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Wu Z, Cheng L, Cao Q, Ye S, Yu S, Sun M, Jing J. Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur. Front Surg 2023; 9:1045307. [PMID: 36704525 PMCID: PMC9872517 DOI: 10.3389/fsurg.2022.1045307] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Primary leiomyosarcoma of the bone (LMSB) is an extremely rare, invasive, and highly destructive primary osteosarcoma with limited treatment options and poor prognosis. Only a few case reports of LMSB have been described because of its rarity. Therefore, clinicians have a limited understanding of its diagnosis, treatment, and prognosis, and the final diagnosis depends on histopathological findings. In this report, we describe a rare case of primary LMSB in the trochanteric region of the femur. Reporting this case may increase the dissemination and understanding of information regarding LMSB and provide a reference for the diagnosis and treatment of similar cases. Case presentation A 63-year-old woman presented with pain and limited movement of the left hip, which had lasted for 3 months, with no history of trauma or illness. Plain radiography and computed tomography revealed a solitary osteolytic lesion in the trochanteric area of the left femur with focal cortical destruction. Magnetic resonance imaging findings suggested invasion of the lesion into the bone cortex, forming a soft tissue mass, although no distant positive findings were observed on a whole-body bone scan. A bone tumor puncture biopsy was performed to obtain a final diagnosis, and histopathological evaluation revealed left femoral intertrochanteric leiomyosarcoma, classified as G1T2M0 and staged as IB (extracompartmental low-grade malignant) according to the Enneking staging system. Thus, we performed extensive debridement and left hip arthroplasty. Postoperative chemotherapy was administered, and the patient was followed up for 4 years. Four years later, the patient's left hip pain had resolved, joint activity was good, and no signs of recurrence or distant metastasis of the bone tumor were noted. Conclusion For proximal femoral Enneking stage IB LMSB, extensive tumor resection combined with tumor prosthesis replacement may be an effective treatment method to prolong the patient's lifespan and to restore joint function.
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Affiliation(s)
- Zhonghan Wu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Li Cheng
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Qiliang Cao
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuming Ye
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuisheng Yu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Min Sun
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,Correspondence: Juehua Jing
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Zhang J, Chen Y, Xing X, Wang Q, Liu K, Zhang E, Lang N. Primary leiomyosarcoma of the spine: an analysis of imaging manifestations and clinicopathological findings. Insights Imaging 2022; 13:195. [PMID: 36520263 PMCID: PMC9755377 DOI: 10.1186/s13244-022-01336-y] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary leiomyosarcoma of the spine is extremely rare and lacks specific clinical symptoms. This study investigated the imaging manifestations and clinicopathological findings of primary leiomyosarcoma of the spine, aiming to improve the radiologists' understanding of the disease and reduce misdiagnoses. METHODS The clinical, imaging, and pathological manifestations in eleven patients with pathologically confirmed primary leiomyosarcoma of the spine were retrospectively analyzed. The imaging features analyzed included lesion location, shape, border, size, and density/intensity, and adjacent bone destruction status, residual bone trabeculae, vertebral compression, and contrast enhancement. RESULTS The patients' primary clinical symptom was usually focal pain. Primary leiomyosarcoma of the spine was mostly a solitary lesion and tended to occur in the posterior elements. The tumors had a lobulated shape with osteolytic bone destruction, ill-defined borders, and could involve multiple segments. Computed tomography (CT) examination showed isodense masses. Six patients showed residual bone trabeculae. Two patients had miscellany T2-weighted imaging (T2WI) signals, while the tumor and spinal cord of the remaining patients were isointense on T1-weighted imaging (T1WI) and T2WI. Among the seven patients who underwent contrast-enhanced scanning, six displayed homogeneous enhancement. Eight patients underwent gross-total tumor resection with no recurrence. CONCLUSIONS Primary leiomyosarcoma of the spine tends to be a solitary lesion in the posterior elements and appears as a lobulated mass with osteolytic bone destruction and an ill-defined border. The tumor and spinal cord can be isointense on T1WI and T2WI. Contrast-enhanced scanning displays homogeneous enhancement. The lesion tends not to recur after surgical gross-total tumor resection.
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Affiliation(s)
- Jiahui Zhang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Yongye Chen
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Xiaoying Xing
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Qizheng Wang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Ke Liu
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Enlong Zhang
- grid.449412.eDepartment of Radiology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Ning Lang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
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Pluemvitayaporn T, Piyaskulkaew C, Kunakornsawat S, Pruttikul P. Primary leiomyosarcoma of the spine treated with total en bloc spondylectomy: the first case in Thailand-a case report and literature review. J Spine Surg 2017; 3:707-714. [PMID: 29354752 DOI: 10.21037/jss.2017.10.04] [Citation(s) in RCA: 2] [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] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Leiomyosarcoma is a rare type of malignant soft tissue tumor and also one of the most aggressive soft tissue sarcomas. It commonly occurs in uterus, abdominal viscera, retroperitoneal space and soft tissue of the extremities. Primary osseous leiomyosarcoma is a rare condition. Furthermore, primary leiomyosarcoma of the spine is extremely rare. Only few cases have been reported. However, the treatment and outcomes remains controversial. Therefore, the objective of this case report is to illustrate the management of this extremely rare disease by using total en bloc spondylectomy (TES) procedure, which is one of a suitable option for surgical resection of the spinal tumors. In this study, we presented an unusual case of a 61-year-old female, who was diagnosed as primary leiomyosarcoma of the twelfth thoracic spine with liver metastasis, treated with total en bloc spondylectomy of the twelfth thoracic vertebra followed by chemotherapy. On last follow-up, 6 months after the surgery, the clinical outcome remained in good condition and no signs of local recurrence. In conclusion, primary leiomyosarcoma of the spine is an extremely rare and difficult to diagnosis. Immunohistochemistry studies are very important for confirmation of the diagnosis. Standard treatment remains controversial. However, surgical resection is still treatment of choice. One of the most effective surgical options is TES, which give the better outcome and minimize local recurrence, if indicate.
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Rekhi B, Kaur A, Puri A, Desai S, Jambhekar NA. Primary leiomyosarcoma of bone--a clinicopathologic study of 8 uncommon cases with immunohistochemical analysis and clinical outcomes. Ann Diagn Pathol 2011; 15:147-56. [PMID: 21393038 DOI: 10.1016/j.anndiagpath.2010.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 10/24/2010] [Accepted: 11/11/2010] [Indexed: 01/15/2023]
Abstract
Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity. Over a 7-year period, we identified 8 such cases that fulfilled the diagnostic criteria in 6 men and 2 women, with age ranging from 25 to 59 years (mean, 42.7 years). All cases were noted in the lower limbs, including femur and tibia as the commonly involved bones in 4 and 3 cases, respectively. On radiography, the most consistent feature was a solitary osteolytic lesion with cortical destruction, unassociated with matrix formation. On histopathology, all cases showed spindly sarcomatous cells, mostly arranged in fascicles and whorls. Of 8 cases, 6 (75%) were of high grade. Prominent vasculature was noted in 5 cases. Two cases displayed focal mineralization, including calcification and heterotropic woven bone formation in 1 case each, but lacked malignant osteoid or chondroid matrix. One case showed osteoclast-like giant cells. On immunohistochemistry, smooth muscle actin was diffusely positive in all cases (100%), desmin was positive in 6 (75%) of 8 cases, and h-caldesmon was positive in 5 (83.3%) of 6 cases. Five cases underwent surgery, including 3 amputations and 2 wide excisions. One case underwent chemotherapy. On follow-up, 5 cases developed metastasis, including 1 case with another, who died within 17 and 5 months. Leiomyosarcoma of bone is uncommon and diagnostically challenging. An index of suspicion is necessary for this diagnosis, especially in cases of lytic, destructive bone lesions, unassociated with matrix production, that show spindly sarcomatous cells on histopathology. Immunohistochemical analysis, including an optimum panel formed by smooth muscle actin (diffuse positivity), desmin, and h-caldesmon, is necessary for substantiating this diagnosis. Surgery forms the treatment mainstay. The prognosis appears to be dismal.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, India.
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Atalar H, Gunay C, Yildiz Y, Saglik Y. Primary leiomyosarcoma of bone: a report on three patients. Clin Imaging 2008; 32:321-5. [PMID: 18603190 DOI: 10.1016/j.clinimag.2007.10.022] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2007] [Accepted: 10/20/2007] [Indexed: 11/24/2022]
Abstract
Primary leiomyosarcoma of bone is a rare aggressive tumor that occurs mainly in older people. It resembles other malignancies clinically and radiologically, and differential diagnosis is based on histopathology, including immunohistochemistry. If leiomyosarcoma is found in bone, the possibility that it is a metastasis from a distant tumor should be investigated. The treatment is surgical excision with wide margins. Here we present three patients who had primary leiomyosarcoma of radius, ilium, and femur, respectively, and who were treated surgically.
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Affiliation(s)
- Hakan Atalar
- Department of Orthopaedic Surgery and Traumatology, Fatih University, Alparslan Turkes Caddesi No. 57, 06510 Emek/Ankara, Turkey.
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Cotta CV, Konoplev S, Medeiros LJ, Bueso-Ramos CE. Metastatic tumors in bone marrow: histopathology and advances in the biology of the tumor cells and bone marrow environment. Ann Diagn Pathol 2006; 10:169-92. [PMID: 16730315 DOI: 10.1016/j.anndiagpath.2006.04.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The nonhematopoietic tumors most often diagnosed in the bone marrow are metastatic. Currently, accurate diagnosis of tumor metastasis requires integration of the clinical findings; morphological features; and results of immunohistochemical stains, cytogenetics, and molecular studies. This review focuses on a practical approach to the diagnosis of metastatic tumors in the bone marrow according to current standards of practice and discusses recent advances in understanding of tumor metastasis and the interaction between tumors and the bone marrow environment.
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Affiliation(s)
- Claudiu V Cotta
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, 77030, USA
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Affiliation(s)
- Kenji Endo
- Department of Orthopedics, The University of Tokushima, Tokushima, Japan.
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Abstract
Primary leiomyosarcoma of bone is a very rare tumor. Four cases are reported: 3 tumors were located in the femur and 1 in the talus. Clinical and imaging findings including radiographs, CT, and MRI are described. The final diagnosis was made by histopathological, immunohistochemical, and/or ultrastructural study after biopsy.
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