Oral leiomyosarcomas: report of two cases with immunohistochemical profile

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.

Primary Leiomyosarcoma of the Mandible: Posttreatment Malocclusion Treated with an Overpartial Mandibular Resection Prosthesis

Leiomyosarcoma is a rare malignant condition occurring in the maxillofacial region in which the mandible may be affected. Management of this tumor in the mandible may include segmental mandibulectomy, osteocutaneous fibula free-flap reconstruction, endosseous implants, and postoperative radiotherapy. Posttreatment malocclusion can be managed with an overpartial mandibular resection prosthesis. The purpose of this report is to describe the expeditious oral rehabilitation of an oncologic patient with posttreatment malocclusion, demonstrating the utility of an overpartial mandibular resection prosthesis.

Primary oral leiomyosarcoma: A systematic review and update

The aim of this systematic review was to address the clinicopathologic inconsistencies noted with primary oral leiomyosarcoma in the literature by amassing the available data published into a comprehensive analysis. Eligibility criteria included publications of cases with dedicated immunohistochemical work-up along with radiographs to evaluate location. Based on these criteria, the systematic review compiled 29 cases. Four primary location sites were identified in the reported cases: soft tissue presentation only, soft tissue with bony involvement, bony involvement only, and bony involvement with a soft tissue component. The majority of primary oral leiomyosarcoma cases reviewed showed a soft tissue predilection, which is in contrast to prior reports of jawbones being the most common site. In addition, there was an improved 5-year survival rate for primary oral leiomyosarcoma limited to the oral cavity and gnathic bones without extension into paranasal sinuses.

Gingival Leiomyosarcoma in a Young Woman: Case report and literature review

Leiomyosarcoma (LMS) is a rare mesenchymal malignancy, of which 3-10% of cases occur in the head and neck region. We report a 22-year-old woman who was referred to the University Hospital of Siena, Italy, in 2016 with an ostensibly benign asymptomatic lump on the mandibular gingiva. The lesion grew rapidly, causing otalgia in the right ear. An excisional biopsy was performed and primary LMS was diagnosed histologically. Subsequently, the patient underwent radical re-excision of the perilesional mucosa, a partial bone resection and the extraction of four teeth. No recurrences or metastases were detectable at a 20-month follow-up. This report discusses the differential diagnosis of LMS with regards to other benign and malignant lesions and reviews the recent literature on primary and secondary oral LMS. Due to its innocuous clinical features-including its asymptomatic nature and presentation at a young age-this aggressive malignancy can go undetected; therefore, an early histopathological diagnosis is crucial.

Primary Leiomyosarcoma of the Mandibular Alveolar Mucosa of a 12-Year-Old Child from Ethiopia: A Case Report

Leiomyosarcomas (LMSs) are rare malignant mesenchymal tumors which show smooth-muscle differentiation. Most LMSs involving the oral tissues primarily affect the maxillary sinus, the maxillary or mandibular bone. We present a case of LMS of the mandibular alveolar mucosa, arising in a 12-year-old male child from Ethiopia. A malignant spindle cell-like neoplasm was diagnosed on clinical and radiographic findings as well as on incisional biopsy. The tumor was resected with wide margins. The following histopathologic examination with additional immunohistochemical studies secured the diagnosis LMS. Microscopically, the spindle-shaped tumor cells were arranged in an interlacing fascicular pattern and contained oval to elongated, blunt-ended (cigar-shaped) nuclei. The immunohistochemical examination showed immunoreactive tumor cells for vimentin, actin, desmin, and H-caldesmon, which is pathognomonic for LMS. Immunohistochemical studies are mandatory to differentiate the LMS from other similar spindle cell neoplastic lesions. Radical resection with safety margins and a lifelong periodic follow-up has to be recommended.

Tonsillar leiomyosarcoma

Leiomyosarcomas of the head and neck is an extremely rare entity that because of its infrequency has been associated with both delayed diagnosis and misdiagnosis. Sinonasal tract is the most common site in this region. The overall prognosis is poor. It is necessary for appropriate immunohistochemical investigation for accurate diagnosis. Tonsillar leiomyosarcoma presented only 1 case in the English-language literature (PubMed, Ovid, and Proquest databases). We report a second case of leiomyosarcoma arising in the tonsil in a 38-year-old woman.

LEVEL OF EVIDENCE

Level IV therapeutic study.

Primary leiomyosarcoma of the maxilla: An investigative loom-report of a challenging case and review of literature

Leiomyosarcoma (LMS) is a malignant neoplasm composed of cells showing distinct smooth muscle features. Majority of the tumors are located in the retroperitoneum, including the pelvis and the uterus but are rare in the oral and pharyngeal region. Intraorally, they are present as painless, lobulated, fixed masses of the submucosal tissues in middle-aged or older individuals. Lesions are usually slow growing and are less than 2 cm in diameter at the time of diagnosis. Here we report the clinico-pathological findings of a case of primary LMS of the maxilla in 63-year-old male patient with an emphasis on the judicious use of ancillary diagnostic modalities to arrive at a definitive diagnosis.

Role of myocyte enhancing factor 2B in epithelial myofibroblast transition of human gingival keratinocytes

It has recently emerged that the myogenic contribution of the epithelial mesenchymal transition plays a role in neoplastic invasion and metastasis. Myocyte enhancing factor 2B (MEF2B) is the only MEF2 isoform expressed during early embryonic development, and is herein proposed to transactivate the downstream target proteins of the epithelial myofibroblast transition (EMyT). We have previously generated eight preneoplastic cell lines with spindle and cobblestone morphology from human gingival mucosal keratinocytes immortalized by E6/E7 of human papillomavirus type 16. Spindle cells formed tubulogenic morphogenesis on Matrigel and exhibited contractility, anchorage-independent growth and invasiveness to a greater extent than cobblestone cells. Expression of MEF2B mRNA and myofibroblast proteins was higher in spindle cells compared with cobblestone cells. Epidermal growth factor (EGF) treatment of cobblestone cells also induced expression of these genes. Knockdown of MEF2B in a cobblestone cell line abolished EGF-induced upregulation of MEF2, vimentin and non-muscle caldesmon proteins, but enhanced basal expression of mesenchymal vimentin and fibronectin. Differential regulation of intermediate filaments revealed an unrecognized role of MEF2B in myogenic transformation of the epithelial to a myofibroblast phenotype, which occurs as epithelioid variants in some soft tissue sarcomas.

Primary oral leiomyosarcoma: a retrospective clinical analysis of 20 cases

PURPOSE

As a review and clinical analysis of primary oral leiomyosarcoma (LMS) cases in West China stomatology Hospital in the past 37 years, this study provides demographic, therapeutic and prognostic information of this rare tumor.

PATIENTS AND METHODS

In our study, 20 cases of primary oral LMS treated between 1972 and 2008 in West China Stomatology Hospital were analyzed retrospectively. A thorough review of clinical records was carried out and potential indicators of survival were analyzed.

RESULTS

The most common symptom of oral LMS presented as a painless mass. The median age of patients was 37 years, and the peak incidence age of this tumor was in the 2nd and 5th decades. There was no predilection of gender, and the male-to-female ratio was 11:9. The most frequently occurring site of oral leiomysarcoma was the jawbones. The prognosis of this tumor was poor as a result of the high local recurrence and the estimated 2 year survival was 17.6%. The bony involvement and method of therapy was observed to have an influence on the prognosis and survival of this tumor (P < 0.05).

CONCLUSION

There was a predilection site of jawbones for oral LMS, and bony involvement was a potential indicator suggesting a poorer prognosis. The recommended method of therapy on this tumor was aggressive, radical surgical resection; however, adjuvant radiotherapy and chemotherapy may also have a beneficial effect.