Head and neck leiomyosarcoma

Leiomyosarcoma of sphenoid sinus- A rare tumor at an unusual site

Leimyosarcoma (lms) is a malignant soft tissue tumor of smooth muscles. The tumor arises intramuscularly and in subcutaneous locations. It is unusual to encounter lms in head and neck region, even more infrequent to discover lms in nasal and paranasal sinuses. A case of 28 years old male with leiomyosarcoma originating from sphenoid sinus with intracranial extension is being presented with aim to highlight its rarity and to highlight the differential diagnosis and the need for prudent diagnosis in the work-up of the patient.

Use of an open partial laryngectomy technique for a massive laryngeal leiomyosarcoma in a 40-year-old man with functional preservation postoperatively

Laryngeal cancers are one of the most common head and neck malignancies and can lead to significant morbidity and mortality. Although they most commonly originate from squamous cell carcinoma, there are multiple different pathologies that can arise. We present a patient with an atypical presentation of a glottic mass for which final pathology revealed a leiomyosarcoma (LMS). We report the first case in the English literature of a large bulky LMS that was removed entirely through a partial vertical laryngectomy and pharyngectomy, with maintained swallow and speech function postoperatively.

Lingual Leiomyosarcoma: A Histopathological Case Report

Leiomyosarcomas are rare malignant mesenchymal neoplasms originating from smooth muscle cells. Although leiomyosarcoma is commonly located in the female reproductive system, gastrointestinal tract, and subcutaneous tissues, it is a rare entry in the head and neck area, probably due to the scarcity of smooth muscle tissue in this topographical region. Herein we present a histopathological case report of a 60-year-old male with a slow-growing painless mass on the middle third of the right lateral lingual margin, with focal ulceration measuring 1x1.5cm. After gross excision, histopathology revealed pleomorphic spindle cells, some with bizarre nuclei and abundant pathological mitotic activity with a tendency to grow in a fascicular pattern. As the patient had the demographic characteristic and risk factors for oral cavity squamous cell carcinoma, a spindle-shaped variety (sarcomatoid) variety was suspected, and immunohistochemistry with a broad set of antibodies was used to prove the histogenetic group of the tumor. As the tumor was pan-cytokeratin and desmin negative, focally positive for caldesmon, and positive for smooth muscle actin, the diagnosis of pleomorphic leiomyosarcoma of the tongue was established.

Epstein-Barr virus-associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature

We investigated the clinical features, treatment, and prognosis of laryngeal leiomyosarcoma (LLMS) and Epstein-Barr virus-associated (EBV-associated) LMS. We report a case of EBV-associated LLMS in an adult patient with HIV infection. We also conducted a review of the English-language literature on LLMS and EBV-associated leiomyosarcoma. To the best of our knowledge, 62 cases of LLMS and EBV-associated leiomyosarcoma have been reported to date. Of patients with LLS, 18.9% had distant metastases and 17.0% had local recurrence. The overall 5-year survival rate was 64.0%. Distant metastases affected the survival of patients with LLMS (p = 0.04). EBV-positive patients had a low survival rate (p = 0.01). Among patients with EBV-associated LMS, 8.2% had distant metastases and recurrence and the overall 5-year survival rate was 50.0%. EBV-associated LLMS is rare. The EBV infection might be a poor prognostic factor of LLMS.

Low-Grade Fibromyxoid Sarcoma Featuring an Unusual EWSR1-CREB3L2 Gene Fusion: Report of a Rare Case Arising in the Parotid Gland

Low-grade fibromyxoid sarcoma (LGFMS), also known as Evan's tumor, is a fibroblastic tumor with a deceptively bland morphology but a high metastasizing potential and late recurrence. It presents clinically as a slowly growing mass in the deep soft tissue of extremities and trunk. Morphologically, it shows a biphasic pattern with alternating fibrous and myxoid areas, whorling growth pattern, hypocellularity, and bland fibroblasts with curvilinear or arcuate vessels in between. Collagen rosettes with central hyalinization is a helpful feature but not specific. MUC-4 is the most sensitive immunostain in LGFMS. The majority of cases harbor a gene fusion in FUS - CREB3L2. Herein, we present a 23-year-old female patient with a slow growing painless mass in the left parotid gland, which was later diagnosed as LGFMS. Involvement of the head and neck region by LGFMS is uncommonly encountered. To date, only two cases within the parotid gland have been described.

Leiomyosarcoma of the Maxilla: A Case Report and Literature Review

Leiomyosarcoma is a malignant tumor arising from smooth muscle cells accounting for 10-20% of soft tissue sarcomas and less than 2% are located in head and neck region. We report a case of leiomyosarcoma of maxilla in a 26-year-old female patient referred to Shahid-Beheshti University of Medical Sciences, Faculty of Dentistry. Patient complained of swelling of left side of the face from 5 months ago without a history of significant illness. Clinical examination showed asymmetric swelling of left side of the face with tenderness. The lesion in the left buccal vestibule was tender to the touch and contained erythematous mucosa with a firm tissue. Results of the neck computed tomography (CT) scan indicated mucosal thickening in the left maxillary sinus. In the preoperative magnetic resonance imaging (MRI), a mass with an estimated size of 4.7×3.1×3.0cm was found, extending from the posterior wall to the posterolateral wall of the left maxillary sinus, causing impression and remodeling of the sinus wall. Incisional biopsy was preformed and immunohistochemistry suggested leiomyosarcoma. Partial maxillectomy of the posterior maxillary walls was performed, using an intraoral incision and dissection from the maxillary vestibule up to the mandibular vestibule. The tumor was excised using frozen section. Pathological examination reported the lesion compatible with leiomyosarcoma, with all surgical margins free of tumor. Post-operative MRI showed no definite mass in the region. In conclusion, according to the present results, the clinical features of leiomyosarcoma of the maxilla are clear, and diagnosis is feasible.

Update on MR Imaging of Soft Tissue Tumors of Head and Neck

This article reviews soft tissue tumors of the head and neck following the 2020 revision of WHO Classification of Soft Tissue and Bone Tumours. Common soft tissue tumors in the head and neck and tumors are discussed, along with newly added entities to the classification system. Salient clinical and imaging features that may allow for improved diagnostic accuracy or to narrow the imaging differential diagnosis are covered. Advanced imaging techniques are discussed, with a focus on diffusion-weighted and dynamic contrast imaging and their potential to help characterize soft tissue tumors and aid in distinguishing malignant from benign tumors.

Inflammatory leiomyosarcoma of the head and neck: Case report

Introduction and importance

Primary sarcomas in the head and neck region are rare. Inflammatory leiomyosarcoma was first described in 1995. The case reported herein is the first reported inflammatory leiomyosarcoma occurring in the head and neck.

Presentation of case

A 37-year-old male presented with a long history of an asymptomatic slowly enlarging neck mass. Examination revealed a firm mass in the lower third of the right sternocleidomastoid muscle. Computerized tomography and magnetic resonance imaging showed a lobulated, well-circumscribed tumour with malignant features. A wide local excision was performed and histopathological examination confirmed an inflammatory leiomyosarcoma.

Discussion

Inflammatory leiomyosarcoma is a recently described peculiar soft tissue tumour with histological features overlapping conventional leiomyosarcoma, and dense lymphocytic inflammation and immunohistochemical reactivity for both smooth and skeletal muscle markers. These are indolent tumours and wide local excision is curative.

Conclusion

This case highlights the importance of considering primary sarcomas in the differential diagnosis of asymptomatic head and neck masses.

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The differential diagnosis of asymptomatic head and neck masses is broad.

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Non-epithelial neoplasms should be considered.

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Primary sarcomas in the head and neck region are rare.

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Inflammatory leiomyosarcoma is a recently described peculiar soft tissue tumour.

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This case is the first reported head and neck inflammatory leiomyosarcoma.

Chemoradiotherapy for Inoperable Carotid Body Leiomyosarcoma: A Case Report and Review of Literature

Vascular leiomyosarcoma is an extremely rare tumor and is associated with poor prognosis among leiomyosarcoma. Surgical resection remains the main treatment option. But outcome of definitive treatment with chemoradiotherapy in inoperable patients is not clear. Here, we report treatment and outcome of definitive chemoradiotherapy in a case of vascular leiomyosarcoma. A 64-year-old man with the initial presentation of pulsatile right neck mass was diagnosed with right carotid body leiomyosarcoma. He refused surgical intervention due to risk of carotid body injury and ischemic stroke. Successful tumor control was achieved with carboplatin-based concurrent chemoradiotherapy. Investigational liquid biopsy for circulating sarcoma cells was also performed to analyze drug sensitivity profile of this rare tumor. One year after treatment, the disease remained well controlled and there was no evidence of baroreflex failure or treatment-related late toxicities. To our best knowledge, this is the first case report of right carotid body leiomyosarcoma controlled with definitive concurrent chemoradiotherapy. The approach of personalized multi-modality treatment will be a focus of our future investigation.

Leiomyosarcoma of the jaw: case series

Objectives

Leiomyosarcoma is a malignant neoplasm that affects smooth muscle tissue and it is very rare in the field of oral and maxillofcial surgery. The purpose of this study was to obtain information on diagnosis of and treatment methods for leiomyosarcoma by retrospectively reviewing of the cases.

Patients and Methods

The study included nine patients who were diagnosed with leiomyosarcoma in the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. The subjects were analyzed with respect to sex, age, clinical features, primary site of disease, treatment method, recurrence, and metastasis.

Results

Particular clinical features included pain, edema, mouth-opening limitations, dysesthesia, and enlarged lymph nodes. All cases except one were surgically treated, and recurrence was found in two cases. Four of nine patients were followed up without recurrence and one patient underwent additional surgery due to recurrence.

Conclusion

In our case series, notable symptoms included pain, edema, mouth-opening limitations, and dysesthesia; however, it was difficult to label these as specific symptoms of leiomyosarcoma. Considering the aggressive characteristics of the disease and poor prognosis, surgical treatment is necessary with careful consideration of postoperative radiotherapy and chemotherapy.

Leiomyosarcoma: Prognostic outline of a rare head and neck malignancy

Soft tissue sarcomas (STS) are mesenchymal malignant neoplasms with a broad spectrum of biologic behaviour. Most STS show predilection for extremities with rarity in head and neck. Leiomyosarcoma (LMS) is an extremely rare STS in head and neck due to the paucity of smooth muscles in this anatomical region. Owing to its rarity, diagnosis of LMS is often delayed or is often misdiagnosed. Our study aimed to evaluate clinico-demographic factors determining clinical course of primary head-neck LMS. Further, we also assessed cases of secondary head-neck LMS and LMS due to other causes to compare their clinical outcome with primary head-neck LMS. In primary LMS cases, intraoral LMS showed slightly better prognosis than extraoral LMS. Survival analysis revealed that prognosis of primary LMS was significantly better than secondary LMS. No significant difference in survival was seen between primary LMS and LMS due to other causes. These observations indicate that site of origin appears to determine the clinical behaviour of LMS. Results showed that size, recurrence and metastasis are important prognostic variables. Though large tumor size was associated with poor prognosis, tumor aggressiveness may not be directly proportional to its size. Surgical management with or without adjuvant therapy was associated with favourable outcome. As several factors are associated with prognostic outcome of head-neck LMS, multimodality therapy approach after careful analysis of various prognostic variables in each case on an individual basis is essential.

Leiomyosarcoma of Mandible: A Diagnostic Dilemma; Case Report and Review of Literature

Leiomyosarcoma and its pleomorphic variant are rare entities in the head and neck region. Since they usually present as slow growing, discrete firm, and non-ulcerated painless mass, they seem to be deceptively benign and are thus misdiagnosed. Histopathological and immunohistochemical studies are the ways of getting a definitive diagnosis. Till date surgery has been the primary treatment but effectiveness of radiotherapy/chemotherapy is still questionable. Here, we describe a case of leiomyosarcoma in mandible along with discussion about the ways of diagnosis, its differentiation with its pleomorphic variant and their managements.

Head and Neck Sarcomas: A Review of Clinical and Imaging Findings Based on the 2013 World Health Organization Classification

OBJECTIVE

Head and neck sarcomas are a complex, heterogeneous group of tumors that present a diagnostic challenge to radiologists because they have many overlapping imaging features. The purpose of this article is to review the imaging and clinical features and highlight distinguishing features of head and neck sarcomas.

CONCLUSION

An understanding of characteristic imaging and clinical features of head and neck sarcomas is important for the radiologist to narrow the differential diagnosis and help guide management.

Primary intracranial leiomyosarcoma in an immunocompetent patient: Case report and review of the literature

Primary leiomyosarcoma is a rare tumor in the CNS, with few reported cases. Here, we describe a case of a primary intracranial leiomyosarcoma of the tentorium cerebelli. A 43-year-old woman presented with headache, acute vision loss, and difficulty speaking. MRI revealed a large heterogeneous-enhancing occipital mass, which was subsequently resected and diagnosed as a primary intracranial leiomyosarcoma. The patient went onto adjuvant radiotherapy delivering 60 Gy in 30 fractions. These tumors are exceedingly rare in immunocompetent individuals. We reviewed the 16 cases that have been reported in the literature. Surgical resection was the most common treatment (92%) with 53% receiving adjuvant radiation. There currently is no standard treatment regimen for intracranial leiomyosarcomas. Additional case reports that include descriptive treatment approaches with patient outcomes may help ascertain the best approach to treating these malignancies.

Primary leiomyosarcoma in the floor of mouth: a case report

Leiomyosarcoma (LMS) is a malignant soft tissue tumor that exhibits smooth muscle differentiation, and its occurrence in the oral cavity is exceedingly rare, especially in the floor of mouth. A 54-year-old male was admitted for evaluation of a painless nodular mass in the left floor of mouth with a 3-month history. With the help of computed tomography (CT) and magnetic resonance imaging (MRI) examination, the patient went on a surgery excision, and by pathological and immunohistochemical findings, a diagnoses of LMS was confirmed. Then the patient went on chemotherapy, and six-month follow up showed no recurrence of cancer. The diagnosis of LMS is difficult to be made, and it is usually confirmed by immunohistochemical stains, such as positive for smooth muscle actin (SMA), vimentin, and Ki-67.

Disseminated and late metastatic disease from nasal pit leiomyosarcoma after radical surgical resection. Case report of a singular presentation of a rare disease

Background

Leiomyosarcoma of the head and neck is a rare cancer with high local aggressiveness. Radical surgery and adjuvant treatment offer the best chance for cure, nonetheless 5-years recurrence rate remains high. Despite international guidelines are available for soft tissue sarcomas, no recommendations are specifically endorsed for leiomyosarcoma of the head and neck, due to the rarity of its presentation and consequently scarcity of data on long-term outcome.

Case presentation

A 50-year old woman, operated 10 years before for leiomyosarcoma of the nasal pit and with negative 5-years follow-up, was admitted to our ward for impairment of the hepatic function. Total-body CT scan detected multiple localizations at lungs, kidneys, pancreas, bones, muscles, lymph nodes and thyroid. The pathologic report after lung biopsy confirmed the diagnosis of metastasis from leiomyosarcoma and the patients was scheduled for first line chemo-radiotherapy.

Conclusions

Despite adequate primary treatment, distant and disseminated metastatic disease may be not excluded in leiomyosarcoma of the head and neck.