosis of leiomyosarcoma of the sigmoid colon. Clinical presentation and radiological features of leiomyosarcomas are non-specific, and the definitive diagnosis is only established after an anatomopathological examination.
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Affiliation(s)
- Narjisse Aichouni
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Hamid Ziani
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Nassira Karich
- Department of Pathology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Amal Bennani
- Department of Pathology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Imane Kamaoui
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Siham Nasri
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
| | - Imane Skiker
- Department of Radiology, Mohammed VI University Hospital, Faculty of Medicine, University Mohammed First, BP 4806 Oujda University 60049, Morocco
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Matsuura K, Inoue K, Hoshino E, Yasuda M, Hasegawa K, Okada Y, Baba Y, Kozawa E. Utility of magnetic resonance imaging for differentiating malignant mesenchymal tumors of the uterus from T2-weighted hyperintense leiomyomas. Jpn J Radiol 2021; 40:385-395. [PMID: 34750737 PMCID: PMC8977266 DOI: 10.1007/s11604-021-01217-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Accepted: 10/28/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE To generate a new discrimination method to distinguish between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma based on magnetic resonance imaging findings and clinical features. MATERIALS AND METHODS Data from 32 tumors of 32 patients with malignant mesenchymal tumors of the uterus and from 34 tumors of 30 patients with T2-weighted hyperintense leiomyoma were analyzed. Clinical parameters, qualitative magnetic resonance imaging features, including computed diffusion-weighted imaging, and quantitative characteristics of magnetic resonance imaging of these two tumor types were compared. Predictive values for malignant mesenchymal tumors of the uterus were calculated using variant discriminant analysis. RESULTS The T1 bright area on qualitative assessment and mean apparent diffusion coefficient value on quantitative assessment yielded the most independent magnetic resonance imaging differentiators of malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma. The classification accuracy of the variant discriminant analysis based on three selected findings, i.e., a T1 bright area, computed diffusion-weighted imaging with a b-value of 2000s/mm2 (cDWI2000), and T2-hypointense bands, was 84.8% (56/66), indicating high accuracy. CONCLUSIONS Variant discriminant analysis using the T1 bright area, cDWI2000, and T2-hypointense bands yielded high accuracy for differentiating between malignant mesenchymal tumors of the uterus and T2-weighted hyperintense leiomyoma.
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Affiliation(s)
- Koichiro Matsuura
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan.
| | - Kaiji Inoue
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Eri Hoshino
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Masanori Yasuda
- Department of Pathology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Kosei Hasegawa
- Department of Gynecologic Oncology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
| | - Yoshitaka Okada
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Yasutaka Baba
- Department of Diagnostic Radiology, Saitama Medical University International Medical Center, 1397-1 Yamane, Hidaka, Saitama, Japan
| | - Eito Kozawa
- Department of Radiology, Saitama Medical University, 38, Morohongo, Moroyamamachi, Saitama, Japan
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Tresgallo-Parés R, De Virgilio-Salgado L, Torres-Lugo NJ, Asenjo-Molina NA, Ramirez N, Bibiloni-Rodríguez J. Primary leiomyosarcoma of the great saphenous vein: A case report. Int J Surg Case Rep 2021; 88:106565. [PMID: 34741863 PMCID: PMC8581499 DOI: 10.1016/j.ijscr.2021.106565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 10/14/2021] [Accepted: 10/30/2021] [Indexed: 11/17/2022] Open
Abstract
Introduction and importance Vascular smooth muscle sarcomas are rare neoplasms that comprise less than 2% of all leiomyosarcomas. These malignancies usually originate in the inferior vena cava, with a limited number of cases affecting the great saphenous vein. Due to the limited reports on these sarcomas, epidemiologic data remains insufficient. Case presentation We report the case of a 67-year-old Hispanic female that presented with an asymptomatic growing mass in her right thigh. She was managed with an En bloc resection under the impression of a smooth muscle vascular sarcoma. The diagnosis was confirmed after histopathologic evaluation. Clinical discussion Vascular leiomyosarcomas remain a rare and challenging diagnosis. They usually present as a slowly growing mass that is initially asymptomatic. High clinical suspicion and a comprehensive radiologic evaluation, including magnetic resonance imaging, are crucial. Histopathological evaluation is essential for diagnostic confirmation. Surgical excision remains the treatment of choice, with radiation therapy mostly considered for local disease control. Postsurgical surveillance is necessary every three months to monitor for signs of recurrence. Conclusion Physicians should remain aware of the nonspecific presentation of leiomyosarcomas and the importance of a comprehensive diagnostic approach. Early diagnosis and adequate management are fundamental elements in the treatment of these aggressive tumors. Consider leiomyosarcoma within the differential diagnosis of a painless enlarging mass. Doppler ultrasound and magnetic resonance imaging are valuable diagnostic tools. Data support radiation therapy for local control of these neoplasms. This case contributes to the limited literature regarding the epidemiology and treatment of these tumors.
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Affiliation(s)
- Ruben Tresgallo-Parés
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067
| | - Lucas De Virgilio-Salgado
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067.
| | - Norberto J Torres-Lugo
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067.
| | - Natalia A Asenjo-Molina
- School of Medicine, University of Puerto Rico, Medical Sciences Campus, San Juan Puerto Rico 00936-5067.
| | - Norman Ramirez
- Department of Pediatric Orthopaedic Surgery, Mayagüez Medical Center, Mayagüez, Puerto Rico 00680
| | - Juan Bibiloni-Rodríguez
- Orthopaedic Surgery Department, University of Puerto Rico, Medical Sciences Campus, San Juan, Puerto Rico 00936-5067
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Xie XJ, Jiang TA, Zhao QY. Diagnostic value of contrast-enhanced ultrasonography in mediastinal leiomyosarcoma mimicking aortic hematoma: A case report and review of literature. World J Clin Cases 2021; 9:9652-9661. [PMID: 34877303 PMCID: PMC8610851 DOI: 10.12998/wjcc.v9.i31.9652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 07/18/2021] [Accepted: 09/19/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Primary mediastinal leiomyosarcomas are extremely rare. We report a case of leiomyosarcoma around the thoracic and abdominal aorta, mimicking an aortic hematoma, and discuss the diagnostic value of ultrasound.
CASE SUMMARY A 63-year-old female was hospitalized for abdominal pain. Initial computed tomography angiography revealed an enhanced mass around the lower thoracic and upper abdominal aorta. Aortic hematoma was strongly suspected, and stents were placed by interventional surgery. About 1 mo postoperatively, the patient was re-hospitalized because of progressive abdominal pain. Ultrasound showed that the mass had a heterogeneous echo. In contrast-enhanced ultrasound, the hyperechoic regions were filled with contrast medium after the aortic region was, indicating that the blood supply was abundant but had no direct connection with the aorta. There was no obvious contrast medium-filling in the hypoechoic area. These findings were similar to those of malignant tumors with liquefaction and necrosis. Positron emission tomography/computed tomography confirmed that the mass had a high metabolic signal similar to that of a malignant tumor. Leiomyosarcoma was confirmed by postoperative pathology.
CONCLUSION Symptoms of mediastinal leiomyosarcoma surrounding the aorta may mimic aortic hematoma. Contrast-enhanced ultrasound can provide valuable and unique diagnostic clues.
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Affiliation(s)
- Xiu-Jing Xie
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Tian-An Jiang
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
| | - Qi-Yu Zhao
- Department of Ultrasound Medicine, Zhejiang University School of Medicine First Affiliated Hospital, Hangzhou 310003, Zhejiang Province, China
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Brudner Y, Salman L, Haran G, Blecher A, Hallak M, Bruchim I. High incidence of gynecologic sarcomas in Israel-A comparison to European and American reports: Gynecologic Sarcoma in Israel. Maturitas 2021; 154:1-6. [PMID: 34736574 DOI: 10.1016/j.maturitas.2021.09.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 08/23/2021] [Accepted: 09/01/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Gynecologic Sarcomas are rare, aggressive tumors. The aim of this study was to explore the incidence and outcomes of gynecologic sarcomas in a large national data registry and to compare them with reports from other countries. STUDY DESIGN Records of gynecologic sarcomas diagnosed in Israel (1980-2014) were extracted from the National Cancer Registry and classified according to International Classification of Diseases for Oncology-3 and characterized according to anatomical site, morphology and demographics. Age-standardized incidence rates and 1, 3, 5 and 10-year relative survival rates were calculated for 3 time periods (1980-1994, 1995-2001 and 2005-2014) according to patient age, stage and years of diagnosis. RESULTS During 1980-2014, 1271 new gynecologic sarcomas were diagnosed in Israel, with incidence slightly increasing in 1980-2004, to an age-standardized incidence rate of 13 per million women. The most common histologic diagnosis was leiomyosarcoma (48%) and the most common anatomical site was the uterus (89%). The age-standardized incidence rate for uterine sarcoma is higher in Israel (10.55 per million) than in England (7.4 per million) and Germany (5.8 per million) respectively. The 5-year overall survival was significantly poorer in patients >70-years, as compared to younger patients (p<0.001) and in those with leiomyosarcoma compared to endometrial stromal sarcoma (p<0.001). The survival rate of patients with leiomyosarcoma in Israel are comparable to survival rates reported by other studies, although substantially lower regarding endometrial stromal sarcoma. CONCLUSIONS Uterine leiomyosarcoma was the most common gynecologic sarcoma found in the Israeli, European and American registries. Older patients and those with leiomyosarcoma have the worst prognoses. Histological and anatomical variations in Israel are comparable with global statistics, but the incidence in Israel seems higher than in Europe.
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Affiliation(s)
- Yana Brudner
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Lina Salman
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel.
| | - Gabi Haran
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Anna Blecher
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Mordechai Hallak
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
| | - Ilan Bruchim
- Gynecologic Oncology Division, Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel, affiliated with the Technion, Israel Institute of Technology, Haifa, Israel
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Willner A, Fechner K, Agaimy A, Haller F, Eckstein M, Ott OJ, Putz F, Gaipl US, Kersting S, Meidenbauer N, Grützmann R, Fietkau R, Semrau S. Neoadjuvant concurrent chemoradiotherapy with and without hyperthermia in retroperitoneal sarcomas: feasibility, efficacy, toxicity, and long-term outcome. Strahlenther Onkol 2021; 197:1063-1071. [PMID: 34735576 PMCID: PMC8604874 DOI: 10.1007/s00066-021-01830-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 07/16/2021] [Indexed: 01/04/2023]
Abstract
Purpose Retroperitoneal (RPS) sarcomas are associated with poor local and abdominal tumor control. However, the benefit of preoperative radio- or chemotherapy alone for these entities is currently unclear. Moreover, as intermediate- and high-grade sarcomas have a tendency toward early metastasis, exploration of neoadjuvant strategies is of high importance. This analysis reports the results of our 20-year single-institution experience with preoperative neoadjuvant concurrent chemoradiation. Methods From 2000–2019, 27 patients with intermediate- or high-grade RPS (12 dedifferentiated liposarcoma, 10 leiomyosarcoma, 5 others) were treated with radiotherapy (median dose: 50.4 Gy; range 45–75 Gy) and two cycles of chemotherapy (doxorubicin 50 mg/m2 BSA/d3 q28 and ifosfamide 1.5 g/m2 BSA/d1‑5 q28) in neoadjuvant intent. Chemotherapy consisted of doxorubicin alone in two cases and ifosfamide alone in one case. Fifteen patients (56%) additionally received deep regional hyperthermia. Results The median follow-up time was 53 months (±56.7 months). 92% of patients received two cycles of chemotherapy as planned and 92% underwent surgery. At 5 and 10 years, abdominal-recurrence-free survival was 74.6% (±10.1%) and 66.3% (±11.9%), distant metastasis-free survival was 67.2% (±9.7%) and 59.7% (±11.1%), and overall survival was 60.3% (±10.5%) and 60.3% (±10.5%), respectively. CTC grade III and IV toxicities were leukocytopenia (85%), thrombocytopenia (33%), and anemia (11%). There were no treatment-related deaths. Conclusion Neoadjuvant chemoradiotherapy with and without hyperthermia for retroperitoneal sarcomas is feasible and provided high local control of intermediate- and high-grade sarcoma.
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Affiliation(s)
- A Willner
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - K Fechner
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - A Agaimy
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - F Haller
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - M Eckstein
- Institute of Pathology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Krankenhausstraße 8-10, 91054, Erlangen, Germany
| | - O J Ott
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - F Putz
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - U S Gaipl
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - S Kersting
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - N Meidenbauer
- Department of Haematology and Oncology, University Hospital, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Ulmenweg 18, 91054, Erlangen, Germany
| | - R Grützmann
- Department of Surgery, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Maximiliansplatz 1, 91054, Erlangen, Germany
| | - R Fietkau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany
| | - S Semrau
- Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
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Ozluk E, Wei EX, Cotelingam J, Shackelford RE. Primary Pulmonary Leiomyosarcoma in a Forty-Year-Old Woman. Case Rep Oncol 2021; 14:1333-1336. [PMID: 34720937 PMCID: PMC8525287 DOI: 10.1159/000516273] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 03/30/2021] [Indexed: 11/19/2022] Open
Abstract
Primary pulmonary leiomyosarcomas (PPLs) are rare aggressive malignancies originating from the smooth muscle cells of the pulmonary interstitium, bronchial tree, or blood vessels. Accounting for <0.5% of lung tumors, PPLs are often initially undetected or misdiagnosed as pulmonary emboli, cardiac neoplasms, or as other more common lung cancer subtypes. Due to their aggressive and often lethal clinical profile, the diagnostic delay of PPL can significantly affect patient outcomes and must be avoided. Here we describe a case of PPL in a 40-year-old woman.
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Affiliation(s)
- Ekin Ozluk
- Department of Pathology & Translational Pathobiology, LSU Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Eric X Wei
- Department of Pathology, University of South Alabama, Mobile, Alabama, USA
| | - James Cotelingam
- Department of Pathology & Translational Pathobiology, LSU Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Rodney E Shackelford
- Department of Pathology & Translational Pathobiology, LSU Health Sciences Center Shreveport, Shreveport, Louisiana, USA
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Wang MX, Menias CO, Elsherif SB, Segaran N, Ganeshan D. Current update on IVC leiomyosarcoma. Abdom Radiol (NY) 2021; 46:5284-5296. [PMID: 34415408 DOI: 10.1007/s00261-021-03256-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/14/2021] [Accepted: 08/16/2021] [Indexed: 12/22/2022]
Abstract
Primary leiomyosarcoma of the inferior vena cava (IVC) is a rare soft tissue sarcoma associated with poor prognosis. Patients are often asymptomatic or present with nonspecific abdominal symptoms, which delays initial diagnosis and contributes to poor oncologic outcome. Key imaging modalities include ultrasonography (US), computed tomography (CT), and magnetic resonance imaging (MRI). Characteristic imaging features include imperceptible caval lumen, dilation of the IVC, heterogeneous enhancement of the tumor, and development of extensive collateral circulation. Surgical resection is the mainstay of treatment, while chemotherapy and/or radiation may serve as therapy adjuncts. This article reviews the pathology, clinical findings, imaging features and management of IVC leiomyosarcoma.
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Affiliation(s)
- Mindy X Wang
- Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, Houston, TX, 77030, USA
| | - Christine O Menias
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Sherif B Elsherif
- Department of Radiology, UF College of Medicine-Jacksonville, 653-1 8th St W, Jacksonville, FL, 32209, USA
| | - Nicole Segaran
- Department of Radiology, Mayo Clinic in Arizona, 13400 E. Shea Blvd., Scottsdale, AZ, 85259, USA
| | - Dhakshinamoorthy Ganeshan
- Unit 1473, Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX, 77030-4009, USA.
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Dymek P, Kiełbowski K, Sienkiewicz S, Błaszkowski T, Kudrymska A, Halczak M, Lubikowski J, Kładny J. Leiomyosarcoma in adrenal gland. Endokrynol Pol 2021; 72:674-675. [PMID: 34647613 DOI: 10.5603/ep.a2021.0083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 08/27/2021] [Accepted: 09/01/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Przemysław Dymek
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland.
| | - Kajetan Kiełbowski
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Sandra Sienkiewicz
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Tomasz Błaszkowski
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
| | | | - Mirosław Halczak
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Jerzy Lubikowski
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
| | - Józef Kładny
- Department of General and Oncological Surgery, Pomeranian Medical University, Szczecin, Poland
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125
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Otto PO, Loft MK, Grimm P, Rafaelsen SR, Pedersen MRV. Ultrasound and contrast enhanced CT imaging of a colon mesentery leiomyosarcoma. Eur J Radiol Open 2021; 8:100376. [PMID: 34621918 PMCID: PMC8484734 DOI: 10.1016/j.ejro.2021.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/27/2022] Open
Abstract
Primary mesenteric leiomyosarcoma is a very rare, aggressive neoplasm. Tumour recurrence and metastatic spread is a significant risk following surgical treatment. Follow-up is warranted and likely improves patient survival rates.
Primary leiomyosarcoma of the colon mesentery is an extremely rare neoplasm, and only a small number of cases have been reported. We describe a case of leiomyosarcoma originating in the colonic mesentery, in a 68-year-old woman. Ultrasound showed a heterogeneous mass with varying vascularization in the left fossa. Central areas of the mass were hypoechoic, without detectable vascularization. Contrast enhanced computed tomography (CECT) of chest and abdomen showed a contrast enhanced tumour, with central non-enhanced areas. The tumour was radically resected and histopathology showed primary leiomyosarcoma. Two years after primary surgery, follow-up CECT revealed a local recurrence, which was re-resected. Subsequent follow-up CECT since have shown no sign of recurrence.
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Affiliation(s)
- Peter Obel Otto
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark
| | - Martina K Loft
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Grimm
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Malene Roland V Pedersen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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126
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Jagannathan JP, Steiner A, Bay C, Eisenhauer E, Muto MG, George S, Fennessy FM. Differentiating leiomyosarcoma from leiomyoma: in support of an MR imaging predictive scoring system. Abdom Radiol (NY) 2021; 46:4927-4935. [PMID: 34075468 DOI: 10.1007/s00261-021-03132-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/08/2021] [Accepted: 05/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE The purpose of this study was to determine the Magnetic Resonance (MR) imaging features that best differentiate leiomyosarcoma (LMS) from leiomyoma, and to explore a scoring system to preoperatively identify those at highest risk of having LMS. METHODS Our Institutional Review Board approved this retrospective HIPAA-compliant study with a waiver for written informed consent. Institutional Research Patient Data Registry identified patients with histopathologically-proven LMS (n = 19) or leiomyoma (n = 25) and a pelvic MRI within six months prior to surgery. Qualitative differentiating MRI features were selected based on prior publications and clinical experience. Patient and MRI characteristics for leiomyomas versus LMS were compared using Wilcoxon rank-sum tests or Fisher's exact tests and using a basic classification tree. Hypothesis testing was two-tailed, with a p value < 0.001 used to determine inclusion of variables into an MR imaging predictive (MRP) score. Diagnostic performance [sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV)] of the MRP in diagnosis of LMS used all possible scores as cutoffs. RESULTS Seven out of 15 MRI features were found to have an association with LMS. The final MRP scores ranged from 0 to 7: a score of 0-3 was associated with 100% NPV for LMS, and a MRP score of 6-7 with 100% PPV for LMS. CONCLUSION Seven qualitative MR imaging features, extracted from a standard MR imaging protocol, allow differentiation of LMS from leiomyoma. An exploratory risk stratification MRP score can be used to determine the likelihood of LMS being present.
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Affiliation(s)
- Jyothi P Jagannathan
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Aida Steiner
- Department of Radiology, Turku University Hospital, University of Turku, Kiinamyllynkatu 4-8, 20521, Turku, Finland
| | - Camden Bay
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
- Department of Medicine/Biostatistics, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA
| | - Eric Eisenhauer
- Department of Gynecologic Oncology, Harvard Medical School, Massachusetts General Hospital, 55 Fruit St, Boston, MA, 02214, USA
| | - Michael G Muto
- Division of Surgical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Suzanne George
- Department of Medical Oncology, Harvard Medical School, Dana Farber Cancer Institute, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Fiona M Fennessy
- Department of Radiology, Harvard Medical School, Brigham and Women's Hospital, 75 Francis Street, Boston, MA, 02115, USA.
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127
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Bananzadeh A, Mokhtari M, Sohooli M, Shekouhi R. Two cases of primary leiomyosarcoma of sigmoid colon treated with laparoscopic surgery: A case report and a review of literature. Int J Surg Case Rep 2021; 87:106420. [PMID: 34543950 PMCID: PMC8455635 DOI: 10.1016/j.ijscr.2021.106420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Leiomyosarcoma (LMS) of the colon is an extremely rare and highly invasive tumor arising from the muscularis propria of the gastrointestinal tract. After the introduction of oncogenic role of KIT by immunohistochemistry (IHC), the reported cases of gastrointestinal leiomyosarcoma were highly limited. True LMS of the colon is such a rare disorder that there isn't much description of its nature. CASE PRESENTATION We reported two very rare cases of primary leiomyosarcoma of sigmoid colon, which referred to our institution with symptoms of abdominal pain, lower GI bleeding and fatigue. After the initial investigations, both patients were diagnosed with primary LMS of sigmoid colon that underwent laparoscopic tumor resection. CLINICAL DISCUSSION The classical colonic LMS presents with a vast majority of non-specific symptoms including mild abdominal pain, fresh/obscure rectal bleeding, and weight loss. The most common location for colonic LMS is the sigmoid colon, and ascending colon. The prognostic factors for the disease outcome have not been established properly; however, patient age, tumor size/grade, and local/distant dissemination are of great importance. CONCLUSION Herein, we reported two rare cases of primary leiomyosarcoma of sigmoid colon that was treated with laparoscopic surgery.
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Affiliation(s)
- Alimohammad Bananzadeh
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohooli
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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128
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Willis F, Schneider M. [Retroperitoneal soft tissue sarcoma: surgical management]. Chirurg 2021. [PMID: 34596706 DOI: 10.1007/s00104-021-01506-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Retroperitoneal soft tissue sarcomas are rare and heterogeneous tumors with high recurrence rates that require a multimodal treatment approach and a surgical resection strategy adapted to tumor localization and histological subtype. OBJECTIVE Based on current scientific data this article intends to provide an overview on subtype-specific features, prognostic factors and operative techniques in the surgical management of retroperitoneal soft tissue sarcomas. MATERIAL AND METHODS A review of the literature addressing surgical management of retroperitoneal soft tissue sarcomas was performed. Current evidence and recommendations were summarized. RESULTS AND CONCLUSION Macroscopically complete tumor resection represents the sole curative treatment option for both primary and recurrent retroperitoneal soft tissue sarcomas. To minimize the probability of tumor-infiltrated resection margins, compartmental resection has become a standard treatment for retroperitoneal soft tissue sarcomas. This approach includes resection of all organs and structures adjacent to the tumor. Multivisceral resection is often associated with this approach and it is acceptable in terms of morbidity and mortality if performed at a center with experience in retroperitoneal sarcoma surgery. Histologic subtype, tumor grading, and quality of initial surgical treatment are major prognostic factors for oncologic overall survival.
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129
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Abstract
BACKGROUND Up to 30% of all scrotal masses are sarcomas. Leiomyosarcoma of the scrotal wall is rare, and its clinical significance and prognosis have not been well defined, since the most reported cases have little or no follow-up. CASE PRESENTATION We report a 45-year-old Caucasian man who was admitted with a firm, nontender, mobile scrotal wall mass from 15 months ago. Laboratory data including testicular tumor markers were within normal range, and transscrotal ultrasonography revealed an oval-shaped, hypoechogenic, solid mass with blood flow and well-defined border. Histopathologic examination and immunohistochemistry staining, following surgical excision, were in favor of malignant leiomyosarcoma. CONCLUSION Here we describe the morphological features and immunohistochemical presentations of the tumor and the patient's relatively long-term follow-up.
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Affiliation(s)
- Zahra Erfani
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Aileen Azari-yam
- Department of Pathology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Seyed Reza Yahyazadeh
- Department of Urology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
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130
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Ge W, Chen Y, Guo Y, Zhao D, Mu L, Zhang K, Zhuo W. KIF15 upregulation promotes leiomyosarcoma cell growth via promoting USP15-mediated DEK deubiquitylation. Biochem Biophys Res Commun 2021; 570:117-124. [PMID: 34280614 DOI: 10.1016/j.bbrc.2021.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 07/12/2021] [Indexed: 12/21/2022]
Abstract
Kinesin Family Member 15 (KIF15) is a plus end-directed microtubule motor, which exerts complex regulations in cancer biology. This study aimed to explore the functional role of KIF15 in leiomyosarcoma (LMS). Bioinformatic analysis was carried out using data from The Cancer Genome Atlas (TCGA)-Sarcoma (SARC). LMS cell lines SK-UT-1 and SK-LMS-1 were used as in vitro cell models. Results showed that LMS patients with high KIF15 expression had significantly worse survival than the low KIF15 expression counterparts. KIF15 knockdown slowed, while KIF15 overexpression increased the proliferation of SK-UT-1 and SK-LMS-1 cells. Co-IP assay confirmed mutual interaction between endogenous KIF15 and DEK (encoded by DEK proto-oncogene). KIF15 knockdown facilitated DEK degradation, while KIF15 overexpression slowed DEK degradation. In ubiquitination assay, a significant increase in DEK polyubiquitylation was observed when KIF15 expression was suppressed. USP15 physically interacted with both DEK and KIF15 in the cells. USP15 knockdown decreased DEK protein stability and canceled KIF15-mediated DEK stabilization. USP15 overexpression enhanced DEK stability, the effect of which was impaired by KIF15 knockdown. USP15 overexpression reduced DEK polyubiquitination. USP15 knockdown increased DEK polyubiquitination and canceled the effect of KIF15 overexpression on reducing DEK polyubiquitination. DEK overexpression enhanced the proliferation of SK-UT-1 and SK-LMS-1 cells. DEK knockdown decreased cell proliferation and canceled the effect of KIF15 overexpression on cell proliferation. In conclusion, this study revealed a novel mechanism that KIF15 enhances LMS cell proliferation via preventing DEK protein from degradation by increasing USP15 mediated deubiquitylation.
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Affiliation(s)
- Weiming Ge
- Foot and Ankle Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Yuxuan Chen
- Center of Traumatic Orthopedics, People's Liberation Army 990 Hospital, Xinyang, Henan, China
| | - Yusheng Guo
- Foot and Ankle Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Dawei Zhao
- Foot and Ankle Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Ling Mu
- Foot and Ankle Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Kun Zhang
- Foot and Ankle Surgery, Luoyang Orthopedic Hospital of Henan Province, Orthopedic Hospital of Henan Province, Luoyang, Henan, China
| | - Wenkun Zhuo
- Department of Orthopedics and Traumatology, 960 Hospital of PLA, Jinan, Shandong, China.
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Kyi C, Friedman CF, Mueller JJ, Benayed R, Ladanyi M, Arcila M, Yang SR, Hensley ML, Chiang S. Uterine mesenchymal tumors harboring ALK fusions and response to ALK-targeted therapy. Gynecol Oncol Rep 2021; 37:100852. [PMID: 34522753 PMCID: PMC8427213 DOI: 10.1016/j.gore.2021.100852] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 08/21/2021] [Indexed: 12/21/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) of the uterus is a rare but aggressive malignancy that is often misdiagnosed. Approximately 50% of uterine IMTs (UMT) harbor rearrangements involving the ALK gene on chromosome 2p23 with subsequent overexpression of the ALK protein. Molecular characterization and wider availability of immunohistochemistry (IHC) and next generation sequencing (NGS) have improved clinical recognition and accurate diagnosis of UMT. The discovery of ALK fusions as a genomic driver led to the FDA approval of ALK inhibitors in ALK-altered lung cancers, but there are limited data to date on the spectrum of ALK fusions or patterns of response and resistance to ALK inhibitors in ALK-altered UMT. In this report we describe the genomic and histopathological characteristics and the response to ALK-targeted therapy in four patients with UMT. In all four patients, clinical activity of ALK inhibition was observed, with durable responses lasting 12 months or more. Moreover, three patients derived benefit from a second-generation ALK inhibitor after progression of disease or intolerance to the first-generation inhibitor crizotinib. Our report advocates for consideration of expanding the current National Comprehensive Cancer Network (NCCN) guidelines to include later-generation ALK inhibitors for the treatment of ALK-rearranged UMTs.
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Affiliation(s)
- Chrisann Kyi
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Claire F Friedman
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Jennifer J Mueller
- Weill Cornell Medical College, New York, NY, United States.,Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Ryma Benayed
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Marc Ladanyi
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Maria Arcila
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Soo Ryum Yang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY, United States.,Weill Cornell Medical College, New York, NY, United States
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, United States
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132
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Novotny JP, George S. Leiomyosarcoma: Does Location of Primary Help to Determine the Best Systemic Therapy Options? Curr Treat Options Oncol 2021; 22:99. [PMID: 34524549 DOI: 10.1007/s11864-021-00897-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2021] [Indexed: 11/30/2022]
Abstract
OPINION STATEMENT Management of leiomyosarcoma is based on the specifics of each individual case. Specifically, the location of the disease and whether the disease is metastatic or localized and if localized disease, whether the tumor is resectable or unresectable. In patients with recurrent or metastatic disease, factors such as disease-free interval and pattern of spread should be considered within the context of treatment planning. In general, patients with metastatic disease are typically treated with systemic chemotherapy with either an anthracycline-based regimen or gemcitabine-based regimen as first-line therapy. Additional systemic options include trabectedin, pazopanib, eribulin, and DTIC. Uterine LMS has been the most studied site-specific LMS with respect to systemic therapy. The increasing use of tumor genomics may ultimately define subsets which may benefit from tailored systemic therapies.
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Affiliation(s)
- Jan Philipp Novotny
- Department of Pathology, Brigham and Women's Hospital, Harvard Medical School, 20 Shattuck Street, Thorn, Boston, MA, USA
| | - Suzanne George
- Sarcoma Center, Dana-Farber Cancer Center, 450 Brookline Ave, Boston, MA, 02215, USA.
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133
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Pinzón-Osorio CA, Meneses-Martínez H, Botero-Espinosa L, Herrera-Luna CV. Invasive leiomyosarcoma involving the tongue of an Arabian mare. J Equine Vet Sci 2021; 104:103718. [PMID: 34416982 DOI: 10.1016/j.jevs.2021.103718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2021] [Revised: 07/07/2021] [Accepted: 07/12/2021] [Indexed: 10/20/2022]
Abstract
A 10 year-old endurance Arabian mare was presented with an invasive, firm, multilobulated mass at the left ventral face of the tongue. The mare had a history of four months of ptyalism, dysphagia, severe halitosis, and dysmastication. The Evaluation of the horse included physical and oral examination, complete blood count and serum biochemistry profile, computed tomography evaluation of the head, and histopathology of the mass. The computerized tomography (CT) head scan showed the homogeneous mass in the oral cavity confirming the degree of invasion on the tongue, as well as a small mineral focus at the left dorsal mandibular border and increased density of the submandibular lymph nodes. At necropsy, gross findings in the oral cavity revealed an irregular, nodular and partially ulcerated mass at the level of the body of the tongue in the ventral aspect, with a size of approximately 10 × 15 × 8 cm. Histologically, the tongue revealed a neoplastic process of mesenchymal muscle origin. The tumor cells showed distinctive morphological and architectural patterns in some areas. An immunohistochemistry panel was done yielding a positive reaction for Calponin and Desmin, confirming diagnostics of as a soft tissue leiomyosarcoma in the tongue. Immunohistochemistry results, in combination with histopathologic morphology, were suggestive of a leiomyosarcoma originating in the perivascular wall tissue. Oral leiomyosarcoma are very rare in veterinary medicine, and to the authors' knowledge, this is the first case report to utilize histopathology, immunohistochemistry and imaginology to describe oral leiomyosarcoma in a horse.
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Affiliation(s)
- César Augusto Pinzón-Osorio
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia; College of Veterinary Medicine, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil.
| | - Henry Meneses-Martínez
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Lucía Botero-Espinosa
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
| | - Carlos Vladimir Herrera-Luna
- Animal Health Department, Faculty of Veterinary Medicine and Animal Science, Universidad Nacional de Colombia, Bogotá DC, Colombia
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134
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Zhang HX, Wang K, Hong P, Lu M, Liu Z, Liu L, Wang GL, Ma LL. Clinical experience with the treatment of retroperitoneal vascular leiomyosarcoma originating from large veins. BMC Surg 2021; 21:326. [PMID: 34392834 PMCID: PMC8364698 DOI: 10.1186/s12893-021-01322-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 08/08/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Retroperitoneal vascular leiomyosarcoma (RVLMS) is an extremely rare disease in clinical practice, and it has poor prognosis. This article is to explore the diagnosis and treatment of RVLMS and present our experience. METHODS Data of RVLMS patients were continuously collected in our hospital from August 2018 to February 2020: two males and two females with a median age of 56 (min-max = 33-61) years were included. Patients in whom paraganglioma could not be excluded were asked to take phenoxybenzamine before surgery. A multi-disciplinary team (MDT) meeting had been held and surgery was recommended. The operation procedures varied based on the tumor location, shape, and stage, and the core steps were "exposure of the retroperitoneum and tumor, identification of vital blood vessels, blocking the bloodstream, complete removal of the tumor and tumor thrombus, and release of blood flow". A Satinsky clamp was used to partially block the blood vessels. Follow-up was conveyed by revisits and phone calls. RESULTS One patient underwent open surgery, and three patients underwent laparoscopic surgery, one of whom underwent conversion to open surgery. The procedures were finished successfully, with a median operative time of 314.5 (min-max = 224-467) mins. The median amount of intraoperative bleeding was 550 (min-max = 200-1500) ml, and three patients had transfusion during the operation. The mass was irregular in shape, with a median maximum size of 7.45 (min-max = 4.2-10.7) cm, and the pathological examination confirmed RVLMS, which has spindle-shape, high mitotic activity and atypia. One week after the operation, the median serum creatinine level was 85 (min-max = 70-99) µmol/L. The median follow-up time was 16 (min-max = 13-21) months, and 1 case reported asymptomatic recurrence. CONCLUSION Uncharacteristic manifestations and imaging features contribute to the problematic diagnosis of RVLMS. Comprehensive preoperative evaluation and careful surgical planning are essential. Multicenter research is needed in the future to reach a dominant consensus.
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Affiliation(s)
- Hong-Xian Zhang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Kai Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Peng Hong
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Min Lu
- Department of Pathology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Zhuo Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Lei Liu
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China
| | - Guo-Liang Wang
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
| | - Lu-Lin Ma
- Department of Urology, Peking University Third Hospital, 100191, Beijing, People's Republic of China.
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135
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Lee J, Cho Y, Choi KH, Hwang I, Oh YL. Metastatic leiomyosarcoma of the thyroid gland: cytologic findings and differential diagnosis. J Pathol Transl Med 2021; 55:360-365. [PMID: 34384147 PMCID: PMC8476313 DOI: 10.4132/jptm.2021.06.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/22/2021] [Indexed: 12/03/2022] Open
Abstract
Metastatic leiomyosarcoma to the thyroid is an extremely rare occurrence, and only 18 cases have been reported. Here, we report a case of a 37-year-old woman who presented with multiple masses on the scalp. Excisional biopsy was done and the mass revealed fascicles of smooth muscle fibers which showed positive staining for smooth muscle actin, thus confirming the diagnosis of leiomyosarcoma. The patient was also found to have a 0.9 cm mass within the left thyroid. Fine-needle aspiration was done and the cytological smear showed hypercellular spindle cell clusters with hyperchromatic and large nuclei. Normal thyroid follicular cells were found within or around tumor cells. In this report, we present the cytologic findings of metastatic leiomyosarcoma to the thyroid and offer differential diagnoses of the aspirated spindle cells.
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Affiliation(s)
- Jiyeon Lee
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yunjoo Cho
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kyue Hee Choi
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Inwoo Hwang
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Lyun Oh
- Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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Sheaffer WW, Davila VJ, Mendes BC, Meltzer AJ, Stone WM, Soh IY, Truty MJ, Nagorney DM, Money SR, Bower TC. Surgical and reconstructive outcomes in primary venous leiomyosarcoma. J Vasc Surg Venous Lymphat Disord 2021; 10:901-907. [PMID: 34352417 DOI: 10.1016/j.jvsv.2021.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Accepted: 07/22/2021] [Indexed: 11/25/2022]
Abstract
OBJECTIVES Primary venous leimyosarcomas (PVL) are rare and pose challenges in surgical management. This study evaluates the clinical outcomes and identifies predictors of survival in our surgical series of PVL. METHODS A retrospective review was performed of patients who had resection of PVL at three centers between 1990-2018. Patient demographics, comorbidities, intraoperative data, survival, and graft related outcomes were recorded. Survival analysis was performed using Kaplan-Meier curves and Cox proportional hazards regression. RESULTS Seventy patients with a diagnosis of PVL were identified between 1990 and 2018. Fifty-four patients (77%) had PVL of the IVC and 16 (23%) had peripheral PVL. Mean follow up for the series was 55.0 months (range 1-217 months). Fifty one patients (96%) with IVC PVL needed caval reconstruction and 3 (4%) had resection only. There were no deaths within thirty days of surgery. Five patients (9%) required early re-intervention including one (2%) IVC stent. Sixteen peripheral PVL were identified. Eight patients (50%) had venous reconstructions performed and 8 (50%) had the vein resected without reconstruction. There were no deaths within thirty days. Five year survival was 57.5% for IVC PVL and 70.0% for peripheral PVL . Kaplan-Meier survival analysis for IVC and peripheral PVL revealed no difference in overall survival (p = 0.624) at 5 years. CONCLUSIONS PVL is a rare and aggressive disease even with surgical resection. We found no difference in survival between IVC and peripheral lesions suggesting aggressive management is warranted for PVL of any origin. Management of PVL requires a multidisciplinary approach to provide patients with the best long term outcomes.
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Affiliation(s)
- William W Sheaffer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054.
| | - Victor J Davila
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Bernardo C Mendes
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
| | - Andrew J Meltzer
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - William M Stone
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Ina Y Soh
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Mark J Truty
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - David M Nagorney
- Mayo Clinic Rochester Department of General Surgery Subspecialties, 200 First St. SW, Rochester, MN 55905
| | - Samuel R Money
- Mayo Clinic Arizona Division of Vascular Surgery, 5777 E Mayo Boulevard, Phoenix, AZ 85054
| | - Thomas C Bower
- Mayo Clinic Rochester Division of Vascular Surgery, 200 First St. SW, Rochester, MN 55905
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137
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Berkeley R, Andrei V, Saifuddin A. The rare primary bone sarcomas: imaging-pathological correlation. Skeletal Radiol 2021; 50:1491-1511. [PMID: 33410967 DOI: 10.1007/s00256-020-03692-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 11/30/2020] [Accepted: 12/01/2020] [Indexed: 02/02/2023]
Abstract
Rare primary bone sarcomas are challenging entities both radiologically and pathologically. These include the diagnoses of spindle cell sarcoma (leiomyosarcoma, fibrosarcoma, synovial sarcoma, and malignant peripheral nerve sheath tumor), pleomorphic liposarcoma, and undifferentiated pleomorphic sarcoma. The radiographic and cross-sectional imaging features of each of these tumors are presented, along with current key pathological concepts. Frequently non-specific, the radiological appearances must be correlated with all clinical and pathological information available to enable an accurate diagnosis.
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Affiliation(s)
- Rupert Berkeley
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK.
| | - Vanghelita Andrei
- Department of Pathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
| | - Asif Saifuddin
- Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore, Middlesex, HA7 4LP, UK
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Nooromid M, De Martino R, Squizzato F, Benedetto F, De Caridi G, Chou EL, Conrad MF, Pantoja J, Abularrage C, Sorber R, Garcia-Ortega DY, Luna-Ortiz K, Eichler C, Zarkowsky D, Chia M, Kalluri A, Cohnert T, Szeberin Z, Grotemeyer D, Shalhub S, Fagg D, Jackson MJ, Charlton-Ouw K, Gombert A, Jacobs M, Boyd A, Motaganahalli R, Uceda D, Woo K, Eskandari MK. Surgical resection and graft replacement for primary inferior vena cava leiomyosarcoma: a multicenter experience. J Vasc Surg Venous Lymphat Disord 2021; 10:617-625. [PMID: 34271247 DOI: 10.1016/j.jvsv.2021.06.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 06/30/2021] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Primary leiomyosarcoma of the inferior vena cava (IVC) is best managed with surgical resection when technically feasible. However, consensus is lacking regarding the best choice of conduit and reconstruction technique. The aim of the present multicenter study was to perform a comprehensive assessment through the VLFDC (Vascular Low Frequency Disease Consortium) to determine the most effective method for caval reconstruction after resection of primary leiomyosarcoma of the IVC. METHODS A multicenter, standardized database review of patients who had undergone surgical resection and reconstruction of the IVC for primary leiomyosarcoma from 2007 to 2017 was performed. The demographics, periprocedural details, and postoperative outcomes were analyzed. RESULTS A total of 92 patients (60 women and 32 men), with a mean age of 60.1 years (range, 30-88 years) were treated. Metastatic disease was present in 22%. The tumor location was below the renal veins in 49 (53%), between the renal and hepatic veins in 52 (57%), and above the hepatic veins in 13 patients (14%). The conduits used for reconstruction included ringed polytetrafluoroethylene (PTFE; n = 80), nonringed PTFE (n = 1), Dacron (n = 1), autogenous vein (n = 1), bovine pericardium (n = 4), and cryopreserved tissue (n = 5). Complete R0 resection was accomplished in 73 patients (79%). In-hospital mortality was 2%, with a median length of stay of 8 days. The primary patency of PTFE reconstructed IVCs was 97% and 92% at 1 and 5 years, respectively, compared with 73% at 1 and 5 years for the non-PTFE reconstructed IVCs. The overall 1-, 3-, and 5-year survival for the entire cohort were 94%, 86%, and 65%, respectively CONCLUSIONS: The findings from our multi-institutional study have demonstrated that complete en bloc resection of IVC leiomyosarcoma with vascular surgical reconstruction in selected patients results in low perioperative mortality and is associated with excellent long-term patency. A ringed PTFE graft was the most commonly used conduit for caval reconstruction, yielding excellent long-term primary patency.
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Affiliation(s)
- Michael Nooromid
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill; Division of Vascular and Endovascular Surgery, Department of Surgery, Thomas Jefferson University Hospital, Philadelphia, Pa
| | - Randall De Martino
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Francesco Squizzato
- Department of Vascular and Endovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Filippo Benedetto
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Giovanni De Caridi
- Division of Vascular and Endovascular Surgery, University of Messina, Messina, Italy
| | - Elizabeth L Chou
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Mark F Conrad
- Division of Vascular Surgery and Endovascular Surgery, Department of Surgery, Massachusetts General Hospital, Boston, Mass
| | - Joe Pantoja
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Christopher Abularrage
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Rebecca Sorber
- Division of Vascular Surgery and Endovascular Therapy, Department of Surgery, Johns Hopkins Medical Institutions, Baltimore, Md
| | - Dorian Yarih Garcia-Ortega
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Kuauhyama Luna-Ortiz
- Department of Skin and Soft Tissue Tumors and Head and Neck, Instituto Nacional de Cancerologia, Mexico City, Mexico
| | - Charles Eichler
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Devin Zarkowsky
- Division of Vascular Surgery and Endovascular Therapy, University of California, San Francisco, San Francisco, Calif
| | - Matthew Chia
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Aravind Kalluri
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill
| | - Tina Cohnert
- Department of Vascular Surgery, Graz Medical University, Graz, Austria
| | - Zoltan Szeberin
- Department of Vascular and Endovascular Surgery, Semmelweis University, Budapest, Hungary
| | - Dirk Grotemeyer
- Department of Vascular Surgery, Hopitaux Robert Schuman, Hopital Kirchberg, Luxembourg City, Luxembourg
| | - Sherene Shalhub
- Division of Vascular Surgery, Department of Surgery, University of Washington School of Medicine, Seattle, Wash
| | - Damen Fagg
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Mark J Jackson
- Department of Vascular Surgery, Gold Coast University Hospital, Southport, Queensland, Australia
| | - Kristofer Charlton-Ouw
- Department of Clinical Sciences, University of Houston College of Medicine and Gulf Coast Vascular, HCA Houston Healthcare, Gulf Coast Division, Houston, Tex
| | - Alexander Gombert
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - Michael Jacobs
- European Vascular Center Aachen-Maastricht, Department of Vascular Surgery, University Hospital RWTH Aachen, Aachen, Germany
| | - April Boyd
- Division of Vascular Surgery, Department of Surgery, Health Sciences Centre, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Raghu Motaganahalli
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Domingo Uceda
- Division of Vascular Surgery, Department of Surgery, Indiana University School of Medicine, Indianapolis, Ind
| | - Karen Woo
- Division of Vascular Surgery, Department of Surgery, David Geffen School of Medicine, Los Angeles, Calif
| | - Mark K Eskandari
- Division of Vascular Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Ill.
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Lin YC, Liao CC, Lai HC. Intraperitoneal splenosis mimics peritoneal carcinomatosis of leiomyosarcoma and ovarian cancer. Taiwan J Obstet Gynecol 2020; 59:773-6. [PMID: 32917336 DOI: 10.1016/j.tjog.2020.07.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE Leiomyosarcoma and ovarian cancer are often diagnosed late due to the absence of initial symptoms. Patients seek help when abdominal distension occurs; this is associated with pelvic tumor and carcinomatosis. Initial imaging often reveals pelvic tumors with diffuse abdominal nodules; however, this imaging could be misleading, such as in the cases of splenosis. CASE REPORT A female presented with vaginal bleeding at our outpatient department. Serum CA125 level was elevated. Abdominal and pelvic CT showed multiple uterine masses and left adnexal cysts with peritoneal nodules. Leiomyosarcoma or ovarian cancer with carcinomatosis was suspected. Exploratory laparotomy was performed. Multiple purple spots spreading over peritoneal cavity were noted during the surgery. Pathological examination revealed adenomyosis with multiple uterine myomas and left ovarian endometrioma. Splenic tissues peritoneal implants were observed. CONCLUSION In patients with a history of spleen rupture or splenectomy, splenosis should be considered in the differential diagnosis, especially in young patients.
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Pérez-de-Villar JM, Arjona-Sanchez A, Rufián-Andujar B, Valenzuela-Molina F, Sánchez-Hidalgo JM, Rodriguez-Ortiz L, Casado-Adam A, Viyuela-García C, Rufián-Peña S, Caro-Cuenca T, Moreno-Vega A, Briceño-Delgado J. Surgical treatment of vena cava leiomyosarcomas: Series of cases in a referral center and literature review. Cir Esp 2021; 100:S0009-739X(21)00179-2. [PMID: 34148656 DOI: 10.1016/j.ciresp.2021.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/02/2021] [Accepted: 05/04/2021] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Primary tumors of the inferior vena cava are rare tumors of mesenchymal origin. They arise from the smooth muscles of the vena cava wall. Due to its low prevalence, there are few definitive data on its treatment and prognosis. Its treatment is based on general oncological principles. METHODS A series of six cases operated from 2010 to 2020 were analyzed. Different parameters related to the demographic characteristics, the tumor, the treatment received, and the results obtained in survival and morbidity were analyzed. In addition, a bibliographical review of the currently available evidence was carried out. RESULTS Optimal surgical resection was accomplished in all patients with R0 in 4/6 and R1 in 2/6. The greatest morbidity occurred in a patient who died in the intraoperative period. Cavography was performed in one patient and cavoplasty in 5/6 using cryopreserved graft in 3/6 and prothesis in 2/6. The 50% were still alive at the end of the follow-up (with a mean follow-up of 10.7 months). The mean survival was 11.3±9.07 months. 3/6 patients presented hematogenous recurrences with a disease-free interval of 9±2 months. CONCLUSION The diagnosis and treatment of inferior vena cava leiomyosarcoma is still a challenge. Due to its low prevalence, it will be difficult to establish a totally standardized treatment and its approach is recommended in specialized centers. On the other hand, a multicentric study should be made to collect the most cases as possible in order to advance in the understanding of the approach to this disease.
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Affiliation(s)
| | | | | | | | | | | | - Angela Casado-Adam
- Unidad de Cirugía Oncológica, Hospital Universitario Reina Sofía, Córdoba, España
| | | | | | - Teresa Caro-Cuenca
- Unidad de Anatomía Patológica, Hospital Universitario Reina Sofía, Córdoba, España
| | - Alberto Moreno-Vega
- Unidad de Oncología Médica, Hospital Universitario Reina Sofía, Córdoba, España
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Ajmal Z, Khan AM, McCarthy L, Lupinetti A, Mehdi S. Leiomyosarcoma of the Tracheostomy Site in a Patient with History of Laryngeal Squamous Cell Carcinoma. Case Rep Oncol 2021; 14:912-917. [PMID: 34267638 PMCID: PMC8261261 DOI: 10.1159/000516797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 04/22/2021] [Indexed: 11/19/2022] Open
Abstract
Leiomyosarcoma (LMS) of the trachea is an extremely rare malignancy with only a few reported cases in English literature. As such the diagnosis can be frequently missed or delayed. We present a case of a 69-year-old male who underwent tracheostomy for airway obstruction secondary to glottic squamous cell carcinoma and treated definitely with radiation therapy. Subsequently, the patient developed LMS of the tracheostomy site. The case further details multiple risk factors that could contribute to development of LMS including radiation exposure, prior malignancy, and chronic inflammation. These risk factors have been well established for LMS in other sites but less so in the head and neck region, which is the subject of our discussion. We also review the current guidelines for head and neck as well as limb sarcomas and discussed role of surgery or radiation and their accompanying challenges in management of this rare malignancy.
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Affiliation(s)
- Zainub Ajmal
- Department of Internal Medicine, Albany Medical Center, Albany, New York, USA
| | - Abdul Moiz Khan
- Department of Internal Medicine, Albany Medical Center, Albany, New York, USA
| | - Lezah McCarthy
- Department of Pathology, Stratton Veteran Affairs Medical Center, Albany, New York, USA
| | - Allison Lupinetti
- Department of Otolaryngology, Stratton Veteran Affairs Medical Center, Albany, New York, USA
| | - Syed Mehdi
- Department of Hematology and Oncology, Stratton Veteran Affairs Medical Center, Albany, New York, USA
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Abou Chakra R, Najib B, Abdallah W, Akiki M, El Khoury L, Atoui A, Moubarak M, Atallah D. B-Cell Lymphoblastic Lymphoma in Relapse Presenting as a Uterine Mass: A Case Report and Review of Literature. Case Rep Oncol 2021; 14:868-873. [PMID: 34248553 PMCID: PMC8255752 DOI: 10.1159/000515196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 02/08/2021] [Indexed: 12/03/2022] Open
Abstract
B-cell lymphoblastic lymphoma (LBL) is a highly aggressive malignant proliferation of lymphoblasts of B-origin grouped with acute lymphoblastic leukemia. Multiple studies demonstrated the various sites of involvement in adult LBL. The involvement of the uterus as a site of relapse for such disease is rare. We herein report the case of relapsed B-cell LBL mimicking endometrial sarcoma. The patient is a 56-year-old female patient known to have B-cell LBL on chemotherapy. She presented with abdominal pain and fever. Positron emission tomodensitometry-computed tomography showed the presence of a uterine mass with bilateral iliac lymph node involvement. She underwent surgery with mass removal and pathology showed relapsed B-cell LBL.
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Affiliation(s)
- Rim Abou Chakra
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Bernard Najib
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Wael Abdallah
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Mira Akiki
- Department of Pathology, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Lea El Khoury
- Department of Pathology, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - Ali Atoui
- Hematology-Oncology Division, Internal Medicine Department, American University of Beirut Medical Center, Beirut, Lebanon
| | - Malak Moubarak
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
| | - David Atallah
- Department of Gynecologic Oncology and Reproductive Medicine, Hotel-Dieu de France University Hospital, Saint-Joseph University of Beirut, Beirut, Lebanon
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Testa S, Million L, Longacre T, Bui N. Uterine Leiomyosarcoma with FN1-Anaplastic Lymphoma Kinase Fusion Responsive to Alectinib and Lorlatinib. Case Rep Oncol 2021; 14:812-819. [PMID: 34248545 PMCID: PMC8255722 DOI: 10.1159/000516758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2021] [Accepted: 04/14/2021] [Indexed: 11/19/2022] Open
Abstract
Uterine leiomyosarcoma (LMS) is a rare malignant neoplasm of the female genital tract poorly responsive to conventional chemotherapy and radiotherapy, with an overall poor prognosis. Pazopanib is at the moment the only FDA-approved targeted molecular therapy for uterine LMS, given the exceedingly rare occurrence of actionable genetic mutations in this type of cancer. Here, we describe the first reported case of metastatic uterine LMS with an FN1-anaplastic lymphoma kinase (ALK) fusion mutation occurring in a 63-year-old woman with a history of uterine leiomyomas. The patient progressed on several lines of therapy, including conventional chemotherapy, pazopanib, and the first-generation ALK inhibitor crizotinib. Interestingly, the patient showed a remarkable 16-month response to second generation ALK inhibitors alectinib and lorlatinib. This case demonstrates that ALK inhibitors can be an effective therapeutic strategy for patients with ALK fusion-positive uterine LMS that has progressed on conventional chemotherapy.
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Affiliation(s)
- Stefano Testa
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Lynn Million
- Department of Radiation Oncology, Stanford University Medical Center, Stanford, California, USA
| | - Teri Longacre
- Stanford Cancer Institute, Stanford University School of Medicine, Stanford, California, USA.,Department of Pathology, Stanford University School of Medicine, Stanford, California, USA
| | - Nam Bui
- Department of Medicine, Division of Oncology, Stanford University School of Medicine, Palo Alto, California, USA
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Ely Cheikh T, Hamza K, Hicham B, Fatiha EM, Hajar EO, Mustapha B, Mohamed E, Mohamed E. Leiomyosarcoma of the male breast: Case report. Ann Med Surg (Lond) 2021; 67:102495. [PMID: 34168877 DOI: 10.1016/j.amsu.2021.102495] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2021] [Revised: 06/05/2021] [Accepted: 06/06/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Primary sarcoma in man is very rare and knowledge about this tumor is limited with very few cases published in the literature. Case report A 65-year-old man operated on 20 years ago for a left breast tumor with a skin graft at the tumor site (no documentation or pathology report). He consulted for a mass in the left breast, bleeding on contact, associated with nodules in the right breast that looked suspicious. On breast ultrasound, a tissue formation in the lower medial quadrant of the left breast with irregular contours, measuring 42 × 53mm with the presence of several suspicious tissue formations in the right breast, the largest measuring 2 × 2cm. Surgical removal of the left mass with a right mastectomy with pathology report of breast leiomyosarcoma with healthy surgical borders followed by radiotherapy for local control. Discussion Leiomyosarcoma is an extremely rare tumor in the breast and usually originates from the blood vessels, myoepithelium, or nipple musculature, as in our case. Breast sarcomas represent less than 1% of all malignant neoplasms of the breast. Their incidence in women is much higher than in men. Conclusion Primary breast sarcomas are rare tumors that originate from the mesenchymal tissue of the breast and represent less than 1% of all malignant neoplasms of the breast. Their diagnosis is confirmed by biopsy with immunohistochemical and only surgery can guarantee cure. Radiotherapy is recommended for local control after surgery. Primary sarcomas in man are very rare and knowledge about this tumor is limited with very few cases published in the literature. The diagnosis is histological, a histopathological examination followed by an immuno-histochemical analysis is very important for a precise diagnosis. Surgery is the only guarantee of recovery. radical mastectomy with surgical margins of at least 3cm is the standard procedure. Axillary lymph node dissection is not recommended. Radiotherapy is recommended for local control after surgical excisioN.
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145
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Hong SM, Kim GH, Kim D, Lee S. Duodenal Leiomyosarcoma Presenting with Gastrointestinal Bleeding and Obstruction: A Case Report. Korean J Gastroenterol 2021; 75:94-97. [PMID: 32098463 DOI: 10.4166/kjg.2020.75.2.94] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/15/2019] [Accepted: 10/27/2019] [Indexed: 11/03/2022]
Abstract
Duodenal leiomyosarcoma is a rare condition with a poor prognosis. Early diagnosis of duodenal leiomyosarcoma is challenging because it presents with nonspecific symptoms and endoscopic biopsies usually do not enable a definitive diagnosis. Duodenal leiomyosarcomas are diagnosed on the basis of the histopathological identification of a mesenchymal lesion composed of malignant tumor cells that on immunohistochemical examination is positive for smooth muscle actin and desmin. We report the case of a 38-year-old man who presented with gastrointestinal bleeding and obstruction who was diagnosed with duodenal leiomyosarcoma after surgical resection.
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Affiliation(s)
- Seung Min Hong
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Gwang Ha Kim
- Biomedical Research Institute, Pusan National University Hospital, Busan, Korea
| | - Dami Kim
- Department of Internal Medicine, Pusan National University School of Medicine, Busan, Korea
| | - Sojeong Lee
- Department of Pathology, Pusan National University School of Medicine, Busan, Korea
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Mohindra S, Batish A, Tripathi M, Nambiyar K, Gupta K. Leiomyosarcoma in a cervical myelomeningocele: a rare complication in a neglected case. Childs Nerv Syst 2021; 37:2097-2103. [PMID: 33070214 DOI: 10.1007/s00381-020-04928-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 10/12/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND IMPORTANCE Asymptomatic myelomeningoceles are usually more of cosmetic deformities and left without evaluation and untreated, amongst low socio-economic strata. Such midline swellings, if left neglected may become the seat for malignancies, usually of squamous cell origin. CLINICAL PRESENTATION The authors report a case of an 18-year-old male patient who developed leiomyosarcoma within chronically neglected cervical myelomeningocele. CONCLUSION A non-healing ulcer of any aetiology is a bed for carcinogenesis. Neglected myelomeningoceles, for any reason, may convert a benign entity to a malignant pathology. To our best knowledge, this is the first case of a leiomyosarcoma arising de novo from myelomeningocele.
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Affiliation(s)
- Sandeep Mohindra
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India.
| | - Aman Batish
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Manjul Tripathi
- Department of Neurosurgery, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh, 160012, India
| | - Kaniyappan Nambiyar
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Kirti Gupta
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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147
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Murphy CA, Zarudskaya O, Kakish C, Zoorob D, Seo-Patel S. Uterine Fibroid in a 16-Year-Old Adolescent Managed with a Fertility-Sparing Approach: A Case Report and Review of the Literature. J Pediatr Adolesc Gynecol 2021; 34:427-431. [PMID: 33359317 DOI: 10.1016/j.jpag.2020.12.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/10/2020] [Accepted: 12/19/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND Uterine fibroids are the most common benign tumor of the uterus in adult women. However, it is exceedingly rare in adolescents. CASE A 16-year-old girl presented with severe anemia and abnormal uterine bleeding. MRI of the pelvis demonstrated a 9-cm mass within the uterus concerning for leiomyoma or leiomyosarcoma. A fertility preserving myomectomy led to the final diagnosis of a benign uterine fibroid. SUMMARY AND CONCLUSION Despite the rare incidence of leiomyomas in adolescents, it is imperative that it is included in the differential diagnosis when young women present with abnormal uterine bleeding. A less common diagnosis to consider is leiomyosarcoma; however, this is histologically diagnosed. Thus, a fertility-preserving myomectomy permits for a diagnostic opportunity to rule out a potential malignancy.
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Affiliation(s)
- Courtney A Murphy
- Department of Obstetrics and Gynecology, University of Toledo Medical Center, Toledo, Ohio.
| | - Oxana Zarudskaya
- Department of Obstetrics and Gynecology, University of Toledo Medical Center, Toledo, Ohio
| | - Carmen Kakish
- Department of Obstetrics and Gynecology, University of Toledo Medical Center, Toledo, Ohio
| | - Dani Zoorob
- Department of Obstetrics and Gynecology, University of Toledo Medical Center, Toledo, Ohio
| | - Sonyoung Seo-Patel
- Department of Obstetrics and Gynecology, ProMedica Toledo Hospital, Toledo, Ohio
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148
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Kim HG, Yang JW, Hong SC, Ju YT, Jeong CY, Kim JY, Park JH, Lee JK, Kim JM, Cho JK, Kwag SJ. Ileocolonic Intussusception Caused by Epithelioid Leiomyosarcoma of the Ileum: A Report of Case and Review of the Literature. Ann Coloproctol 2021; 38:176-180. [PMID: 34044504 PMCID: PMC9021852 DOI: 10.3393/ac.2020.12.08] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 12/08/2020] [Indexed: 11/02/2022] Open
Abstract
Small intestinal malignant tumor accounts for about 3% of all malignant tumors in the gastrointestinal tract, among which 13% are leiomyosarcoma (LMS). In addition, epithelioid LMS is of very rare occurrence. As small intestinal malignant tumors are initially asymptomatic and nonspecific, diagnosis is often delayed, and this can lead to large tumor at the time of detection and lead to intussusception. We observed ileocolonic intussusception in an 80-year-old male patient who was admitted to the hospital with a complaint of abdominal pain and palpable mass on right lower quadrant. The laparoscopic ileocecectomy was performed by the emergency operation because of obstruction. The pathologic examination revealed that the epithelioid LMS developed in the terminal ileum was the leading point of intussusception. To the best of our knowledge, laparoscopic surgery for ileocolonic intussusception with epithelioid LMS has not yet been reported.
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Affiliation(s)
- Han-Gil Kim
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jung Wook Yang
- Department of Pathology, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Soon-Chan Hong
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Young-Tae Ju
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Chi-Young Jeong
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ju-Yeon Kim
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Ji-Ho Park
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Kwon Lee
- Department of General Surgery, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
| | - Jae-Myung Kim
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin-Kyu Cho
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Seung-Jin Kwag
- Department of General Surgery, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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149
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Abdallah H, Dergamoun H, Hachem F, Boughaleb A, Al Sayegh H, Nouini Y. Testicular leiomyosarcoma: A case report and literature review. Int J Surg Case Rep 2021; 83:105996. [PMID: 34049173 DOI: 10.1016/j.ijscr.2021.105996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction and importance Leiomyosarcoma is a malignant mesenchymal tumor derived from the smooth muscle, it represents approximately 7% of all soft tissue sarcomas. Male genitourinary leiomyosarcomas are rare (Abdullazade et al., 2013 [1]). Primary testicular leiomyosarcoma is an exceptional entity with only 30 cases reported in the literature (Giridhar et al., 2011). Due to its rarity, additional studies are necessary to better define the optimal therapeutic management. Case presentation We report a case of a 42-years-old male diagnosed in the urology department A of the University Hospital Ibn Sina in Rabat who complains of testicular swelling. The anatomopathological examination and immunohistochemical study revealed a leiomyosarcoma therefore, a radical inguinal orchiectomy with a primary ligation of the spermatic cord was performed for diagnostic and therapeutic purposes. The assessment of extension did not reveal any lymph node location or secondary appearance thus the decision of the multidisciplinary meeting opted for regular cancer check-ups without adjuvant treatment. Discussion The actual etiology of testicular leiomyosarcoma is still unknown added to its clinical presentation and radiological results that are non-specific. Conclusion Leiomyosarcoma of the testis is a very rare tumor and its clinical and radiological presentation remains similar to other testicular malignancies. Leiomyosarcoma of the testis is a rare tumor. Its clinical aspects doesn't differ from other testicular malignancies. The exact diagnosis is based on histological studies. Radical inguinal orchiectomy is the treatement of choice. The actual etiology of testicular leiomyosarcomas is already unknown.
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150
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Smrke A, Benson C, Strauss DC, Hayes AJ, Thway K, Hallin M, Fisher C, Messiou C, Huang PH, Jones RL, Smith MJ. Gastrointestinal leiomyosarcoma demonstrate a predilection for distant recurrence and poor response to systemic treatments. Eur J Surg Oncol 2021; 47:2595-2601. [PMID: 33966946 DOI: 10.1016/j.ejso.2021.04.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 04/23/2021] [Accepted: 04/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Primary leiomyosarcoma (LMS) of the gastrointestinal (GI) tract is rare. Limited literature exists regarding the clinical characteristics and outcome for patients with localised and metastatic disease. METHODS A retrospective chart review was performed for patients greater than 18 years of age diagnosed with GI LMS at The Royal Marsden Hospital between 1 January 2000-1 May 2020. Descriptive statistics were performed. Patients were censored at data cut-off date of 27 June 2020. RESULTS Forty-six patients with a median age at diagnosis of 54 years (range 25-85) were identified. Fifteen percent (n = 7) of patients previously received abdominal radiation for an unrelated cancer. All patients with localised disease (n = 36) had resection with oncological margins. For patients who underwent potentially curative surgery, median recurrence-free survival (mRFS) was 13 months (0.4-183 months), and half of these patients (n = 18) developed recurrent disease post resection (distant n = 16, local n = 2). Median overall survival (mOS) was 27 months for patients with distant recurrence. Twenty-one percent (n = 10) of patients presented with synchronous metastatic disease and their mOS was 19 months. Median progression-free survival (mPFS) for patients treated with conventional chemotherapy ranged from 2.0 to 8.0 months. CONCLUSION The risk of recurrence is significant, and recurrence-free survival was short even with complete oncologic resection. The relationship of prior abdominal radiotherapy to the development of GI LMS warrants further investigation. Outcomes with systemic therapy for metastatic disease were poor and there is a need for the development of more effective systemic therapies.
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Affiliation(s)
- Alannah Smrke
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | | | - Dirk C Strauss
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Andrew J Hayes
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Khin Thway
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Magnus Hallin
- The Royal Marsden Hospital NHS Foundation Trust, London, UK
| | - Cyril Fisher
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Christina Messiou
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | | | - Robin L Jones
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK
| | - Myles J Smith
- The Royal Marsden Hospital NHS Foundation Trust, London, UK; The Institute of Cancer Research, London, UK.
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