Lower gastrointestinal bleeding due to small bowel metastasis from leiomyosarcoma in the tibia

Small bowel metastasis from primary bone leiomyosarcoma is very rare. Here we report on a 50-year-old man who presented with general weakness, weight loss (six kg in two months) and intermittent tarry stools for two months. He had undergone an above-knee amputation for left tibia leiomyosarcoma seven years previously. No local recurrence and/or distant metastasis developed during a seven-year period of follow-up. Subsequent imaging study revealed a multilobulated mass in the ileum. He received segmental resection of the small bowel and a multilobulated mass was noted in the submucosal layer of the ileum with mucosa ulceration. His postoperative course was uneventful. Histopathological examination of the resected mass revealed small bowel metastatic leiomyosarcoma. No local recurrence or distant metastases were detected during a six-month follow-up period. To the best of our knowledge, this is the first report of small bowel metastasis from primary bone leiomyosarcoma presenting with lower gastrointestinal bleeding.

Laryngeal leiomyosarcoma: a case report and review of the literature

Laryngeal leiomyosarcoma (LLM) is a rare malignancy originating from the smooth muscles of blood vessels or from aberrant undifferentiated mesenchymal tissue. Histological diagnosis may be particularly difficult and correct diagnosis is based on immunohistochemical investigations and electron microscopy. A case report of a LLM in a 74-year-old man is presented. Direct laryngoscopy revealed a large glottic lesion causing airway compromise and an emergency tracheotomy was performed. Subsequent total laryngectomy confirmed the diagnosis of leiomyosarcoma. Lung metastases developed 8 months following treatment, despite the absence of local or regional recurrence, and the patient died 3 months later. A review of the English and French literature revealed 30 previous cases of LLM. Clinical presentation, histological diagnosis, and management of this rare malignancy are analyzed aiming to improve our knowledge regarding the best treatment modality.

Gynecologic Cancers: Factors Affecting Survival After Pulmonary Metastasectomy

BACKGROUND

Little information is available regarding long-term survival after pulmonary metastasectomy for gynecologic malignancies.

METHODS

All patients who underwent pulmonary resection for gynecologic malignancies at our institution between January 1985 and June 2001 were reviewed. Factors affecting long-term survival were analyzed.

RESULTS

There were 103 patients, 70 of whom had metastatic disease limited to the lungs. Median age of these 70 patients was 59.4 years (range, 31 to 80 years). The primary tumor originated in the uterine corpus in 37 patients, endometrium in 23, cervix in 7, ovaries in 2, and vagina in 1. Histopathology was leiomyosarcoma in 29 patients, adenocarcinoma in 23, other sarcoma in 11, squamous cell carcinoma in 5, and choriocarcinoma and endolymphatic stromal myosis in 1 each. The median time interval between the first gynecologic procedure and pulmonary resection was 24 months (range, 0 to 237 months). A wedge excision was performed in 44 patients, lobectomy in 14, bilobectomy in 2, pneumonectomy in 1, and a combination in 9. Five patients (7%) had an incomplete resection. Eighteen patients (25.7%) developed at least one complication and 1 died (operative mortality, 1.4%). At last follow-up, 35 had died, and the median follow-up among those who were still alive was 36 months (range, 6 months to 13 years). Five-year and 10-year survival was 46.8% (95% confidence interval, 34.2% to 63.0%) and 34.3% (95% confidence interval, 19.7% to 52.5%), respectively. Factors that adversely affected survival include a disease-free interval between the first gynecologic procedure and pulmonary resection of less than 24 months (p = 0.004) and a primary site located in the cervix (p < 0.001).

CONCLUSIONS

Pulmonary resection for metastatic gynecologic cancer in selected patients is safe and effective. Both a short disease-free interval between the primary gynecologic procedure and pulmonary metastasectomy, and a primary cervical tumor had an adverse effect on survival.

Hemoperitoneum secondary to spontaneous rupture of metastatic gastric leiomyosarcoma of the liver: report of a case

Hepatic rupture with resulting hemoperitoneum due to metastatic cancer is uncommon. Reports in the literature have described a wide variety of neoplasms causing this usually fatal phenomenon. We describe a rare case of spontaneous rupture of hepatic metastases from gastric leiomyosarcoma. A 72-year-old male patient with sudden onset severe epigastric pain was rushed into emergency service. After examination, the patient underwent urgent operation with possible diagnosis of perforated gastric or duodenal ulcer. During exploration, we determined bleeding mass on the diaphragmatic side of the left lobe of the liver and a mass on the posterior wall of the stomach. Hemostasis was provided.

Cardiac metastasis from uterine leiomyosarcoma

Cardiac metastases are more frequent than primary heart neoplasias. Nearly any malignant tumour may metastasize to the heart, but the most common are carcinomas rather than sarcomas. We report the case of a patient who presented with heart metastasis 6 years after resection of an uterine leiomyosarcoma. The patient died thirty months after surgical resection without evidence of cardiac recurrence. Although cardiac metastases from uterine leiomyosarcoma are exceptional, they should be suspected in the presence of suggestive symptoms, since they can be associated with long survival after surgical treatment.

Computed tomography of gastrocolic ligament: involvement in malignant tumors of the stomach

BACKGROUND

This study investigated computed tomographic (CT) features and anatomic bases of gastrocolic ligament involvement in malignant neoplasms of the stomach.

METHODS

We retrospectively reviewed CT scans of 34 patients known to have gastric malignant neoplasm and gastrocolic ligament involvement. Emphasis was placed on direct invasion, lymph node metastasis, and omental seeding.

RESULTS

CT manifestations of gastrocolic ligament involvement included direct invasion (38.2%, 13 of 34), enlargement of lymph nodes (50%, 17 of 34), "smudged" appearance (26.5%, nine of 34), "omental caking" (5.9%, two of 34), cystic mass (2.9%, one of 34), and varices of the omentum (2.9%, one of 34). We also found that gastric carcinoma and gastrointestinal stromal tumor invaded the transverse colon through the gastrocolic ligament in six patients (17.6%, six of 34).

CONCLUSION

CT scan is useful for detecting gastrocolic ligament involvement in gastric malignant neoplasm. The imaging features consist of a mass sign, enlargement of lymph nodes, smudged appearance, omental caking, and so on. Gastric malignant neoplasm also may involve the transverse colon through the gastrocolic ligament.

[Leiomyosarcoma of the uterus metastatic to the brain]

A case of 52-year-old female presented with dysarthria and paresis of right upper extremity 3 years after an operation and chemotherapy for uterine leiomyosarcoma. Magnetic resonance imaging showed an enhanced mass in the left corona radiata. Brain biopsy was carried out and pathological examination of the specimen showed features of a leiomyosarcoma. Uterine leiomyosarcoma is an uncommon tumor and its metastasis to the brain is rare. Only 13 other cases have been published. The patient underwent gamma-knife therapy and obtains good quality of life.

Whole-body positron emission tomography with F-18 fluorodeoxyglucose for the detection of recurrence in uterine sarcomas

We evaluated the usefulness of whole-body positron emission tomography (PET) using F-18 fluorodeoxyglucose (FDG-PET) for the detection of recurrence in follow-up patients after primary treatment of uterine sarcoma. Eight patients with pathologically proven uterine sarcoma underwent FDG-PET, computed tomography (CT), and ultrasonography (US). Final diagnoses of recurrence were established in five cases (three carcinosarcomas and two leiomyosarcomas). PET revealed recurrent sites in the intraperitoneum, liver, lung, bone, and retroperitoneal lymph nodes. However, the minimum size of the tumor detected by PET depended on the sites of recurrence. CT and US images showed two false-negative cases of intraperitoneal tumors. PET was able to detect a solitary small intraperitoneal tumor, which was very difficult to detect by CT and US. Positive PET findings did not affect the prognosis in three of the five recurrent patients; however, the remaining two patients consequently underwent the combination therapy consisting of surgery and chemotherapy and survived for more than 1 year after the positive FDG-PET results. Application of PET imaging for the early detection of recurrent sites was useful for the decision of treatment strategy for patients with recurrent uterine sarcoma.

Metastasis of uterine leiomyosarcoma to the pancreas

BACKGROUND

Metastasis of uterine leiomyosarcoma to the pancreas is extremely rare.

CASE

A 46-year-old woman presented with hypermenorrhea and dysmenorrhea and underwent surgery. The histologic and immunohistochemical diagnosis was uterine leiomyosarcoma stage I with no metastasis to the ovaries or the pelvic lymph nodes. The mitotic count was very high. Thereafter, recurrences in the lung and subsequently in the pancreas were detected. The lesions in the lung and pancreas were resected and diagnosed as metastases of uterine leiomyosarcoma based on histology and immunohistochemistry.

CONCLUSION

We report an extraordinarily rare case of uterine leiomyosarcoma with metastasis to the pancreas following initial metastasis to the lung, both of which were diagnosed using histology and immunohistochemistry of the specimens obtained at surgery.

Pancreatic and gastric metastases of leiomyosarcoma arising in the left leg

Pancreatic or gastric metastases from other primary malignancies are rare, especially from leiomyosarcoma. We report a case of leiomyosarcoma in the left lower leg with metastases to the pancreas and stomach. A 61-year-old man had liver cirrhosis caused by hepatitis C virus infection and was followed up by his primary physician. Two years before presentation at our hospital, he had undergone surgical resection of leiomyosarcoma in the left lower leg and systemic chemotherapy for multiple metastatic tumors in the lung. On admission, endoscopic examination and computed tomography were performed for a routine checkup to exclude esophageal varices and liver tumor. Although the patient had no specific symptoms, multiple gastric and pancreatic metastases were identified by endoscopy and computed tomography, respectively. In general, metastases to the pancreas and stomach are rare. We discuss the clinical and diagnostic findings of pancreatic and gastric metastases by reviewing previously reported cases.

Metastatic uterine leiomyosarcoma coexisting with papillary carcinoma of the thyroid gland

Metastatic leiomyosarcoma to the thyroid gland has rarely been described. We report a 54-year-old postmenopausal woman with uterine leiomyosarcoma, who presented with a single "cold" nodule in the right thyroid lobe 3 months after hysterectomy. The lesion was identified as a papillary thyroid carcinoma. In a separate area of the thyroid, a 1.2-mm area of a malignant mesenchymal neoplasm with morphologic and immunohistochemical features of leiomyosarcoma existed. Seven months after thyroidectomy the patient developed micronodular lung disease visible on successive chest computed tomography scans, consistent with metastatic disease from the primary uterine leiomyosarcoma that showed very good and prolonged response to chemotherapy. The thyroid papillary carcinoma was likely the recipient of an early and possibly the first metastasis of the patient's uterine leiomyosarcoma. This is the first report of metastatic leiomyosarcoma coexisting with a primary thyroid carcinoma and supports the possibility of a common pathway connecting thyroid gland neoplasms and sarcomas.

[A case of primary hepatic leiomyosarcoma with intrahepatic and abdominal subcutaneous metastasis in Behcet's disease]

Primary hepatic leiomyosarcoma is a very rare tumor of the liver and primary hepatic leiomyosarcoma with Behcet's disease has not been reported previously. Behcet's disease is a multisystem disorder presenting with recurrent oral and genital ulcerations as well as ocular lesions; it has rarely been reported in association with malignant disease. We report a case of primary hepatic leiomyosarcoma with intrahepatic and abdominal subcutaneous metastasis in a patient with Behcet's disease; this is the first report of these findings in Korea.

Imaging of metastatic orbital leiomyosarcoma

A 74-year-old man with a previous history of lower leg soft tissues leiomyosarcoma and multiple metastasis presented with a progressive painless proptosis of the left eye. Orbital ultrasound, CT, and MRI revealed a large mass in the left medial orbit. The mass was surgically removed and pathologic examination confirmed the diagnosis of a metastatic orbital leiomyosarcoma. The imaging characteristics of this rare tumor are comprehensively detailed, using complementary ultrasound, CT, and MRI, the combination of which allowed planning of total excision of the lesion.

On the apparent failure of adjuvant pelvic radiotherapy to improve survival for women with uterine sarcomas confined to the uterus

Despite numerous studies documenting reduction of pelvic relapses after adjuvant pelvic radiotherapy stage I and II uterine sarcomas, improved survival remains unproven. This retrospective report analyzes patterns of failure, survival, and toxicity in 42 women with stage I and 7 patients with stage II uterine sarcomas treated from 1972 through 1998 to identify patients likely to benefit from pelvic or abdominal radiotherapy and chemotherapy. Four of these patients also received adjuvant chemotherapy. There were 20 leiomyosarcomas, 18 homologous mixed mullerian tumors, and 11 heterologous mixed mullerian tumors. Disease-free survivals for mixed mullerian tumors were 65% at 5 years and 61% at 15 years. Disease-free survivals for leiomyosarcomas were 40% at 5 years and 40% at 15 years. There were 14 distant only, 5 distant and abdominal, 1 abdominal, 1 distant and pelvic, and 2 unknown initial sites of failure. Acute toxicity was acceptable as measured by a median 1-kg weight loss from radiotherapy and a 2% rate of failure to complete therapy. Chronic toxicity consisted of 3 small bowel obstructions and 1 sigmoid colon obstruction. In conclusion, the efficacy of adjuvant pelvic radiation is demonstrated by the absence of any isolated pelvic failures. Although the frequent occurrence of peritoneal failures suggests a role for prophylactic abdominal radiation for mixed mullerian tumors, more effective systemic therapy is necessary to substantially increase the chance of cure for women with early-stage uterine sarcomas.

Metastatic uterine leiomyosarcoma masquerading as a primary lesion of the masseter muscle

Leiomyosarcomas are malignant tumours of smooth muscle origin. These tumours are very rare in the head and neck region. We report a case of metastatic uterine leiomyosarcoma masquerading as a primary sarcoma of the masseter muscle. We highlight the importance of considering the possibility of an unrecognised primary abdominal or uterine tumour.

Report of an unusual problematic uterine smooth muscle neoplasm, emphasizing the prognostic importance of coagulative tumor cell necrosis

Follow-up data of the clinical behavior of uterine smooth muscle tumors with low malignant potential are scarce. We present a woman suffering from a uterine smooth muscle cell tumor with increased cellularity, absence of significant atypia, and two to three mitotic figures per 10 HPFs but with minimal focal coagulative tumor cell necrosis (CTCN). These microscopic features are currently accepted to label the lesion as a "smooth muscle neoplasm of low malignant potential, limited experience." After a disease-free survival of 4 years, two retroperitoneal tumors around the iliac vessels were extirpated. Both tumors consisted of smooth muscle cells with mild to moderate atypia and a mitotic index of 5-10 per 10 HPFs but with multifocal and extensive CTCN. These microscopic features were sufficient to establish the diagnosis of leiomyosarcoma. This case adds to the limited experience of the clinical behavior of problematic uterine smooth muscle cell neoplasms and underscores the prognostic importance of CTCN.

[Percutaneous cervical cordotomy in intractable cancer pain]

Percutaneous cordotomy by the lateral high cervical approach may be indicated in the treatment of intractable nociceptive or neuropathic cancer pain below the C5 dermatome. A description of the technique and two case studies are presented.

Métastase duodénale d'un leiomyosarcome utérin. À propos d'une observation

The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor.

Ex situ resection techniques and liver autotransplantation: last resource for otherwise unresectable malignancy

Ex vivo liver resection and hepatic autotransplantation allow treatment of otherwise unresectable hepatobiliary malignancy and expand the role of liver surgery. Few series are reported in the English literature, and they are mainly case reports focused on the technical aspects of the procedure more than on the long-term results. Postoperative mortality rate is still high, as well as early tumor recurrence; recently, improvement in outcomes in selected cases is being reported. The aim of this study is to describe our experience with two cases where we applied the combination of ex situ resection with hepatic autotransplantation for intended cure of two otherwise untreatable malignancies. These two cases are the paradigm of the possibility of performing extreme salvage procedures after the failure of more conventional treatments, allowing improvement in survival and quality of life in a controversial clinical scenario. This should be performed only AT referral centers for liver resection surgery and liver transplantation in light of the technical refinements reached in the era of living-related liver transplantation.

Discordant responses to progestin in a patient with uterine low-grade smooth-muscle tumors metastatic to the lung

A 58-year-old woman presented with pelvic, para-aortic masses and two isolated nodules in the right lung 6 years after hysterectomy and bilateral salpingo-oophorectomy for uterine leiomyoma. Laparotomy was carried out and all the intra-abdominal tumors were excised; pathology showed metastatic low-grade leiomyosarcomas. Immunohistochemical staining revealed a high expression level of estrogen and progesterone receptors in these tumors. The pulmonary nodules were left and the patient was given oral medroxyprogesterone acetate 200 mg daily after the operation. One of the pulmonary masses regressed progressively and had disappeared 7 months later on chest X-ray examination. However, the other was persistent. She then received wedge resection to excise the pulmonary nodule, which showed the same histologic pattern as the abdomen masses. However, the immunohistochemical staining on this nodule showed positive estrogen receptor expression but was negative for progesterone receptor expression. After the operation, she maintained progestin treatment and was tumor free for the following 12 months.

[Subcutaneous leiomyosarcoma metastatic to the eyelid]

BACKGROUND

Metastatic eyelid lesions are rare. Most metastatic lesions to the eyelid are carcinomas. Leiomyosarcomas are soft tissue sarcomas arising most commonly in the uterus and gastrointestinal tract, whereas dermal leiomyosarcomas are less frequent. Dermal leiomyosarcomas metastatic to the eyelid have not been reported so far.

CASE REPORT

A 28-year-old female patient presented with a rapidly growing tumor of her right lower eyelid. A subcutaneous leiomyosarcoma of the neck had been excised 21 months before with subsequent radiotherapy. Seven months later metastases to the lung, liver, and left upper arm were detected. The patient received chemotherapy. The eyelid tumor was completely excised. Histologically the lesion consisted of spindle cells arranged in fascicles with perinuclear vacuoles and myofilaments. There was a strong immunoreactivity for smooth muscle actin, and negative staining for cytokeratin and S100.

CONCLUSION

Cutaneous and subcutaneous leiomyosarcomas occur at almost any age, but are most common between the 5th and 7th decades. They are more common in men and usually occur at the extremities. The prognosis of cutaneous/subcutaneous leiomyosarcoma correlates with the depth of the tumor. To our knowledge this is the first presentation of a subcutaneous leiomyosarcoma metastatic to the eyelid. Presumably, parenchymatous metastases of this tumor occur before dermal metastases arise.

[A case of primary hepatic leiomyosarcoma presenting with multiple subcutaneous scalp mass]

Leiomyosarcoma is an uncommon tumor which arises from various sites including uterus, stomach, retroperitoneum, superficial soft tissues, bladder, kidney, and lung. Primary hepatic leiomyosarcoma is a very rare tumor and fewer than 70 cases of primary hepatic leiomyosarcoma have been reported since the first publication in Japan. And there was only one case report of cutaneous metastasis from hepatic leiomyosarcoma. We recently experienced a case of primary hepatic leiomyosarcoma presenting as subcutaneous palpable mass. Herein we report this case with a review of literatures.

Dual CD117 expression in gastrointestinal stromal tumor (GIST) and paraganglioma of Carney triad: a case report

Carney triad is a rare syndrome, with only 20 complete cases reported. We report a 36-year-old white woman with complete Carney triad, including metastatic gastric stromal tumor (GIST), pulmonary chondroma, and nonfunctioning extra-adrenal paraganglioma. Immunohistochemistry was positive for CD34 and CD117 (c-kit) in the GIST, and positive for chromogranin and CD117 in the paraganglioma. Ultrastructural studies demonstrated skeinoid fibers in the GIST. To our knowledge, this is the 21st complete Carney triad case reported and the first report of dual expression CD117 in both GIST and paraganglioma, a finding with intriguing pathogenetic implications related to the organization of the autonomic nervous system.