Leiomyosarcoma of the tongue: a very rare tumour

Primary oral leiomyosarcoma: A systematic review and update

The aim of this systematic review was to address the clinicopathologic inconsistencies noted with primary oral leiomyosarcoma in the literature by amassing the available data published into a comprehensive analysis. Eligibility criteria included publications of cases with dedicated immunohistochemical work-up along with radiographs to evaluate location. Based on these criteria, the systematic review compiled 29 cases. Four primary location sites were identified in the reported cases: soft tissue presentation only, soft tissue with bony involvement, bony involvement only, and bony involvement with a soft tissue component. The majority of primary oral leiomyosarcoma cases reviewed showed a soft tissue predilection, which is in contrast to prior reports of jawbones being the most common site. In addition, there was an improved 5-year survival rate for primary oral leiomyosarcoma limited to the oral cavity and gnathic bones without extension into paranasal sinuses.

Leiomyosarcoma of the base of the tongue and free edge of the epiglottis: a case report

Introduction

We present the case of a man with a leiomyosarcoma of the base of the tongue. We feel this case is important as this kind of pathology, though rare, can occur at a site where carcinomas are more frequent.

Case presentation

A 77-year-old Caucasian man had been reporting difficulty in swallowing and hoarseness for a month before admission to our department. After several preliminary tests, including a biopsy which was positive for a malignant epithelial neoplasm which required further immunohistochemical study, we decided to operate, removing the base of our patient’s tongue and performing a total laryngectomy. Histological examination of the specimen revealed a high-grade leiomyosarcoma of the base of the tongue and of the free edge of the epiglottis.

Conclusions

We wish to stress the rarity of this clinical case, related to the site of implantation of the tumor, as confirmed by the difficulties in finding reference to this topic in the international literature. In fact, several cases of leiomyosarcoma have been described, but in different locations from that seen in our patient’s case.

A primary leiomyosarcoma of the lateral border of the tongue

Soft tissue sarcomas are rare malignant neoplasms (about 1% of all malignances). The leiomyosarcoma of the tongue is a very rare tumor with only 9 cases described in the literature. This article describes a case report of a primary leiomyosarcoma of the lateral border of the tongue treated with local excision that has been free of recurrence for 4 years. Also described in this article is a new technique to stabilize the tongue during surgery.

Primary oral leiomyosarcoma: a clinico-pathologic study and analysis of prognostic factors

This clinico-pathologic study of primary oral leiomyosarcomas and analysis of potential prognostic factors involved a literature review of 64 cases and a report of four cases treated in the authors' unit. The demographic details, clinical presentation, diagnosis, treatment and outcome were documented for the whole group and clinico-pathologic variables analysed to detect potential prognostic factors. The most common presentation was that of a painless mass, with peak incidence in the 6th decade and a slight male predeliction (M:F=1.3:1). The maxilla was the most frequently involved site, followed by the mandible and tongue. Surgical excision was most commonly employed with radiotherapy and chemotherapy being reserved for recurrent and metastatic tumours. Local recurrence (34%) and metastasis (35%) were not uncommon and occurred most frequently to the lungs and regional lymph nodes (15%). Age, sex, size and mitotic index were not statistically related to recurrence or metastasis. Site (P=0.0125) was a predictor of metastasis. Metastasis (P=0.010) and lesions involving the maxilla and mandible (P=0.019) were associated with decreased survival. The estimated 5 year survival was 55% for the whole group and 43% and 19% for patients with bony involvement and metastasis respectively.

A peculiar site of leiomyosarcoma: the tongue tip—report of a case

Primary leiomyosarcoma of the tongue is an exceedingly rare malignant mesenchymal tumour, which is hardly ever addressed in the differential diagnosis of a tongue lesion. Only 7 cases of this tumour have been documented in English-language medical literature. This study reports an additional case of primary leiomyosarcoma of the tongue in a 54-year-old woman, presenting with a foreign body sensation at the tip of the tongue with a rapidly and progressively enlarging ulcerative nodule. The patient received tumour excision with a 1-year follow-up without evidence of local recurrence or distant metastasis. Leiomyosarcoma in this unusual site seems to have better prognosis than elsewhere, although the number of cases are too small to draw a conclusion. This study further reviews the literature review and discusses the clinico-pathological presentation of this peculiar rare tongue lesion.

Leiomyosarcomas of the oral tissues: clinicopathologic analysis of 50 cases

PURPOSE

Primary oral leiomyosarcomas are rare tumors. Information regarding the biological behavior, prognosis, and appropriate management of this neoplasm is lacking in the literature. The purpose of this report was to summarize the data of isolated case reports of primary oral leiomyosarcoma that have been published in the English literature during the past 25 years. The cases of 4 additional new patients who have been treated in our department during the past 10 years are also presented.

PATIENTS AND METHODS

The data for 46 patients obtained from 32 individual articles retrieved from the English literature were added to our 4 cases and produced a total number of 50 cases of primary leiomyosarcomas of the oral tissues. Patients were analyzed according to demographic data, anatomic location, type of treatment, and survival.

RESULTS

Primary oral leiomyosarcoma may affect any age with peaks of occurrence in the third, sixth, and seventh decades of life. There is no gender predilection. Female patients presented the higher incidence in the third decade, whereas males had an even age distribution. The tumor arises in approximately 70% of the cases in the maxillary and mandibular bones. Radical surgery was the treatment of choice. Radiotherapy and chemotherapy when applied in recurrent tumors had little effect. The most adverse prognostic factor was the positive surgical margins. The 5-year survival was 62% (62.9% for females and 52.6% for males, P > .1968).

CONCLUSIONS

Cases of oral leiomyosarcoma appear to be associated with major neurovascular structures of the facial skeleton, as evidenced from the imaging studies of our 4 patients. Primary oral leiomyosarcoma is a rare tumor that should be managed with aggressive surgical resection in order to safeguard curability. Histopathologic diagnosis is greatly facilitated with positive immunohistochemical staining for smooth muscle antigenic markers.

Malignant tumors of the oral cavity and oropharynx: clinical, pathologic, and radiologic evaluation

Carcinomas of the oral cavity and oropharynx constitute approximately 2% to 5% of head and neck cancers. Alcohol abuse and tobacco chewing, including chewing Shamma, predispose individuals to the development of cancer in the oral cavity. CT and MR imaging are best suited in the evaluation of cancer of the oral cavity and oropharynx. CT in the axial and coronal planes with 3- to 5-mm sections is the primary modality and is best in the evaluation of bony erosion of the mandible and maxilla. Furthermore, lymph node metastases in the neck are optimally evaluated by contrast CT with 5-mm axial sections. MR imaging is preferred for soft tissue assessment because of the greater contrast resolution. It is therefore the first modality in the assessment of tongue carcinomas, oropharyngeal cancer, and tonsillar lesions. The MR examination should be performed with thin-section imaging, applying T1, T2, and T1-GD-DTPA in the axial and coronal planes, with sagittal sections added for paramidline lesions involving the tongue, lips, anterior floor of the mouth, subdivided according to anatomic locations. The local spread, lymph node metastases, prognosis, and therapeutic approaches vary with the location of the lesion represented by a carcinoma either squamous or undifferentiated in 90% of cases. Some malignant lesions may mimic a benign tumor, such as the adenoid cystic or mucoepidermoid carcinoma. Histopathologic diagnosis is therefore necessary for the final diagnosis before treatment by surgery or radiotherapy. PET scanning is indicated in the following instances: in search of an unknown primary tumor in patients who have a neck mass secondary to carcinoma, if a recurrent carcinoma may be present, when there are metastatic N0 lymph nodes in the neck, or where CT is inconclusive for metastatic lymph nodes in the neck.

Primary gingival leiomyosarcoma. A clinicopathological study of 1 case with prolonged survival

BACKGROUND

Leiomyosarcoma is a relatively uncommon mesenchymal tumor that exhibits smooth-muscle differentiation. Only 3 to 10% of leiomyosarcomas arise in the head and neck, the nose and paranasal sinuses, skin and subcutaneous tissue and cervical esophagus being the most common localizations. Most leiomyosarcomas involving the oral tissues primarily affect the maxillary sinus, the maxillary or mandibular bone. A review of the English-language literature since 1908 revealed 30 reported cases of primary leiomyosarcoma of the oral mucosa and soft tissues.

MATERIAL AND METHODS

We report on a case of gingival leiomyosarcoma, arising in a 31-year-old female and involving the upper alveolar mucosa. Following the diagnosis of malignant neoplasm on frozen sections and an en-block resection, the tumour was formalin-fixed and paraffin embedded for histological and immunohistochemical examination.

RESULTS

Microscopically, the tumor was composed of interlacing fascicles of spindle-shaped cells with elongated, blunt-ended nuclei and eosinophilic cytoplasm, containing PAS-positive granules. Mitoses, both typical and atypical, and scattered necrotic foci were present. Consistent desmin, muscle specific and alpha-smooth muscle-specific, and vimentin immunoreactivity was demonstrated in the tumor cells. The patient is alive and free of disease at a 7-year follow-up.

CONCLUSIONS

Intra-oral leiomyosarcomas are exceptionally rare. Accurate diagnosis and treatment is largely based on the careful search of clinical signs indicative of malignancy (e.g., neoplastic bone destruction, wide invasion of adjacent tissues) and intra-operative (frozen sections) examination of the lesion. Though the case reported herein showed an attenuated clinical behavior, prolonged follow-up is mandatory in view of possible tumor relapse.

Primary intraoral leiomyosarcoma of the tongue: an immunohistochemical study and review of the literature

Leiomyosarcoma is a relatively uncommon mesenchymal tumor that exhibits smooth-muscle differentiation. We report a new case of leiomyosarcoma involving the tongue of a 67-year-old male. Histologically, the tumor was composed of variably oriented fascicles of spindle-shaped cells with 'cigar-shaped' nuclei and eosinophilic cytoplasm, containing occasional PAS-positive granules. Atypical mitotic figures and necrotic foci were frequently detected. Consistent desmin, alpha-smooth muscle-specific and sarcomeric actin, and vimentin immunoreactivity was demonstrated in the tumor cells, whereas cytokeratins, CD 30, CD 31, CD 34, CD 45, CD 68, EMA, GFAP, HMB 45 and S-100 protein were negative. The patient underwent wide surgical excision of the tumor and is alive and disease-free at a 5-year follow-up. This report emphasizes the difficulties in the differential diagnosis of these uncommon tumors in an intra-oral location.

Leiomyosarcomas of the oral cavity: an unusual topographic subset easily mistaken for nonmesenchymal tumours

AIMS

Oral leiomyosarcoma is rare and poorly documented. We aimed to characterize these lesions clinicopathologically in order to facilitate their distinction from other spindle cell neoplasms in the oral cavity.

METHODS AND RESULTS

Ten cases of oral leiomyosarcoma were retrieved and studied histologically and immunohistochemically. Clinical data were obtained from referring pathologists and prior literature concerning 46 comparable cases was reviewed. Nine out of 10 cases occurred in adults; 50% arose in the jaws and four showed bone involvement. Histological appearances were similar to leiomyosarcomas elsewhere. In addition to myogenic markers, two cases were also keratin-positive. Four patients developed local recurrence or metastatic disease and three died of tumour (median follow-up 37 months).

CONCLUSIONS

Leiomyosarcoma is under-recognized in the mouth, often being mistaken for a spindle-celled epithelial neoplasm. Aside from an unusual but infrequent tendency to spread to lymph nodes and a location-specific differential diagnosis, its clinicopathological features are comparable to leiomyosarcomas at other locations.