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Kharbat AF, Balasubramanian K, Sankarappan K, Morgan RD, Hassan KM, Palmisciano P, Pelargos PE, Chukwu M, Bin Alamer O, Haider AS, El Ahmadieh TY, Burke JF. Leiomyogenic Tumor of the Spine: A Systematic Review. Cancers (Basel) 2024; 16:748. [PMID: 38398139 PMCID: PMC10887395 DOI: 10.3390/cancers16040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
The study cohort consisted of 83 patients with a mean age of 49.55 (SD 13.72) with a female preponderance (60 patients). Here, 32.14% of patients had primary LTS; the remaining were metastases. Clinical presentation included nonspecific back pain (57.83%), weakness (21.69%) and radicular pain (18.07%). History of uterine neoplasia was found in 33.73% of patients. LTS preferentially affected the thoracic spine (51.81%), followed by the lumbar (21.67%) spine. MRI alone was the most common imaging modality (33.33%); in other cases, it was used with CT (22.92%) or X-ray (16.67%); 19.23% of patients had Resection/Fixation, 15.38% had Total en bloc spondylectomy, and 10.26% had Corpectomy. A minority of patients had laminectomy and decompression. Among those with resection, 45.83% had a gross total resection, 29.17% had a subtotal resection, and 16.67% had a near total resection. Immunohistochemistry demonstrated positivity for actin (43.37%), desmin (31.33%), and Ki67 (25.30). At a follow-up of 19.3 months, 61.97% of patients were alive; 26.25% of 80 patients received no additional treatment, 23.75% received combination radiotherapy and chemotherapy, only chemotherapy was given to 20%, and radiotherapy was given to 17.5%. Few (2.5%) had further resection. For an average of 12.50 months, 42.31% had no symptoms, while others had residual (19.23%), other metastasis (15.38%), and pain (7.69%). On follow-up of 29 patients, most (68.97%) had resolved symptoms; 61.97% of the 71 patients followed were alive.
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Affiliation(s)
- Abdurrahman F. Kharbat
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
| | - Kishore Balasubramanian
- Division of Neurosurgery, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (K.B.); (K.S.)
| | - Kiran Sankarappan
- Division of Neurosurgery, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (K.B.); (K.S.)
| | - Ryan D. Morgan
- Division of Neurosurgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Khawaja M. Hassan
- Department of Neurosurgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Paolo Palmisciano
- Department of Neurosurgery, University of California Davis, Davis, CA 95616, USA;
| | - Panayiotis E. Pelargos
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
| | - Michael Chukwu
- Department of Surgery, New York Presbyterian Hospital/Weill Cornell, New York, NY 10065, USA;
| | - Othman Bin Alamer
- Department of Neurosurgery, University of Pittsburg Medical Center, Pittsburg, PA 15219, USA;
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | | | - John F. Burke
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
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Scoco A, Javed K, Yassari R. A curious cervical spine case: multiple, primary CNS leiomyosarcomas presenting with rapid growth in the immunocompromised patient. Spinal Cord Ser Cases 2023; 9:35. [PMID: 37507367 PMCID: PMC10382576 DOI: 10.1038/s41394-023-00588-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/30/2023] Open
Abstract
INTRODUCTION Primary CNS leiomyosarcomas are rare, dural-based intracranial or intravertebral tumors seen in immunocompromised patients and are associated with latent EBV infection. They may mimic a meningioma or schwannoma on imaging but their clinical presentation progresses much more rapidly. Often times, these tumors are hard to distinguish from secondary, metastatic leiomyosarcoma. CASE PRESENTATION A 30-year-old female with congenital HIV presented to clinic with shoulder pain, paresthesias of the right upper extremity and gait instability. She was noted to have a contrast enhancing dural-based spinal canal lesion measuring 1.5 cm at the C1 vertebral level on MRI. Surgery was proposed but patient deferred. She represented to our Emergency Department 1 month later with right-sided hemiparesis and difficulty with ambulation. On repeat MRI, the lesion had grown to 2.6 cm. She was taken to the OR emergently for gross total tumor resection. The histopathology demonstrated a primary CNS leiomyosarcoma. MRI scan of the brain revealed an extra-axial right frontal lobe lesion measuring 1.8 cm which was also treated with subtotal surgical resection followed by proton beam radiotherapy. DISCUSSION Primary CNS leiomyosarcomas should be considered in young immunocompromised patients presenting with dural-based spinal cord tumors. Histopathological studies including EBV testing can definitively make the diagnosis. These tumors have an aggressive nature and need to be treated with complete surgical resection to prevent severe neurological deterioration and adjuvant therapy to prevent recurrence.
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Affiliation(s)
- Aleka Scoco
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Kainaat Javed
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA
| | - Reza Yassari
- Department of Neurological Surgery, Montefiore Medical Center, Bronx, NY, USA.
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Jin J, Chen Z, Cao Z, Zhou S, Zhang X, Yao H. Epstein-Barr virus-associated leiomyosarcoma of the larynx in an adult patient with human immunodeficiency virus infection: Case report and review of the literature. Head Neck 2022; 44:2886-2903. [PMID: 36069494 PMCID: PMC9826281 DOI: 10.1002/hed.27184] [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: 06/22/2022] [Revised: 08/07/2022] [Accepted: 08/18/2022] [Indexed: 01/11/2023] Open
Abstract
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.
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Affiliation(s)
- Jian‐Di Jin
- Department of Infection, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zhe Chen
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Zai‐Zai Cao
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Shui‐Hong Zhou
- Department of Otolaryngology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Xiu‐Ming Zhang
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
| | - Hong‐Tian Yao
- Department of Pathology, The First Affiliated HospitalZhejiang University School of MedicineHangzhou CityP.R. China
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Townsend DC, Purohit N, Giannoulis K, Shtaya A. Presentation, management and outcome of primary leiomyosarcoma of the spine: A systematic review. World Neurosurg 2022; 163:25-35. [PMID: 35390494 DOI: 10.1016/j.wneu.2022.03.138] [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] [Received: 02/06/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
OBJECTIVE Primary spinal leiomyosarcoma (PSL) is extremely rare. A case is presented, followed by a systematic review establishing the consensus on presentation, diagnosis, management and outcomes. Comparison being made with metastatic spinal leiomyosarcoma (MSL). METHODS A systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria was decided upon before the literature search was conducted. Data were extracted and analysed. RESULTS 397 articles were identified, 25 articles conformed to the eligibility criteria. 34 cases were included in the analysis. PSL had a female preponderance (69.2%) with back pain being the most common presenting symptom (60.9%). Neurological signs were present in the majority (69.6%) with tumours typically being in the thoracic spine (46.9%). Diagnosis was primarily made using MRI (64.7%) and CT (55.9%), with a histological sample being obtained in all cases. Most patients underwent operative management (91.2%) with variable use of neoadjuvant and adjuvant therapies. Operative approach differed greatly and outcome following surgical management was stated in 48.4% of cases, all noting an improvement from presentation. Patient follow up was limited (median 7 months), with the majority of patients being free of disease (43.8%). CONCLUSIONS PSL diagnosis is challenging with PET-CT and histopathological sampling playing an important role. There is a limited evidence base for the treatment strategies employed but surgical management is key with generally good outcomes. Prognosis for PSL would appear to be better than MSL. There is scope for more dedicated research in PSL and MSL.
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Affiliation(s)
- Dominic Charles Townsend
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Wessex Neurological Centre, Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Neeraj Purohit
- Department of Clinical Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kyriakos Giannoulis
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Anan Shtaya
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Wessex Neurological Centre, Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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He S, Xu Y, Li J, Zhang Y, Wei H, Xiao J. Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients. J Neurosurg Spine 2019; 32:89-97. [PMID: 31585418 DOI: 10.3171/2019.7.spine19650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Leiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS). METHODS Twelve patients presented to the authors' institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant. RESULTS The mean patient age was 49.7 ± 12.9 years (range 22-73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0-15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5-21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6-78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS. CONCLUSIONS Surgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.
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