Leiomyosarcoma of scrotum--case report and review of literature

Optimal surgical treatment for paratesticular leiomyosarcoma: retrospective analysis of 217 reported cases

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.

Primary cutaneous Leiomyosarcoma on the left iliac region: A rare case report from Syria

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.

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Primary cutaneous Leiomyosarcoma is a very rare tumor.

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Accurate diagnosis cannot be made without histological and immunohistochemical examination.

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Surgery is the only guaranteed treatment and other methods are still controversial.

Scrotal wall leiomyosarcoma: a case report and review of the literature

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.

Pure cutaneous paratesticular leiomyosarcoma of the scrotum: A rare case report

Leiomyosarcoma (LMS) is a malignant mesenchymal neoplasm arising from the smooth muscle. Paratesticular LMSs are commonly located in the epididymis or spermatic cord. Pure scrotal cutaneous paratesticular LMS arising from the dartos muscle is very rare. Less than 40 cases have been reported in the literature to date. We report a case of pure scrotal cutaneous LMS in a 45-year-old patient.

Leiomyosarcoma of scrotum: case report

Scrotal leiomyosarcoma is rare tumor. It presents as a painless, slow-growing cutaneous lesion. It’s often mistaken for a benign condition. It is best treated by wide local excision. A case of scrotum leiomyosarcoma is presented in a 63 year old patient who was treated for the first time as having a benign lesion.

Leiomyosarcoma of the Lower Limb Presenting as a Benign Mass: A Case Report

Introduction

Soft tissue sarcomas are rare tumors that often present with pain, increasing size and a location deep to the fascia. If they do not present with the aforementioned symptoms and signs, delayed diagnosis can occur.

Case Report

We present an unusual case of a 51-year-old patient who presented with clinical features of a benign mass of the lower limb that turned out to be a soft tissue sarcoma - a leiomyosarcoma.

Conclusion

Medical practitioners must consider the possibility of soft tissue sarcoma in patients that present with a benign looking mass. Diagnostic imaging can be inconclusive on these cases and definite diagnosis is made on histological examination. Treatment includes surgery and radiotherapy.

A case of subcutaneous leiomyosarcoma of the scrotum presenting as a slowly growing mass in a 36-year-old male: A case report and literature review

Leiomyosarcoma of the scrotum, not involving the testis, epididymis, or spermatic cord, is a very rare type of tumor. A 36-year-old male presented with a slowly growing right scrotal mass (size: 3 × 2 cm). An ultrasound examination revealed a hypoechoic, subcutaneous, solid mass. Laboratory investigations detected normal levels of serum alpha-fetoprotein, beta-human chorionic gonadotropin, and lactate dehydrogenase. The mass was slowly growing and surgically resection was performed diagnosing leiomyosarcoma with histological examination. Wide local excision with a 2-cm margin around the operative scar and right orchiectomy were performed as second surgery. The patient has not suffered recurrence for 28 months.

Primary leiomyosarcoma of the skin: a comprehensive review on diagnosis and treatment

Sarcomas are a heterogeneous group of mesenchymal tumors which can affect bone and soft tissue. Leiomyosarcoma (LMS) is a rare subtype localized to the skin or subcutaneous tissue. Due to the heterogeneity of sarcomas, reviews and guidelines with an in-depth focus specifically on primary LMS of the skin are sparse. This article is intended to provide an up to date and systematic overview on diagnosis, treatment, and surveillance of this rare entity to provide a framework for decision making and management for dermato-oncologists. We discuss novel treatment options for advanced disease such as targeted therapy with kinase inhibitors and immune checkpoint blockade which may improve the prognosis even in advanced stages of LMS.

[Metastatic paratesticular liposarcoma]

We report the dramatic case of a 18-year old patient with immediately metastatic round cells paratesticular liposarcoma. It is a rare tumor that develops in the fatty tissue surrounding the testicle and the spermatic cord. Clinical and radiological signs are nonspecific and diagnosis is usually based on surgical specimen examination. The treatment involves radical inguinal orchiectomy, sometimes extended to adjacent structures. Adjuvant radiation therapy could be used in the case of locally advanced mass or incomplete resection. Despite its slow progression, prolonged monitoring is required due to the high risk of late recurrence.

Subcutaneous leiomyosarcoma of scrotum presenting as an exophytic mass: An unusual presentation

Paratesticular leiomyosarcoma originates from testicular tunica (48%), spermatic cord (48%), epididymis (2%) and dartos muscle, as well as subcutaneous tissue of the scrotum (2%). Leiomyosarcomas of the scrotum, not involving the testis, epididymis or spermatic cord, are rare, and belong to the group of subcutaneous superficial leiomyosarcomas. To the knowledge of the authors, less than 10 cases of leiomyosarcoma of the scrotum have so far been reported from India. The tumor usually presents as a painless, slow-growing scrotal mass in middle-aged or elderly men. The current approach is wide local excision, often with adjuvant therapy. The prognosis is usually good following complete excision, though a local recurrence rate of 40% has been reported. Long term follow-up is, therefore, necessary to monitor for recurrence. Herein we present the case of 35-year-old male who presented with an exophytic scrotal mass. Histopathological and immunohistochemical findings of the mass were consistent with leiomyosarcoma.

Case of Subcutaneous Leiomyosarcoma of the Scrotum Presenting as a Sebaceous Cyst in a 71-Year-old Man: A Case Report and Review of the Literature

Leiomyosarcoma of the scrotum is a rare genital malignancy with approximately 35 reported cases in literature. We present a case of leiomyosarcoma of the scrotum in a 71-year-old man appearing as a sebaceous cyst that later developed ulcerations. However, because the irregular mass developed ulcerations, this should trigger one to consider that lesion is potentially malignant. The pathology report demonstrated malignant spindle cell neoplasm consistent with leiomyosarcoma, which tested positive for desmin and actin stains. On literature review, a study reported a 5-year survival rate of 50%-80%. The clinical features, diagnosis, histopathologic images, and treatment are reviewed.

Scrotal leiomyosarcoma associated with bilateral epididymo-orchitis

Leiomyosarcoma of the scrotum is a rare tumor. We report the case of a 60-year-old man who presented with bilateral testicular enlargement that was clinically misdiagnosed as a testicular tumor. The tumor was excised by bilateral inguinal orchiectomy. Histopathologic examination revealed a scrotal wall leiomyosarcoma with bilateral epididymo-orchitis.

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.

Well-differentiated giant scrotal liposarcoma: case presentation and management

Scrotal liposarcoma is an uncommon disease, usually found after the fifth decade. We describe the case of a well-differentiated scrotal liposarcoma associated with a considerable inflammatory reaction, treated with surgical ablation.