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Zhou J, Xu H, Hu J, Hong Q, Yu X, Liu W, Zhao J, Hu H. Current landscape of primary small bowel leiomyosarcoma: cases report and a decade of insights. Front Oncol 2024; 14:1408524. [PMID: 38846972 PMCID: PMC11153743 DOI: 10.3389/fonc.2024.1408524] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2024] [Accepted: 05/09/2024] [Indexed: 06/09/2024] Open
Abstract
The incidence of leiomyosarcoma (LMS) is about 4-5/100,000 individuals per year. LMSs occurring in the small bowel are even rarer, and their preoperative diagnosis is very difficult. We described two patients with pathologically confirmed small bowel LMS and analyzed their clinical and medical imaging features. Similar cases reported in English in Pubmed database over the past decade were reviewed and summarized. These tumors were categorized by the growth direction and relationship with the intestinal lumen into three types: intraluminal (n = 10), intermural (n = 3), and extraluminal (n = 7). Notably, among the three types of LMS, the intramural leiomyosarcoma stands out as a noteworthy subtype. Emerging evidence suggests that smaller tumor size (< 5 cm) and the intraluminal type may serve as favorable prognostic indicators, while the extraluminal type is associated with relatively poor prognosis. Furthermore, the integration of imaging features with CA125 and LDH biomarkers holds promise for potential diagnostic value in LMS.
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Affiliation(s)
- Junjie Zhou
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Houyun Xu
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jibo Hu
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Qiang Hong
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Xiping Yu
- Department of Pathology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Wei Liu
- Department of Radiology, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Jiaxin Zhao
- Department of General Surgery, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Hongjie Hu
- Department of Radiology, Sir Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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Bouassida M, Beji H, Chtourou MF, Nechi S, Chaabane A, Touinsi H. Leiomyosarcoma of the small bowel: A case report and literature review. Int J Surg Case Rep 2022; 97:107456. [PMID: 35907299 PMCID: PMC9403291 DOI: 10.1016/j.ijscr.2022.107456] [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: 06/16/2022] [Revised: 07/19/2022] [Accepted: 07/24/2022] [Indexed: 02/07/2023] Open
Abstract
INTRODUCTION Malignant tumors of the small bowel are rare. The jejunum, ileum, and duodenum represent the most common sites of intestinal leiomyosarcoma (LMS). Herein, we present a case of a 65-year-old patient having ileal LMS successfully treated with surgical resection. PRESENTATION OF CASE A 65-year-old patient, with no comorbidities, presented with chronic and paroxysmal abdominal pain. Upper endoscopy and colonoscopy showed no abnormalities. Thoracoabdominal computed tomography (CT) revealed an ileal lobulated, heterogeneously enhancing solid mass measuring 6 cm. Laparotomy was performed. Findings showed a lobulated ileal mass. We made an enlarged ileal resection with end-to-end anastomosis. The postoperative course was uneventful. Histology and IHC stains concluded into ileal LMS. No relapse of the disease was noted during the 4-month follow-up. CLINICAL DISCUSSION Ileal LMS is a rare tumor originating from the smooth muscle cells within the muscularis mucosa or muscularis propria. CT colonography (CTC) and magnetic resonance enterography (MRE) represent good options to aid the diagnosis. Histologically, LMS often has a comparable morphological appearance to GISTs. IHC is essential to differentiate those tumors. Surgery is the only curative treatment. The prognosis is poor knowing that those tumors are discovered at advanced stages. CONCLUSION Ileal LMS is a rare tumor originating from the smooth muscle cells. It has a comparable morphological appearance to GISTs. Immunohistochemistry is essential to confirm the diagnosis. Surgery is the only curative treatment. The prognosis is poor.
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Affiliation(s)
- Mahdi Bouassida
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Hazem Beji
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Corresponding author at: 52, Street of roses, 8050 Hammamet, Tunisia.
| | - Mohamed Fadhel Chtourou
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
| | - Saloua Nechi
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Abir Chaabane
- University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia,Department of Pathology, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia
| | - Hassen Touinsi
- Department of General Surgery, Hospital Mohamed Taher Maamouri, Nabeul, Tunisia,University Tunis El Manar, Faculty of Medicine of Tunis, Tunisia
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Welten VM, Fields AC, Lu PW, Yoo J, Goldberg JE, Irani J, Bleday R, Melnitchouk N. Surgical resection improves overall survival of patients with small bowel leiomyosarcoma. Int J Colorectal Dis 2020; 35:2283-2291. [PMID: 32812089 DOI: 10.1007/s00384-020-03718-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/14/2020] [Indexed: 02/04/2023]
Abstract
PURPOSE Small bowel leiomyosarcoma (SB LMS) is a rare disease with few studies characterizing its outcomes. This study aims to evaluate surgical outcomes for patients with SB LMS. METHODS The National Cancer Database was queried from 2004 to 2016 to identify patients with SB LMS who underwent surgical resection. The primary outcome was overall survival. RESULTS A total of 288 patients with SB LMS who had undergone surgical resection were identified. The median age was 63, and the majority of patients were female (56%), White (82%), and had a Charlson comorbidity score of zero (76%). Eighty-one percent of patients had negative margins following surgical resection. Fourteen percent of patients had metastatic disease at the time of diagnosis. Nineteen percent of patients received chemotherapy and 3% of patients received radiation. One-year overall survival was 77% (95% CI: 72-82%) and 5-year overall survival was 43% (95% CI: 36-49%). Higher grade (HR: 1.98, 95% CI: 1.10-3.55, p = 0.02) and metastatic disease at diagnosis (HR: 2.57, 95% CI: 1.45-4.55, p = 0.001) were independently associated with higher risk of death. CONCLUSION SB LMS is a rare disease entity, with treatment centering on complete surgical resection. Our results demonstrate that overall survival is higher than previously thought. Timely diagnosis to allow for complete surgical resection is key, and investigation into the possible role of chemotherapy or radiation therapy is needed.
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Affiliation(s)
- Vanessa M Welten
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Adam C Fields
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Pamela W Lu
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Yoo
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Joel E Goldberg
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jennifer Irani
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ronald Bleday
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nelya Melnitchouk
- Division of General and GI Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
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McSweeney WT, Hendahewa R. Incidental leiomyosarcoma within an ischaemic gut: a review of the management of visceral sarcoma. J Surg Case Rep 2020; 2020:rjaa007. [PMID: 32128109 PMCID: PMC7044523 DOI: 10.1093/jscr/rjaa007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/05/2020] [Accepted: 01/10/2020] [Indexed: 12/01/2022] Open
Abstract
Leiomyosarcomas are rare, primary malignancies that can be found in the small bowel in a minority of cases. The management of these visceral sarcomas remains controversial, with surgical resection forming the mainstay, being optimally achieved in a unit familiar with the management of sarcomas. These tumours are difficult to diagnose based on history and are challenging to localize on conventional imaging modalities. We report a case of a 61-year-old female who proceeded to emergent laparotomy with imaging suggestive of small bowel ischaemia secondary to portal venous thrombosis. Incidental leiomyosarcoma was noted on histology and was discussed at local multidisciplinary meeting regarding further management.
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Affiliation(s)
| | - Rasika Hendahewa
- Consultant General Surgeon, Caboolture Hospital, Caboolture, Queensland, Australia
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Tolman CJ. A rare case of small bowel leiomyosarcoma presenting with acute gastro-intestinal bleeding. BJR Case Rep 2016; 3:20160089. [PMID: 30363282 PMCID: PMC6159237 DOI: 10.1259/bjrcr.20160089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Revised: 09/27/2016] [Accepted: 10/29/2016] [Indexed: 11/20/2022] Open
Abstract
A 62-year-old Turkish female was admitted to our hospital with acute, progressive melena. Gastroscopy and colonoscopy could not reveal the cause of the melena. Subsequent CT angiography demonstrated a large, exophytic mass in the ileocecal junction as a source of the haemorrhage, leading to urgent laparotomy and resection. Histopathology revealed a low grade leiomyosarcoma (LMS) and confirmatory immunological staining. Primary LMS of the small bowel is an extremely rare gastrointestinal (GI) malignancy. Presentation with acute GI bleeding is even more exceptional, since LMS is a mainly intramural, exophytic tumour of the bowel wall. Immunohistochemistry plays a crucial role in differentiating LMS from GI stromal tumour. The work up of occult small bowel neoplasms currently consists of MRI enterography or enteroclysis and wireless capsule endoscopy. Treatment is surgical resection. This case highlights the non-specific imaging features of ileal LMS and highlights the management of acute GI bleed.
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RRM1, ERCC1 and TS1 Immunofluorescence Expression in Leiomyosarcoma: A Tissue Microarray Study with Clinical Outcome Correlation Analysis. Pathol Oncol Res 2015; 22:477-82. [PMID: 26612755 DOI: 10.1007/s12253-015-0021-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 11/16/2015] [Indexed: 10/22/2022]
Abstract
UNLABELLED ERCC1, RRM1 and TS1 are reportedly linked to chemotherapy resistance in lung and other cancers. However, there are currently no studies reporting the relationship between these genes and clinical parameters in leiomyosarcomas. METHOD This study investigated the expression pattern of ERCC1, RRM1 and TS1 in forty-four leiomyosarcoma samples by the use of tissue microarray (TMA), immunofluorescence and AQUA methods. The results were then analyzed for expression level and correlations were made with clinical outcome to determine their potential prognostic value in leiomyosarcoma. RESULTS In the forty-four samples studied, the expression level of these three proteins can be well quantified in the AQUA system and reflected by the AQUA score. RRM1 and ERCC1 expression levels did not show any relationship with overall survival. However, a correlation was found between TS1 expression in the cytoplasm and overall survival. The high expression group had a shorter overall survival time (log-rank p = 0.0498). This trend was confirmed by the Cox proportional hazards model. DISCUSSION The poor overall survival of leiomyosarcoma is linked to TS1 cytoplasm expression which may be useful in predicting prognoses of this tumor, methods targeting expression of TS1 may lead to improved overall survival in leiomyosarcoma, though more detailed information regarding treatment information and a larger sample size is needed to confirm this phenomenon.
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