Paraovarian leiomyosarcoma with scalp metastasis: a case report

PURPOSE

Leiomyosarcoma is a rare neoplasm. There is paucity of literature in regards to paraovarian leiomyosarcoma with metastases to the scalp. We present a 72-year-old woman with metastases to the scalp from a primary paraovarian high grade leiomyosarcoma.

METHODS AND RESULTS

The patient underwent a total abdominal hysterectomy, pelvic and aortic lymphadenectomy, excision of Meckel's diverticulum, and radical pelvic tumor debulking with sigmoid colectomy and end-to-end anastomosis and six cycles of taxotere/carboplatin. She presented 18 months later with metastatic high-grade leiomyosarcoma to the scalp. The lesions were excised and she is now receiving palliative taxotere and gemcitabin.

CONCLUSION

High-grade leiomyosarcoma is known for its resistance to chemotherapy, radiation therapy, and propensity for hematological dissemination with an overall poor prognosis.

A rare case of uterine leiomyosarcoma metastasis to the duodenum

Uterine leiomyosarcoma (ULMS) is an uncommon malignant tumor that accounts for less than one-third of uterine sarcomas and approximately 1% of uterine malignancies. Cases of local and distant ULMS metastasis have been widely reported, especially to the lungs. There have been very few cases, however, of ULMS metastasis to the upper gastrointestinal (GI) tract published in the peer-reviewed literature. Here we describe a case of biopsy-proven ULMS metastasis to the first part of the duodenum, representing the third reported case of its kind. Theories regarding presentation, treatment, clinical course, and outcome of patients with ULMS metastasis to the duodenum are presented.

Metastatic pulmonary leiomyosarcoma presenting with a long disease-free interval: report of a case

The prognosis in patients with retroperitoneal leiomyosarcoma and its distant metastasis is poor. We herein present an extremely rare case of an 83-year-old woman with a pulmonary metastasis from retroperitoneal leiomyosarcoma. The disease-free interval between the resection of the primary tumor and the diagnosis of metastasis was longer than 23 years. She was successfully treated with a video-assisted thoracic surgery lobectomy.

Breast metastasis from uterine leiomyosarcoma diagnosed by fine needle aspiration: a case report

BACKGROUND

Leiomyosarcomas of the breast are a rare subgroup of primary breast sarcomas. Even more rare is breast metastasis of an extramammary leiomyosarcoma. To date, only 4 cases have been reported in the literature.

CASE

We report a case of breast metastatic leiomyosarcoma in a 58-year-old woman with a prior history of uterine leiomyosarcoma, resected 18 months earlier. The breast mass was palpable and a fine needle aspiration (FNA) was performed. The microscopic examination showed cellular smears composed of loosely structured clusters and tissue fragments of spindle-shaped and polygonal or rounded malignant cells in disorderly arrangement. The tumor cells were medium- or large-sized, with basophilic cytoplasm and enlarged, irregular, hyperchromatic nuclei with nucleoli. Tumor giant cells and multinucleation were also present. The morphologic features along with immunocytochemical positivity for desmin, muscle-specific actin and vimentin indicated the diagnosis of a metastatic leiomyosarcoma.

CONCLUSION

FNA cytology can be a reliable method for the diagnosis of leiomyosarcoma. The morphologic criteria in combination Swith the clinical history and the immunocytochemical findings can indicate a definitive diagnosis and avoid additional painful and time-consuming diagnostic procedures for the appropriate patient's further clinical management.

[Metastatic lung tumor from uterine leiomyosarcoma; report of a case]

Endometrial leimyosarcoma is rare neoplasm of all the uterine malignancies. We herein present a case of metastatic pulmonary tumor derived from endometrial leiomyosarcoma She had undergone hysterectomy for leiomyosarcoma. About 10 years after the hysterectomy, metastatic hepatic tumors and peritoneal dissemination were pointed out. Following chemotherapy of cisplatin, ifomide and pirarubicine, right hepatectomy was performed. About 12 years after the hysterectomy, a metastatic lesion appeared in the right lower lung field and right S6 segmentectomy was performed. About 15 months after the pulmonary resection, another metastatic lesion appeared in the remaining right lower lobe. The mass grew so rapidly with involvement to adjacent organs that pericardial resection was necessary with completion right lower lobectomy. Postoperative chemotherapy was performed with the same regimen as previously performed. About 10 months after the second pulmonary resection, she died due to dissemination in the right haemithorax and malignant pericardial effusion. Careful follow up after the surgery for the uterine leiomyosarcoma is recommended because metastatic leiomyosarcoma possibly appears even after a long interval, and its progress can be so intensive that adjuvant chemotherapy is necessary if it can not be treated surgically alone.

[Case of pneumothorax due to pulmonary metastases from uterine leiomyosarcoma]

A 44-year-old woman who had undergone hystero-oophorectomy for uterine sarcoma presented to our hospital with palindromic pneumothorax and her chest CT revealed multiple cystic lesions. After admission video-assisted thoracoscopic surgery (VATS) showed the pulmonary lesions to be primarily leiomyoma, however, further examination revealed that her uterine sarcoma resected in 2000 exhibited not only mitosis but also venous invasion. We therefore considered her lung tumors as metastases from uterine leiomyosarcoma. Cases of secondary spontaneous pneumothorax (SSP) due to pulmonary metastases are rare and almost half are from mesenchymal tumors. Thin-wall cavities and cysts are formed by a check-valve mechanism in the process of pulmonary metastases formation. When multiple thin-wall cavities and cysts are found in the lung, pulmonary metastases should be considered as one of the causes, and pathological specimens obtained in past illness should be re-examined in detail.

Retroperitoneal leiomyosarcoma of the inferior vena cava mimicking a liver tumor

Leiomyosarcoma of the inferior vena cava (IVC) is a rare sarcoma, but it is the most common primary malignancy of the IVC. It has an extremely poor prognosis. We describe a 60-year-old white female complaining of abdominal fullness for 7 weeks before she sought medical assistance. Initial work-up including sonography, computed tomography, and magnetic resonance showed a tumor in the right upper quadrant of the abdominal cavity originating from the liver with compression of the IVC and displacement of the right kidney. The patient underwent surgical resection of the tumor with clear margins and reconstruction of the IVC using a Dacron tubular graft. Postoperatively, she was placed on Coumadin and adjuvant chemotherapy was started. Subsequently, the patient developed metastasis into the liver and peripancreatic nodes during the follow-up period. Considering the aggressiveness of this tumor, early radical en block resection with clear margins is still the only chance for long-term survival.

Temporalis muscle metastasis of the uterine leiomyosarcoma: a case report

Leiomyosarcomas are malignant tumors of smooth muscle origin. These tumors are very rare in the head and neck region. The majority of leiomyosarcomas of the head and neck arise in the paranasal sinuses, oral cavity, jaws and superficial soft tissues like the scalp. A mass was observed in the right temporoparietal region of the scalp of a 76-year-old female. Two years before presentation, the patient was operated for primary uterine leiomyosarcoma. Over the ensuing years, the mass substantially increased in size. Radiologic findings revealed a mixed density mass of the right temporalis muscle. Histologic and immunohistochemical examination of the tumor showed a malignant mesenchymal neoplasm consisting of spindle-shaped atypical mesenchymal cells with marked pleomorphism and central cigar shaped nuclei arranged in fascicles. We report a rare case of uterine leiomyosarcoma metastatic to the temporalis muscle, proven by histopathology.

Fentanyl-induced neurotoxicity and paradoxic pain

A patient with pain associated with metastatic leiomyosarcoma received escalating doses of opioids. Upon discontinuation of intravenous morphine, transdermal fentanyl was initiated, and after several days, the dose was increased to 200microg/hour for persistent, severe pain. The patient became somnolent, and further dose adjustments and route change were carried out. She then exhibited severe allodynia, myoclonus, and delirium thereafter fentanyl was stopped. All symptoms resolved with discontinuation of fentanyl and subsequent introduction of a weak opioid. Pain was well controlled. Gradually increasing standard doses of fentanyl may lead to severe neurotoxicity, which may respond to opioid discontinuation and/or rotation. Vigilant scrutiny of all possible causes of apparent analgesic failure followed by consideration of opioid reduction and rotation is warranted in cases of neurotoxicity accompanying opioid treatment.

Endobronchial metastases from a leiomyosarcoma of the uterus

A 63-year-old woman presented with dyspnea, non-productive cough and chest pain. On computed tomography of the thorax, near total atelectasis of the left lung was reported. On bronchoscopic examination, a mass lesion was observed in the mucosa of the left main bronchus leading to near total obstruction. Her medical history revealed that she had been treated with total abdominal hysterectomy and adjuvant radiation therapy for a leiomyosarcoma of the uterus one year ago. She was diagnosed as having a metastatic leiomyosarcoma and was treated with palliative radiation therapy. Six months later, she presented with disseminated disease involving the thorax and the pelvis. She refused further treatment and died one month later. Patients with leiomyosarcomas of the uterus might follow an aggressive clinical course, with relatively early metastases at unusual sites.

Leiomyosarcoma of the uterine corpus with ovarian metastases in a 28-year-old woman: case report

A case of invasive leiomyosarcoma of the uterine corpus with right ovarian metastases in a 28-year-old woman is presented. The patient was submitted to surgery including total abdominal hysterectomy with left salpingo-oophorectomy, dissection of the pelvic and paraaortal lymph nodes and fixation of the right ovary to the psoas muscle. Postoperative radiation therapy was applied. A year after treatment, the patient was well.

Uterine leiomyosarcoma metastasis to the breast

BACKGROUND

Uterine leiomyosarcoma is a rare female neoplasm with a high recurrent and metastatic rate. However, only a few cases have been reported on metastasis to the breast. The purpose of this work is to stress the role of follow-up and to increase physicians' awareness of such lesion. case: A 62-year-old female suffered from a breast nodule and multiple metastases six years after resection for uterine leiomyosarcoma. Pathology revealed a rare condition of uterine leiomyosarcoma with breast metastasis.

CONCLUSION

The case highlights the important role of long-term follow-up in uterine leiomyosarcoma and implies the necessity of tissue proof in patients with the disease.

Metastasis of uterine leiomyosarcoma to the thyroid gland: case report and review of the literature

Metastasis of uterine leiomyosarcoma to the thyroid is extremely rare. Only three cases have been previously reported. We present a case of uterine leiomyosarcoma metastatic to the thyroid gland and review the current literature on this topic.

Pleomorphic leiomyosarcoma of the adrenal gland: case report and review of the literature

Primary adrenal leiomyosarcomas (LMS) are extremely rare mesenchymal tumors. To the best of our knowledge only 12 cases (9 cases of conventional and 2 cases of pleomorphic LMS) have been reported in the literature until the present date. Herein we report a case of pleomorphic LMS in a 47-year-old woman who presented with severe abdominal pain. Computed tomography showed a large heterogeneous left adrenal mass abutting the renal vessels. The adrenal mass was resected and histopathologic examination revealed a highly pleomorphic malignant spindle cell neoplasm diffusely infiltrating the adrenal parenchyma with an immunoprofile consistent with that of a leiomyosarcoma. Clinical management and subsequent follow-up of this patient is presented.

Leiomyosarcoma with dedifferentiation in a premenopausal patient discovered after uterine artery embolization

Although a hysterectomy is the most common treatment for relieving the symptoms attributable to uterine leiomyomas, uterine artery embolization (UAE) is now being used more frequently as an alternative to a hysterectomy. However, it is difficult to differentiate a leiomyoma from a leiomyosarcoma without performing a pathological examination. Reported herein is a rare case of leiomyosarcoma that showed dedifferentiation of the tumor cells after UAE. A premenopausal 48-year-old woman had been suffering from hypermenorrhea for 4 years before visiting the clinic. She underwent UAE for suspected symptomatic leiomyoma. Two months later, dilatation and curettage was performed because of genital bleeding and a necrotic mass was submitted for pathological examination. Three months after curettage, with renewed symptoms, endometrial biopsy was done, which confirmed pleomorphic sarcoma. Metastatic nodes to the lung were also found at that time. Multiple leiomyosarcomas and a leiomyosarcoma showing dedifferentiation of the uterine body were found on pathological examination. The patient had metastatic nodes to the brain later and died of metastatic disease 20 months in total after UAE. This is a rare case of leiomyosarcoma with dedifferentiation and multiple metastases occurring after UAE, suggesting that dedifferentiation could be derived from ordinary leiomyosarcoma and that the traumatic effect of curettage might cause early metastasis. The present case is a warning that careful and detailed evaluation of the uterine tumor are needed before UEA.

Leiomyosarcoma of the Uterus With Sphenoid Bone and Orbital Metastases

A 55-year-old woman presented with a 1-week history of vision loss in the right eye associated with proptosis and diplopia. Past medical history was significant for high-grade leiomyosarcoma of the uterus status post total abdominal hysterectomy and bilateral salpingo-oophorectomy and postoperative pelvic radiation 18 months prior to presentation. Staging studies at the time of initial diagnosis of uterine leiomyosarcoma showed no evidence for metastatic disease. At presentation, CT and MRI showed a well-circumscribed 3.0 cm x 3.6 cm x 2.4 cm mass centered in the right greater sphenoid wing, extending into the middle cranial fossa and the superior and lateral orbital wall. Biopsy of the orbital mass revealed a poorly differentiated high-grade leiomyosarcoma, consistent with recurrent metastatic disease from the uterus. The patient subsequently underwent radiation treatment followed by a left orbital exenteration 6 months after the orbital biopsy. A left thoracostomy was performed 8 months after the orbital biopsy for a metastatic nodule in the left lower lobe of the lung. The clinicopathologic findings of this rare metastatic orbital lesion are presented.

Radiological imaging features of non-uterine leiomyosarcoma

Leiomyosarcomas are unusual soft-tissue tumours that occur in the retroperitoneum, peripheral soft tissues, gastrointestinal and genito-urinary tracts, vessels and (rarely) in bone. The aim of this pictonal review is to delineate the more specific radiological features that would suggest a radiological diagnosis of leiomyosarcoma prior to biopsy.

Metastatic Uterine Leiomyosarcoma Regression Using an Aromatase Inhibitor

BACKGROUND

Metastatic and disseminated uterine leiomyosarcoma has limited chemotherapeutic options.

CASE

A 45-year-old nulligravida was originally diagnosed with a primary uterine leiomyosarcoma and treated with a total abdominal hysterectomy, followed by six courses of adjuvant platinum and doxorubicin chemotherapy. Three years later she developed multiple metastatic tumor nodules in the lungs. Because of the estrogen receptor positivity of the leiomyosarcoma by immunohistochemistry, she was treated with 1 mg of anastrozole daily. Progressive tumor regression was demonstrated by serial imaging in all metastatic lung tumor deposits, with an objective response lasting at least 12 months.

CONCLUSION

Uterine leiomyosarcoma metastatic to the lungs regressed with the use of the anastrozole aromatase inhibitor.

FNA diagnosis of retroperitoneal leiomyosarcoma metastasizing to the breast

Fine-needle aspiration (FNA) biopsy is one of the first-line investigations in any breast lump, and hence cytomorphological recognition of nonmammary metastatic tumors to the breast and their distinction from primary tumors is important. Breast metastasis from extra-mammary malignancy is rare, constituting 2% of breast tumors; even rarer are metastatic leiomyosarcomas. Our patient presented with a breast lump 2 years after operative removal of a retroperitoneal leiomyosarcoma. The breast lump was confirmed to be a metastasis from the earlier primary. Herein, we report the first case of a retroperitoneal leiomyosarcoma metastatic to the breast diagnosed by Fine Needle Aspiration.