Metastatic Leiomyosarcoma of the Spine Updates in Management and Surgical Strategy (original) (raw)
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Journal of surgical oncology, 2015
Several types of soft tissue sarcomas may locally extend to the spine. The best therapeutic strategy for such lesions strongly depends on the histological diagnosis. In this article the authors provide an up-to-date review of current guidelines regarding the management of soft tissue sarcomas involving the spine. Special attention is given to outcomes and complications of modern surgical series in order to highlight current challenges in the management of such lesions. J. Surg. Oncol. 2015 111:580-586. © 2014 Wiley Periodicals, Inc.
Case Study Primary Leiomyosarcoma of Spine-A Rare Entity
The primary leiomyosarcoma invading the spine is an extremely rare neoplasm .We report a case of 75 year old male with no significant medical history presenting with weakness in both lower limbs and incontinence of urine and faeces since 15 days. MRI confirmed the presence a lytic lesion causing collapse of D11-D12 vertebrae with involvement of paravertebral soft tissue and 11-12 th ribs. Decompressive surgery was performed for the same and tumour was sent for histopathological examination. On histology, tumour was found to be low grade leiomyosarcoma which showed positivity for desmin and smooth muscle actin on Immunohistochemistry.
Primary Leiomyosarcoma of the Lumbar Spine: A Case Report and Literature Review
2021
Primary vertebral leiomyosarcoma of the spine is extremely rare. Due to its rarity, the number of studies on pathology, treatment and prognosis is limited. Tissue Biopsy and Immunohistochemical staining techniques provide unequivocal diagnosis of leiomyosarcoma. The mainstay of treatment of spinal leiomyosarcoma is surgery, with or without radiotherapy and embolization. The principles of surgery comprise resection of tumor, decompression and stabilisation of the spinal cord and prevention of tumor recurrence. The Tomita total en-bloc resection is the preferred surgical technique. We hereby present a literature review of spinal leiomyosarcoma and a case report of the first case of a 56-year-old lady in Malaysia who was diagnosed with L3 vertebral leiomyosarcoma and lung metastasis.
Benign Metastasizing Leiomyoma to the Lung and Spine: A Case Report and Literature Review
Case Reports in Oncology, 2019
Benign metastasizing leiomyomas (BML) represent a rare phenomenon consisting of the extra-uterine spread of smooth muscle cells with similar histological, immunological, and molecular patterns to those of benign uterine leiomyomas. They are considered benign based off their low mitotic activity, lack of anaplasia or necrosis, and limited vascularization. This condition represents an interesting diagnostic and treatment challenge based on their rarity and indolent nature. Our case represents a unique finding of BML in the thoracic spine in a postmenopausal woman many years after hysterectomy and partial oophorectomy. There are currently no standard guidelines for treatment of BML, given the rare nature of this condition, with most patients treated with a combination of surgical resection and radiotherapy, followed by hormonal treatment and radiological surveillance serving as the primary backbone of current management plans. Given that these patients present a unique clinical challen...
Unexpected resection of soft-tissue sarcoma
Archives of Orthopaedic and Trauma Surgery, 2000
Sixteen referred patients were reviewed after excision of an unexpected soft-tissue sarcoma of the extremities. Eight tumors were located in the muscle deep to the fascia, and 8 lesions exceeded the size of 5 cm. The lack of awareness by the primary physician towards the possibility of a malignant lesion was striking, although 11 of 16 tumors presented as a newly formed mass. No imaging studies were done in 11 patients. Fine needle biopsy was unsuccessfully performed in 3 patients. Eleven lesions (63%) were high-grade. Resection margins were intralesional in 12 (75%) and marginal in 4 (25%) patients. Surgical oncologic rules were disregarded in 7 cases, including opening of probably uninvolved joints. Postoperative magnetic resonance imaging (MRI) scans showed a poor negative predictive value for residual tumor. Repeated resection, including three amputations, revealed residual tumor in 10 patients (63%). Four patients received adjuvant local radiation, with additional chemotherapy in 2 of them. At an average follow-up of 4.5 years (range 15-149 months), 4 patients (25%) had developed distant metastases with a local recurrence in 3 (19%). There was one tumor-related death (6%). Physicians' alertness towards the possible malignancy of an enlarging mass cannot be overemphasized. Evaluation by adequate imaging techniques, biopsy, and definitive resection and reconstruction should be performed by an oncologically trained orthopaedic surgeon. Inadequate primary excision leads to a high local recurrence rate and more mutilating surgery and obscures the long-term prognosis.
Surgical Management of Destructive Neoplastic Spine Lesions
The Egyptian Journal of Hospital Medicine, 2019
The spine is one of the most common sites of metastasis from distant structures, following the lung and the liver. Aim: to review the pathological distribution, clinical presentation and different surgical procedures and outcome of cases with neoplastic spine lesions managed at our departments. Patients and methods: this is a review of 29 patients presented with destructive spine lesion with compromised neural structure at different degrees, with no history of trauma or infection. All patients subjected to full neurological examination and ASIA scoring, and full radiological evaluation. Different surgical approaches were utilized. Results: this a retrospective study of 29 patients, 11males and 18 females. Mean age of presentation was 50years old. The affected vertebral bodies are 47 distributed among vertebral regions: 6 sacral (12.8%), 16 lumbar (34%), 6 thoracolumbar (12.8%), 12 thoracic (25.5%), 3 cervicothoracic (6.4%), and 4 cervical (8.5%). As regard surgical procedures, 5 pat...
Clinical Outcome of Surgically Treated Leiomyosarcoma of the Extremities: A Retrospective Overview
Anticancer Research, 2020
Aim: This study was interested in extremity leiomyosarcoma with focus on clinical outcome after surgery with or without adjuvant therapy. Patients and Methods: A retrospective case series of all patients with leiomyosarcoma, surgically treated between 2000 and 2015 and a minimum follow-up of 2 years, was drawn from institutional databases in Belgium and the Netherlands. Postoperative complications were reported with the Radiation Therapy Oncology Group (RTOG) and the Henderson classification. Results: Seventy-five patients were operated on, of whom 47 underwent (neo)adjuvant therapy. Infection was observed in 11 patients, seven associated with (neo)adjuvant radiotherapy. Dermatological complaints were observed in 26 patients, 10 associated with (neo)adjuvant radiotherapy. Overall survival was 60%. Local recurrence occurred in 11 (15%) patients. Conclusion: This study describes favourable clinical outcome following (neo)adjuvant radiotherapy. In the future, larger databases on leiomyosarcoma should enhance the power of these findings and define the benefits of adjuvant therapy in leiomyosarcoma. Leiomyosarcoma is a rare malignant tumour that can originate in the soft tissue or bones. It most frequently occurs in the middle aged to older population (50-70 years). Leiomyosarcomas of the soft tissue preferentially occur in the retroperitoneum and the great blood vessels (i.e. vena cava) and are divided into three groups: Uterine, abdominal (retroperitoneum and gastro-intestinal) and non-visceral (somatic) (1). In the limbs, leiomyosarcoma accounts for 2-10% of all soft-tissue tumours. They can also arise from bone but this is even rarer (1-4). This study focused on leiomyosarcoma located in the limbs (extremity leiomyosarcoma (eLMS). In such cases, the depth can vary from (sub)cutaneous to intramuscular and the neoplasm can even infiltrate the bone. In general, it presents as a (small) local mass, without initial symptoms. However, the tumour can compromise vital structures when expanding, resulting in pain, neurological deficit and limb oedema (3, 5, 6). Magnetic resonance imaging (MRI) generally shows an isointense (T1), hypointense (T2) or hyperintense (T2 with fat suppression) lesion with common relation to neurovascular structures. Depending on its aggressivity, it can appear to be inhomogeneous due to necrosis or display central bleeding. Its presence can be well-circumscribed or infiltrative with the surrounding tissue (7). Histopathology is very characteristic, showing intersecting, dense groups of spindle cells. Most tumours present as highly cellular, although sections with fibrosis and myxoid tissue can occur, especially in large tumours (5). Immunocytology is positive for desmin, smooth muscle actin and H-cadesmin, however these are not specific for leiomyosarcoma (5). Candidate genes on chromosomes 1, 5, 12, 17, 20 were investigated and found to have with possible correlation with leiomyosarcoma (5). For treatment of eLMS there are multiple modalities. Surgery is often combined with (neo)adjuvant chemo-and radiotherapy (RT), with the intent to increase local control and overall survival while maintaining limb function (8, 9).