Asymptomatic leiomyosarcoma of maxillary sinus accompanied by primary mucocele

Leiomyosarcoma of the Nasal Cavity and Paranasal Sinuses: A Case Report and Comprehensive Review of the Literature

Sinonasal leiomyosarcoma (LMS) is a rare and aggressive mesenchymal tumor with smooth muscle differentiation. The sinonasal tract is an unusual primary site for LMS, as scant smooth muscle exists in this location, with only 75 cases reported in the English literature including the case presented herein. Sinonasal LMS is considered an aggressive head and neck tumor with significant potential for recurrence and metastasis. Since recurrence is high and the potential for late metastasis exists, lifelong follow-up in these patients would be beneficial, especially among those with previous history of RB.

Leiomyosarcoma of the maxilla in a 24-year-old man who initially presented with odontalgia, and suffered from tumour mismanagement

Leiomyosarcoma is an uncommon malignant soft tissue tumour originating from smooth muscle cells. It generally occurs in the female genital tract, especially in the uterus, gastrointestinal tract, retroperitoneum and rarely in the head and neck. Here we report a case of leiomyosarcoma in a 24-year-old man with a 6-month history of toothache and extraction of three right upper molar teeth, that was complicated by fistula tract formation and facial swelling. Imaging studies demonstrated tumoural lesions involving the right maxillary sinus, nasal cavity, hard palate and orbit. The histopathological and immunohistochemical studies confirmed that it was leiomyosarcoma.

Sinonasal leiomyosarcoma: review of literature and case report

OBJECTIVES/HYPOTHESIS

To determine prognosis of primary sinonasal leiomyosarcomas after treatment.

STUDY DESIGN

Literature review and case report.

METHODS

Review of English literature from MEDLINE and independent sources with the addition of our case.

RESULTS

Including our case, 63 cases have been reported. Primary treatment includes resection with or without radiation. Chemotherapy has not been reported to be effective. In our case, however, chemotherapy, consisting of etoposide and high-dose ifosfamide, caused the tumor to shrink significantly. On the basis of a review of all reported cases, the overall survival rate at a mean follow-up of 38.24 month is 66%. The minimal overall survival rates at 5 and 10 years are 20% and 6%, respectively.

CONCLUSION

The prognosis for primary sinonasal leiomyosarcomas is poor. However, a 10-year survival has been reported in a few patients. Chemotherapy may be a useful adjunct when managing extensive lesions unamenable to curative resection.

Leiomyosarcoma of the larynx. Review of the literature and report of two cases

Leiomyosarcoma of the larynx is an extremely rare malignancy. Until now, only 35 cases have been reported, and only 19 were reported in English. We present 2 new cases observed in the last 3 years at our department. Correct histologic diagnosis can only be made on immunohistochemical and electron microscopic grounds. A 65-year-old man previously treated for a premalignant vocal cord lesion and a 31-year-old woman who previously underwent operation on a benign vocal cord lesion are presented. Only surgical treatment (total laryngectomy and endolaryngeal laser resection) was performed. Thirty-six and 22 months after the initial surgical intervention, both patients are alive and well, with no evidence of local recurrence or distant metastasis.

Primary leiomyosarcoma of the mandible in a 7-year-old girl: report of a case and review of the literature

Leiomyosarcoma is a malignant neoplasm of smooth muscle origin that manifests itself uncommonly in the oral cavity because of the paucity of smooth muscle in that location. To the best of our knowledge, only 10 cases of leiomyosarcoma primary to the jawbones have been reported in the English language literature. We report the first pediatric case of leiomyosarcoma arising from the mandible. Facial asymmetry and swelling were accompanied by a rapidly growing exophytic soft tissue mass that caused buccal displacement of the mandibular left permanent first molar. The lesion, observed radiographically as an extensive ill-defined area of osteolytic alveolar destruction, perforated the lingual cortex, displaced the inferior alveolar nerve canal inferiorly, and produced a "floating-in-air" appearance of the first molar. Diagnosis of leiomyosarcoma was made after initial incisional biopsy of the lesion. A 5-cm segmental mandibulectomy and supraomohyoid neck dissection were followed by reconstruction with a dynamic mandibular reconstruction plate and placement of a multidimensional mandibular distraction device in a transport rectangle of bone to promote bifocal distraction osteogenesis. Forty millimeters of distraction (the technical limit of the device) were performed; this was followed by terminal iliac crest bone grafting. Seventeen months after the definitive surgical procedure, the patient remains free of disease.

Leiomyosarcoma of the larynx

Leiomyosarcomas account for approximately 7% of all soft-tissue sarcomas and occur most frequently in the gastrointestinal tract and uterus. Leiomyosarcomas of the larynx are extremely rare with only about 27 cases reported in the available literature. We present a leiomyosarcoma of the left vocal cord that was treated by transoral CO2 laser surgery. To date, the patient has been free of disease for more than 25 months. Since these tumors may be difficult to diagnose, immunohistochemical studies may be necessary for making an unambiguous diagnosis. Primary treatment should be surgical resection, with small tumors suitable for partial laryngectomy or transoral laser surgery.

Primary leiomyosarcoma of the maxilla with regional lymph node metastasis. Report of a case and review of the literature

A rare case of oral leiomyosarcoma diagnosed with the aid of immunohistochemical and electron microscopic examinations together with a review of the literature are reported. The patient was a 70-year-old Japanese man. The primary tumor involved the maxillary gingiva and bone and metastasized to the cervical lymph nodes. On histologic examination the tumor showed invasive growth into the maxillary bone. It was composed of interlacing fascicles of spindle-shaped cells with eosinophilic cytoplasm and elongated, blunt-ended nuclei. The tumor formed extensive metastatic foci in the cervical lymph nodes. On immunohistochemical examination most of the tumor cells were positive for desmin, smooth muscle-specific actin, and myosin. The ultrastructural characteristics of the tumor cells were abundant microfilaments, pinocytotic vesicles, and basement membrane formation. The findings were indicative of a tumor demonstrating myogenic differentiation. A review of the literature during the past 50 years disclosed a total of 60 oral leiomyosarcomas, including our case.

Malignant neoplasia of the paranasal sinuses associated with mucocele

Paranasal sinus mucoceles are histologically benign and typically cause ophthalmic morbidity only after significant orbital extension. The authors describe seven patients who had both a mucocele and a malignant tumor in the same paranasal sinus and in whom the neoplasm was discovered incidentally during operation for mucocele. Although malignancy coexistent with paranasal sinus mucocele is uncommon, the association should be considered and appropriate biopsy specimens obtained if operation for mucocele is required.

Primary leiomyosarcoma of the dura mater. Case report

A rare case of leiomyosarcoma arising from the dura mater is presented. A definite histological diagnosis was based on the electron microscopic features. Extensive removal of the tumor and postoperative radiation therapy resulted in complete remission. The etiology and the origin of this tumor are discussed.

Leiomyosarcoma of gingiva: report of a case and review of the literature

Leiomyosarcoma of the oral region has rarely been reported. A review of the literature yield only 24 cases. The histopathology with special reference to ultrastructural findings and immunohistochemical examination of an additional case of leiomyosarcoma of mandibular gingiva has been presented. The manifestation and symptoms, treatment and prognosis, and the origin of this tumor are discussed. Because of the high rate of local recurrence and metastases, extensive surgical excision and long-term follow-up are mandatory.

Cancer of the paranasal sinuses

Cancers of the paranasal sinuses, although rare, continue to cause the death of more than half of patients afflicted with them. The use of combined therapy (surgery and irradiation) has effected some improvement in control, particularly with better surgical and radiation techniques. Unfortunately, better results will not be obtained until earlier diagnoses can be achieved.