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Jiang W, Gong R, Wang J, Yang K, Wang L, Cheng R, Yue B, Zong Y, Wang Y. Successful Endoscopic Resection of Multiple Colorectal Leiomyosarcomas: The First Case Report. Dig Dis Sci 2024:10.1007/s10620-024-08632-1. [PMID: 39261382 DOI: 10.1007/s10620-024-08632-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2024] [Accepted: 08/29/2024] [Indexed: 09/13/2024]
Affiliation(s)
- Wei Jiang
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Rui Gong
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Junxiong Wang
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Kaiqi Yang
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Lumei Wang
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Rui Cheng
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Bing Yue
- Department of Pathology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Ye Zong
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China
| | - Yongjun Wang
- Beijing Key Laboratory for Precancerous Lesion of Digestive Disease, Department of Gastroenterology, National Clinical Research Center for Digestive Diseases, Beijing Digestive Disease Center, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, P.R. China.
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2
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Jenkins P, Joiner M, Kumar A, Miller SR. High grade leiomyosarcoma of the transverse colon with positive lymph node metastasis: to treat or not to treat with adjuvant radiation therapy? BMJ Case Rep 2023; 16:e253466. [PMID: 37336627 PMCID: PMC10314409 DOI: 10.1136/bcr-2022-253466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Intra-abdominal leiomyosarcomas (LMSs) are aggressive malignant tumours arising from smooth muscle cells. These neoplasms are extremely rare and account for 10%-20% of primary soft tissue sarcomas and approximately 0.1% of all colorectal malignancies. Intra-abdominal LMS has a very poor prognosis with an estimated 5-year survival rate between 20% and 50% and the size of the tumour being the main determinant of prognosis. Treatment is further complicated by different anatomic variants with differing clinical behaviours impacting prognosis. Newer techniques in radiation treatment such as intensity-modulated, intraoperative electron and proton beam radiotherapies allow for cases with high probability of local recurrence or likelihood of residual microscopic disease after surgical resection to be treated with precise radiation doses to the targeted tumour volume. We present a case of high grade LMS of the distal transverse colon with positive lymph node metastasis treated by surgical excision followed by adjuvant radiotherapy and discuss the current role of radiotherapy.
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Affiliation(s)
- Phillip Jenkins
- Radiation Oncology, Wayne State University, Detroit, Michigan, USA
| | - Michael Joiner
- Oncology, Wayne State University, Detroit, Michigan, USA
| | - Andrew Kumar
- Pathology, Wayne State University, Detroit, Michigan, USA
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3
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Lugo-Fagundo E, Fishman EK. Colorectal leiomyosarcoma: A case report. Radiol Case Rep 2022; 17:2812-2814. [PMID: 35694635 PMCID: PMC9184291 DOI: 10.1016/j.radcr.2022.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2022] [Revised: 05/02/2022] [Accepted: 05/11/2022] [Indexed: 10/24/2022] Open
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Hong L, Wang YN, Zhang X, Zhou X, Fan S, Xu M, Zhang S, Jiang D. Colorectal leiomyosarcoma with BRCA2 mutation benefit from treatment with olaparib: a case report. J Gastrointest Oncol 2022; 13:1499-1504. [PMID: 35837171 DOI: 10.21037/jgo-22-419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 12/27/2022] Open
Abstract
Background Colorectal leiomyosarcoma (LMS) is a rare colorectal malignancy accounting for approximately 1% of all colorectal malignancies with a poor prognosis and limited treatment options. Targeted therapies have been applied for breast cancer 2 (BRCA2) alterations, but their role remains to be explored in colorectal LMS. This case could provide clinical proof for the application of olaparib for LMS patients. Case Description Here, we present a case of colorectal LMS with BRCA2 alterations who was treated with olaparib and achieved progression-free survival (PFS) for 1 year. In August 2016, a 46-year-old female patient was admitted to hospital due to a mass in the left lower abdomen and was diagnosed with LMS of the sigmoid colon. After surgical resection, chemotherapy with ifosfamide or ifosfamide combined with pirarubicin was given and achieved stable disease (SD) until the disease progressed 1.5 years later. Afterwards, a multi-target tyrosine kinase inhibitor, anlotinib, was taken. Before the observation of lung and liver metastasis, the patient's disease was stable for 1 year. BRCA2 mutation and rearrangement was revealed by next-generation sequencing (NGS), and the targeted therapy, olaparib, was given. Efficacy evaluation showed SD for 1 year, and no obvious toxic and side effects were observed. Conclusions Our case suggested that NGS should be considered for further treatment of patients with colorectal LMS, and poly (ADP-ribose) polymerase (PARP) inhibitors could be a feasible therapy for LMS patients with BRCA2 alterations.
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Affiliation(s)
- Lei Hong
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Nan Wang
- Pathology Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Xue Zhang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinliang Zhou
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaoshuang Fan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mian Xu
- Shanghai OrigiMed Co., Ltd., Shanghai, China
| | | | - Da Jiang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
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5
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Massaras D, Kontis E, Stamatis K, Zampeli E, Myoteri D, Primetis E, Pantiora E, Fragulidis G. Primary leiomyosarcoma of the colon with synchronous liver metastasis. Rare Tumors 2022; 14:20363613221080549. [PMID: 35360880 PMCID: PMC8961372 DOI: 10.1177/20363613221080549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dimitrios Massaras
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Elissaios Kontis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Konstantinos Stamatis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology Alexandra General Hospital, Athens Greece
| | - Despoina Myoteri
- Department of Pathology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | | | - Eirini Pantiora
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Georgios Fragulidis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
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6
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Otto PO, Loft MK, Grimm P, Rafaelsen SR, Pedersen MRV. Ultrasound and contrast enhanced CT imaging of a colon mesentery leiomyosarcoma. Eur J Radiol Open 2021; 8:100376. [PMID: 34621918 PMCID: PMC8484734 DOI: 10.1016/j.ejro.2021.100376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 09/14/2021] [Accepted: 09/18/2021] [Indexed: 11/27/2022] Open
Abstract
Primary mesenteric leiomyosarcoma is a very rare, aggressive neoplasm. Tumour recurrence and metastatic spread is a significant risk following surgical treatment. Follow-up is warranted and likely improves patient survival rates.
Primary leiomyosarcoma of the colon mesentery is an extremely rare neoplasm, and only a small number of cases have been reported. We describe a case of leiomyosarcoma originating in the colonic mesentery, in a 68-year-old woman. Ultrasound showed a heterogeneous mass with varying vascularization in the left fossa. Central areas of the mass were hypoechoic, without detectable vascularization. Contrast enhanced computed tomography (CECT) of chest and abdomen showed a contrast enhanced tumour, with central non-enhanced areas. The tumour was radically resected and histopathology showed primary leiomyosarcoma. Two years after primary surgery, follow-up CECT revealed a local recurrence, which was re-resected. Subsequent follow-up CECT since have shown no sign of recurrence.
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Affiliation(s)
- Peter Obel Otto
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark
| | - Martina K Loft
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Peter Grimm
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark
| | - Søren Rafael Rafaelsen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Malene Roland V Pedersen
- Department of Radiology, Vejle Hospital, University Hospital of Southern Denmark, Denmark.,Danish Colorectal Cancer Center South, Vejle Hospital, Vejle, Denmark.,Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
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7
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Bananzadeh A, Mokhtari M, Sohooli M, Shekouhi R. Two cases of primary leiomyosarcoma of sigmoid colon treated with laparoscopic surgery: A case report and a review of literature. Int J Surg Case Rep 2021; 87:106420. [PMID: 34543950 PMCID: PMC8455635 DOI: 10.1016/j.ijscr.2021.106420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Leiomyosarcoma (LMS) of the colon is an extremely rare and highly invasive tumor arising from the muscularis propria of the gastrointestinal tract. After the introduction of oncogenic role of KIT by immunohistochemistry (IHC), the reported cases of gastrointestinal leiomyosarcoma were highly limited. True LMS of the colon is such a rare disorder that there isn't much description of its nature. CASE PRESENTATION We reported two very rare cases of primary leiomyosarcoma of sigmoid colon, which referred to our institution with symptoms of abdominal pain, lower GI bleeding and fatigue. After the initial investigations, both patients were diagnosed with primary LMS of sigmoid colon that underwent laparoscopic tumor resection. CLINICAL DISCUSSION The classical colonic LMS presents with a vast majority of non-specific symptoms including mild abdominal pain, fresh/obscure rectal bleeding, and weight loss. The most common location for colonic LMS is the sigmoid colon, and ascending colon. The prognostic factors for the disease outcome have not been established properly; however, patient age, tumor size/grade, and local/distant dissemination are of great importance. CONCLUSION Herein, we reported two rare cases of primary leiomyosarcoma of sigmoid colon that was treated with laparoscopic surgery.
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Affiliation(s)
- Alimohammad Bananzadeh
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maral Mokhtari
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Maryam Sohooli
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Ramin Shekouhi
- Colorectal Research Center, Department of Surgery, Shiraz University of Medical Sciences, Shiraz, Iran.
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8
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Tonorezos ES, Friedman DN, Barnea D, Bosscha MI, Chantada G, Dommering CJ, de Graaf P, Dunkel IJ, Fabius AWM, Francis JH, Greer MLC, Kleinerman RA, Kors WA, Laughlin S, Moll AC, Morton LM, Temming P, Tucker MA, van Leeuwen FE, Walsh MF, Oeffinger KC, Abramson DH. Recommendations for Long-Term Follow-up of Adults with Heritable Retinoblastoma. Ophthalmology 2020; 127:1549-1557. [PMID: 32422154 PMCID: PMC7606265 DOI: 10.1016/j.ophtha.2020.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 05/05/2020] [Accepted: 05/08/2020] [Indexed: 12/17/2022] Open
Abstract
PURPOSE To generate recommendations for long-term follow-up of adult survivors of heritable retinoblastoma. DESIGN We convened a meeting of providers from retinoblastoma centers around the world to review the state of the science and to evaluate the published evidence. PARTICIPANTS Retinoblastoma is a rare childhood cancer of the retina. Approximately 40% of retinoblastoma cases are heritable, resulting from a germline mutation in RB1. Dramatic improvements in treatment and supportive care have resulted in a growing adult survivor population. However, survivors of heritable retinoblastoma have a significantly increased risk of subsequent malignant neoplasms, particularly bone and soft tissue sarcomas, uterine leiomyosarcoma, melanomas, and radiotherapy-related central nervous system tumors, which are associated with excess morbidity and mortality. Despite these risks, no surveillance recommendations for this population currently are in place, and surveillance practices vary widely by center. METHODS Following the Institute of Medicine procedure for clinical practice guideline development, a PubMed, EMBASE, and Web of Science search was performed, resulting in 139 articles; after abstract and full-text review, 37 articles underwent detailed data abstraction to quantify risk and evidence regarding surveillance, if available. During an in-person meeting, evidence was presented and discussed, resulting in consensus recommendations. MAIN OUTCOME MEASURES Diagnosis and mortality from subsequent neoplasm. RESULTS Although evidence for risk of subsequent neoplasm, especially sarcoma and melanoma, was significant, evidence supporting routine testing of asymptomatic survivors was not identified. Skin examination for melanoma and prompt evaluation of signs and symptoms of head and neck disease were determined to be prudent. CONCLUSIONS This review of the literature confirmed some of the common second cancers in retinoblastoma survivors but found little evidence for a benefit from currently available surveillance for these malignancies. Future research should incorporate international partners, patients, and family members.
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Affiliation(s)
- Emily S Tonorezos
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York.
| | | | - Dana Barnea
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | | | - Pim de Graaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Ira J Dunkel
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
| | - Armida W M Fabius
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | | | | | - Ruth A Kleinerman
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Wijnanda A Kors
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Suzanne Laughlin
- Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - Annette C Moll
- Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Lindsay M Morton
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | - Margaret A Tucker
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | | | | | | | - David H Abramson
- Memorial Sloan Kettering Cancer Center, New York, New York; Weill Cornell Medical College, New York, New York
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9
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Devriendt S, Leman G, Vanrykel F. Primary leiomyosarcoma of the colon: a case report and review of the literature. Acta Chir Belg 2020; 120:353-356. [PMID: 30879400 DOI: 10.1080/00015458.2019.1589185] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Introduction: Primary leiomyosarcoma (LMS) of the colon is a rare and aggressive gastrointestinal tract tumor, associated with poor prognosis.Case presentation and methods: We present the case of an asymptomatic patient who was diagnosed with a low sigmoidal stricture on routine colonoscopy. Although biopsies were inconclusive, an oncological partial mesorectal excision (PME) was performed due to the malignant macroscopic aspect. Pathological examination surprisingly revealed a LMS. The patient received no adjuvant chemo- or radiotherapy, but is seen on regular follow-up. We review the literature on leiomyosarcoma of the colon: its diagnosis, treatment, and prognosis.Results: Up until now the patient shows no sign of recurrence, 15 months postoperatively.Conclusion: Radical resection is the treatment of choice for primary leiomyosarcoma of the colon and long-term follow-up is needed to evaluate metastatic disease or local recurrence.
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Affiliation(s)
| | - Guido Leman
- Department of General Surgery, AZ Sint Blasius, Dendermonde, Belgium
| | - Filip Vanrykel
- Department of General Surgery, AZ Sint Blasius, Dendermonde, Belgium
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Wang Y, Wang H, Yuan ZL, Zhao JF, Dong DB, Gao Q. A pooled analysis of risk factors of surgically treated leiomyosarcoma of the colon in adults. World J Surg Oncol 2020; 18:61. [PMID: 32222151 PMCID: PMC7103068 DOI: 10.1186/s12957-020-01838-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background This current systematic review aimed to evaluate the role of surgical management and risk factors by pooled cases from all identified patients with colonic leiomyosarcomas. Methods The authors searched the Ovid MEDLINE, Embase, PubMed, and Cochrane databases using the keywords “colonic,” “colon,” and “leiomyosarcoma.” Risk factors of colonic leiomyosarcoma in the pooled cohort were also evaluated. Results Between 1923 and 2019, 41 cases of colonic leiomyosarcoma were identified in 22 (53.7%) males and 19 (46.3%) females, with a mean and median age of 58.7 ± 2.2 years and 56.0 years. According to univariate analysis, smaller tumor size < 8 cm was significantly associated with longer progression-free survival (HR = 6.957, 95% CI 1.405–34.442; p = 0.017), and younger age < 60 years was trending toward better overall survival (HR = 2.765, 95% CI 0.924–8.272; p = 0.069). Conclusions Colonic leiomyosarcomas are rare neoplasms with aggressive clinical behaviors. Age < 60 years and tumor size < 8 cm were favorable factors for patients’ better survival.
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Affiliation(s)
- Yun Wang
- Department of Digestive System, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, China.,Qinghai University, Xining, 810000, Qinghai, China
| | - Hao Wang
- Department of Intensive Care Medicine, Qinghai Province People's Hospital, Xining, 810007, China
| | - Zhi-Lu Yuan
- Department of General Surgery, Liao Cheng The Third People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Jing-Fei Zhao
- Department of General Surgery, Liao Cheng The Third People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Dian-Bo Dong
- Department of Anorectal Medicine, Liao Cheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Qian Gao
- Department of Digestive System, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, China.
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11
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Mesenteric Lymph Node Recurrence of a Primary Colorectal Leiomyosarcoma. Case Rep Surg 2020; 2020:6935834. [PMID: 32257499 PMCID: PMC7125469 DOI: 10.1155/2020/6935834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
Primary colorectal leiomyosarcoma is an excessively rare entity. It is associated with an aggressive behavior and typically favor hematogenous spread. The current standard of care is surgical resection. A 49-year-old patient presented with a 2-month history of fever. A PET-scan revealed a hypermetabolic mass in the transverse colon, and colonoscopy confirmed a tumor. A right hemicolectomy was performed. Histopathological diagnosis was of a leiomyosarcoma. Fourteen months after the surgery, a follow-up abdominal scan revealed a 2 cm mesenteric lymph node that was hypermetabolic on PET-scan. The mesenteric lymph node was resected and histopathology confirmed a leiomyosarcoma metastasis. This case opens the controversy on the management of rare lymph node recurrences in colorectal leiomyosarcoma.
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12
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Leiomyosarcoma of the colon. A very uncommon condition with poor prognosis. GASTROENTEROLOGIA Y HEPATOLOGIA 2019; 43:200-201. [PMID: 31864684 DOI: 10.1016/j.gastrohep.2019.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2019] [Revised: 10/03/2019] [Accepted: 11/17/2019] [Indexed: 11/22/2022]
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13
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Yahagi M, Ishii Y, Hara A, Watanabe M. Laparoscopic surgery to treat leiomyosarcomas of the sigmoid colon:a case report and literature review. Surg Case Rep 2019; 5:20. [PMID: 30756192 PMCID: PMC6372699 DOI: 10.1186/s40792-019-0579-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Accepted: 01/31/2019] [Indexed: 12/24/2022] Open
Abstract
Background Leiomyosarcomas (LMSs) of the colon are extremely rare and highly aggressive. Although treatment of gastrointestinal LMS is not standardized, surgical resection is generally performed. The fact that the tumors are usually large at the time of diagnosis may explain why no report on laparoscopic resection of a colonic LMS has appeared. Case presentation A 46-year-old male presented with hematochezia 1 month in duration. Abdominal examination including palpation was normal. The levels of several blood tumor markers were normal. Colonoscopy revealed a polypoid lesion approximately 30 mm in diameter in the sigmoid colon 30 cm from the anal verge. Contrast-enhanced computed tomography revealed that the tumor was 28 mm in diameter, and that no lymph node or distant metastasis was apparent. Histopathological examination of a biopsy specimen revealed spindle-shaped cells exhibiting significant nuclear atypia and a trabecular proliferation pattern upon hematoxylin-eosin staining. Immunohistochemically, the sample was positive for SMA and desmin, and negative for c-kit, DOG-1, CD34, and S-100. Furthermore, the Ki-67 index was > 50%. We thus diagnosed a leiomyosarcoma of the sigmoid colon without any metastasis. We performed laparoscopic sigmoid colectomy and regional lymphadenectomy using five trocars. After complete curative resection, a colorectal end-to-end anastomosis was created employing the double-stapling technique. All surgical margins were negative, and no lymph node metastasis was observed. The postoperative course was uneventful, and the patient was discharged 9 days after operation. No recurrence was noted to 1 year after surgery. Conclusions We report the first case of a colonic LMS treated via laparoscopic surgery. Although further work is necessary to assess prognosis and to develop the treatment further, laparoscopic surgery to treat small colonic LMSs may be feasible, being both minimally invasive and curative.
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Affiliation(s)
- Masashi Yahagi
- Department of Surgery, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan
| | - Yoshiyuki Ishii
- Department of Surgery, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan. .,Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, Japan.
| | - Atsuko Hara
- Department of Pathology, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan
| | - Masahiko Watanabe
- Department of Surgery, Kitasato University Kitasato Institute Hospital, 5-9-1 Shirokane, Minato-ku, Tokyo, Japan.,Department of Surgery, Kitasato University School of Medicine, 1-15-1 Kitasato, Sagamihara, Kanagawa, Japan
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14
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Primary Leiomyosarcoma of the Colon: A Report of Two Cases, Review of the Literature, and Association with Immunosuppression for IBD and Rheumatoid Arthritis. Case Rep Surg 2018; 2018:6824643. [PMID: 29780656 PMCID: PMC5892970 DOI: 10.1155/2018/6824643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/10/2018] [Indexed: 01/17/2023] Open
Abstract
Primary leiomyosarcomas (LMS) of the colon are rare and aggressive neoplasms and have been infrequently reported in the literature. These tumors are more aggressive and have poorer prognoses than adenocarcinoma of the colon and are often mistaken as such on initial evaluation. While the former has a clear association with inflammatory bowel disease (IBD), this correlation is not known to exist with LMS and IBD. Nor is there a known link between LMS and the immunosuppression for IBD, despite the known association between malignancy and immunosuppression for other diseases. Due to the low prevalence of this disease entity, there is limited knowledge and literature on the approach to diagnosing and treating these neoplasms, especially in the setting of the aforementioned comorbidities. Here, we describe two cases of this rare entity, presenting in two different circumstances: one in the setting of immunosuppression for IBD and arthritis, with a synchronous urothelial carcinoma, and the second appearing as the source of an acute abdomen. Both diagnoses were established following pathologic analysis.
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