Leiomyosarcoma of the submandibular gland. Report of a case and review of the literature

Primary leiomyosarcoma of the submandibular gland: a case report

Background

Leiomyosarcoma is a rare malignant mesenchymal tumor that represents 5–7 % of all soft tissue sarcomas. The occurrence of this tumor in the salivary glands is exceptional. Only five cases are reported in the submandibular gland.

Case presentation

A 65-year-old white Moroccan woman presented with a history of progressive right submandibular swelling which had grown over a period of 8 months. Clinical examination showed a submandibular painless, mobile and hard mass without cervical lymphadenopathy. Ultrasonography and computed tomography revealed a solid and heterogeneous mass measuring 4 × 2 cm involving the submandibular gland. A resection of the gland was performed. Pathological findings were consistent with primary leiomyosarcoma of the submandibular gland. No recurrence occurred after two months of follow-up.

Conclusion

Primary leiomyosarcoma of the submandibular gland is an extremely rare mesenchymal tumor. Clinical and radiological features are not specific. Differential diagnosis includes metastatic leiomyosarcoma and gastrointestinal stromal tumor, myoepithelioma, sarcomatoid carcinoma, melanoma and other sarcomas. Little is known about the overall biologic behavior of this tumor, but the prognosis seems to be poor.

Primary sarcomas of the salivary glands: case series and literature review

BACKGROUND

Mesenchymal malignancies of salivary origin are rare and are histologically diverse. We reviewed our experience with these tumors, as well as the published literature, with an emphasis on treatment modalities and prognosis.

METHODS

We identified 17 patients treated for malignant mesenchymal cell tumors at The University of Texas MD Anderson Cancer Center between 1990 and 2007. We compared our results to the literature from January 1990 to July 2010.

RESULTS

Tumors were located primarily in the parotid gland and were primarily T1 tumors (<5 cm). All patients were treated with surgical resection, and 13 patients were given adjuvant therapy. Seven patients (41%) had recurrence, and 4 developed distant metastases. The overall 5-year and 10-year survival rates were 42% and 20%, respectively.

CONCLUSIONS

Our case series and literature review show that sarcomas of the salivary glands have a high rate of recurrence and are associated with a poor prognosis.

The surgical management of a leiomyosarcoma of the submandibular gland in a 95-year-old patient

Primary sarcomas of the major salivary glands are rare and appear to originate from undifferentiated pluripotential mesenchymal cells. They must be distinguished from malignant supporting tissue neoplasms that secondarily involve the glands by direct extension or metastasis. Multidisciplinary management of head and neck soft tissue sarcomas is still controversial. We report a case of leiomyosarcoma of the submandibular gland in a 95-year-old man who was treated with excision of the right submandibular gland, extended to the surrounding tissues, without neck dissection. The patient tolerated the treatment well. Twenty-four months after surgery, the patient was doing well without any evidence of locoregional or distant disease. Surgery is the cornerstone of the management of leiomyosarcomas of the salivary glands. Wide surgical excision with histologically proven tumor-free margins was an appropriate treatment that may guarantee prolonged survival.

[Leiomyosarcoma of the submandibular gland]

INTRODUCTION

A leiomyosarcoma is a malignant tumor of the smooth muscle. Its malignancy is difficult to assess. Submandibular gland involvement is extremely rare.

OBSERVATION

A 62-year-old patient was admitted with a primary leiomyosarcoma of the submandibular gland. He was treated by surgery and radiotherapy. The patient died 11 months later from pulmonary metastases.

DISCUSSION

LMS of the submandibular gland is extremely rare. Its diagnosis is very difficult because of the non-specific clinical and radiological signs. The histological diagnosis often relies on immunohistochemistry. Treatment is based on surgery associated to radiotherapy. The prognosis remains poor because of frequent recurrence and metastases.

Leiomyosarcoma arising in the pancreatic duct: a case report and review of the current literature

Context. Leiomyosarcomas are rare malignant smooth muscle tumors that may arise in any organ or tissue that contains smooth muscle, commonly within the gastrointestinal tract. They are most often found in the stomach, large and small intestines, and retroperitoneum. Primary pancreatic leiomyosarcoma is extremely rare, and to the best of our knowledge only 30 cases have been reported in the world literature since 1951. Our case represents the first to have a clear origin from the main pancreatic duct. Case Report. This case was diagnosed in a large, tertiary care center in Tampa, Florida. Pertinent information was obtained from chart review and interdepartmental collaboration. A mass in the tail of the pancreas was identified with large pleomorphic and spindle-shaped cells. Immunohistochemistry for vimentin, smooth muscle actin, and desmin was positive. All remaining immunohistochemical markers performed were negative. The tumor clearly originated from the pancreatic duct wall, filled and expanded the duct lumen, and was covered with a layer of benign biliary epithelium. Conclusion. Leiomyosarcoma of the pancreas is an extremely rare malignancy with few reported cases in the literature. The prognosis is poor, and treatment consists of alleviating symptoms and pain management. To our knowledge, this represents the first reported case demonstrating clear origin of a leiomyosarcoma from the pancreatic duct.

Radiation-induced leiomyosarcoma of the maxillofacial region: facial reconstruction with implant-retained prosthesis

Radiation-induced sarcoma represents an exceptional rarity in the head and neck region. The treatment is surgical excision with negative margins and follow-up. After surgery, reconstruction of the defects can be accomplished either surgically or prosthetically. Implant-retained maxillofacial prostheses may offer an acceptable solution. In this report, a large facial defect resulting from radiation-induced leiomyosarcoma was reconstructed with implant-retained prosthesis. A patient with a large facial defect resulting from tumor surgery presented for reconstructive treatment. The primary tumor was fibrous histiosarcoma. Four years after the patient was treated with surgical resection and subsequent irradiation, leiomyosarcoma was diagnosed in the defect site. Leiomyosarcoma was treated with complete surgical resection, and the defect was reconstructed with implant-retained prosthesis. The patient was evaluated every 6 months. Implants provided secure retention to the prosthesis. The patient was satisfied with the appearance of the prosthesis. At 12 months' examination, functioning implants were successful; however, color fade of the prosthesis was observed. Radiation-induced leiomyosarcoma, which is an uncommon tumor in the head and neck region, was treated by means of large surgical resection. Implant-retained prosthetic rehabilitation of the patient resulted in acceptable functional and cosmetic results, and the patient has resumed social activities.

Metastatic uterine leiomyosarcoma to the submandibular gland

Metastasis of uterine leiomyosarcoma to the salivary glands is exceedingly rare. In this report, we present the clinicopathologic features of one such case. The patient was diagnosed with uterine leiomyosarcoma at age 58 years and was treated by hysterectomy only. The tumor was confined to the uterine body. The patient remained free of disease for 4 years and then developed a left submandibular mass. Imaging studies also showed lung involvement but no tumor in the abdomen or pelvis. The submandibular mass was resected; it had histologic and immunohistochemical features similar to those seen in the previous uterine leiomyosarcoma. After 7 months of follow-up, the patient is alive with disease, with progression of disease in the lungs despite receiving chemotherapy.

Mesenchymal neoplasms of the major salivary glands: clinicopathological features of 18 cases

Non-lymphoid mesenchymal neoplasms of salivary gland origin are rare, accounting for 1.9-5% of major salivary gland tumors. We describe the clinico-pathologic features of 18 cases of mesenchymal neoplasms of the major salivary glands experienced at Asan Medical Center, Seoul, Korea, from 1998 to 2004. Mesenchymal neoplasms accounted for 3.4% of the total of 524 major salivary gland tumors. The parotid gland was the preponderant site (15 cases). Thirteen tumors were benign, constituting 3.5% of the total of 371 benign neoplasms. Schwannomas were the most common benign tumors (six cases), followed by lipomas (three cases), plexiform neurofibroma, hemangioma, desmoid tumor, and solitary fibrous tumor (one each). The malignant tumors consisted of one dermatofibrosarcoma protuberans, synovial sarcoma, leiomyosarcoma, pleomorphic liposarcoma and desmoplastic small round cell tumor each. Immunohistochemical analysis for the expression of vimentin, actin, desmin, neuron-specific enolase, keratin, CD34, CD99 and bcl-2 contributed to the differential diagnoses. Genetic analysis for fusion transcripts was conclusive in the diagnosis of desmoplastic small round cell tumor, which is extremely rare at this location. Pre-operative imaging study and fine needle aspiration cytology had limitations in prediction of the mesenchymal nature of the tumors, due to either low index of suspicion, similarities to mixed tumors, or specimen inadequacy. Awareness of the development of various mesenchymal tumors in the major salivary glands could increase the accuracy of preoperative and postoperative diagnosis, and therapeutic efficacy.