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Austell PJ, Levinson JS, Plitt MA, Ghai R, Gattuso P, Rupcich CR, Tajudeen BA. Endometrial Sarcoma Metastasis to the Pterygopalatine Fossa: A Case Report and Review of the Literature. EAR, NOSE & THROAT JOURNAL 2024; 103:148-150. [PMID: 33415993 DOI: 10.1177/0145561320983943] [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: 11/15/2022] Open
Abstract
Metastatic skull base malignancies infrequently occur but, when present, typically arise from breast malignancies. Pterygopalatine fossa (PPF) metastasis of any malignancy is further seldom reported, and metastasis of gynecologic malignancies to the PPF has not been previously described in the literature. We present a single case of a 42-year-old female with the first likely case of high-grade endometrial sarcoma metastatic to the PPF. The patient presented with facial pain and numbness in the V2 distribution presented for evaluation. History was significant for several months of dysmenorrhea and metrorrhagia. Computed tomography, magnetic resonance imaging, and positron emission tomography imaging revealed a PPF mass with local extension and bony metastases. Endoscopic biopsy was performed, and final pathology was most consistent with metastatic high-grade endometrial stromal sarcoma. This is the first reported case of likely metastatic endometrial sarcoma to the PPF. This case report highlights the possibility of rare distant metastasis of gynecologic malignancy to this area of the skull base.
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Affiliation(s)
- Paris J Austell
- Department of Otorhinolaryngology, Northwestern University, Chicago, IL, USA
| | - John S Levinson
- Department of Otorhinolaryngology, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
| | - Max A Plitt
- Department of Otorhinolaryngology, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
| | - Ritu Ghai
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | - Paolo Gattuso
- Department of Pathology, Rush University Medical Center, Chicago, IL, USA
| | | | - Bobby A Tajudeen
- Department of Otorhinolaryngology, Rush Sinus Program, Rush University Medical Center, Chicago, IL, USA
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Miki K, Samura K, Takahashi K, Kawashima M. Treatment of skull metastasis from uterine leiomyosarcoma: A single-center experience with literature review. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2020.101004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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3
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Rizzo A, Nigro MC, Ramponi V, Gallo C, Perrone AM, De Iaco P, Frezza G, Balestrini D, Di Benedetto M, Morbiducci J, Pantaleo MA, Nannini M. Skull Metastasis From Uterine Leiomyosarcoma, a Rare Presentation for a Rare Tumor: A Case Report and Review of the Literature. Front Oncol 2020; 10:869. [PMID: 32612948 PMCID: PMC7308452 DOI: 10.3389/fonc.2020.00869] [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: 02/17/2020] [Accepted: 05/04/2020] [Indexed: 11/13/2022] Open
Abstract
Uterine leiomyosarcoma (uLMS) is a rare and aggressive malignancy with poor clinical outcomes. Even when localized, uLMS is associated with high rates of local and distant recurrences that are usually fatal. Common sites of recurrence are lung, liver, pelvic lymph nodes, and vertebral and long bones, though atypical patterns of recurrence have been described. Among them, intracranial recurrence appears as a rare finding, almost exceptional in skull and dura. We describe the case of a solitary skull metastasis from uLMS in a 39-year-old woman, which represents the third reported case of skull recurrence in literature. After multidisciplinary discussion, the patient underwent surgery and received adjuvant radiotherapy. After 4 months, she is currently alive, without evidence of extracranial disease. This case highlights the importance of suspecting and recognizing atypical and extremely rare metastasis to this region. We encourage the need for large case series in order to provide further information about cranial recurrences of uLMS taking into account the paucity of data currently available in literature and the frequently unpredictable behavior of this rare and highly lethal disease.
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Affiliation(s)
- Alessandro Rizzo
- Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Maria Concetta Nigro
- Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy
| | - Vania Ramponi
- Department of Neurosurgery, Bellaria Hospital, Azienda USL-IRCCS Institute of Neurological Sciences, Bologna, Italy
| | - Carmine Gallo
- Anatomic Pathology, Ospedale Bellaria, Bologna, Italy
| | | | | | - Giovanni Frezza
- Department of Radiotherapy, Bellaria Hospital, Bologna, Italy
| | | | - Maika Di Benedetto
- Radiotherapy Unit, Azienda Ospedaliero Universitaria, Ospedali Riuniti Ancona, Ancona, Italy
| | - Jarno Morbiducci
- ASUR Marche, Zona Territoriale 9, Macerata Hospital, Macerata, Italy
| | - Maria Abbondanza Pantaleo
- Department of Specialized, Experimental and Diagnostic Medicine, S.Orsola-Malpighi Hospital, University of Bologna, Bologna, Italy.,"Giorgio Prodi" Cancer Research Center, University of Bologna, Bologna, Italy
| | - Margherita Nannini
- Medical Oncology Unit, S.Orsola-Malpighi University Hospital, Bologna, Italy
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Gore MR. Treatment, outcomes, and demographics in sinonasal sarcoma: a systematic review of the literature. BMC EAR, NOSE, AND THROAT DISORDERS 2018; 18:4. [PMID: 29581706 PMCID: PMC5861608 DOI: 10.1186/s12901-018-0052-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 03/01/2018] [Indexed: 02/06/2023]
Abstract
Background Sarcomas comprise a diverse group of soft tissue mesenchymal malignancies. The sinuses and nasal region are a relatively rare site of sarcomas. Methods Retrospective review of the literature on sinonasal sarcomas from 1987-2017. Data were analyzed for demographics, treatment type, stage, and histopathologic type. Kaplan-Meier analysis was used to assess and compare survival. Results A total of 198 cases of sinonasal sarcoma were identified and analyzed. The median age at diagnosis was 39 years. Overall 5-, 10-, and 20-year survival was 61.3%, 58.9%, and 49.1%, respectively, and disease-free 5-, 10-, and 20-year survival was 53.2%, 49.1%, and 38.3%, respectively. Lymph node metastasis was present at diagnosis in 3.0% of cases, and distant metastasis was present in 3.5% of cases. On univariate analysis T stage, overall stage, treatment type, histopathologic subtype, and presence of distant metastasis significantly affected survival. On multivariate analysis overall stage alone significantly predicted overall survival. Open vs. endoscopic surgery, total radiation dose, and presence of neck metastasis did not significantly affect survival. Combined modality treatment was associated with higher survival rates than single modality therapy. Conclusions Sinonasal sarcoma is a relatively rare malignancy. Lower T and overall stage, lack of distant metastasis, and multimodality therapy were associated with improved survival. Certain histopathologic subtypes were associated with poorer survival. Electronic supplementary material The online version of this article (10.1186/s12901-018-0052-5) contains supplementary material, which is available to authorized users.
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Melone GA, D'Elia A, Brogna C, Salvati M. Uterine Leiomyosarcoma Metastatic to the Brain: Case Report. TUMORI JOURNAL 2018; 94:856-60. [DOI: 10.1177/030089160809400615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background We report a leiomyosarcoma of the uterus, an uncommon tumor with a very aggressive course and poor prognosis due to the fact that, despite complete resection, it recurs with micrometastases. The most common metastatic sites are the lung, intraperitoneal, pelvic and paraaortic lymph nodes, and liver. Brain and skull metastases are very rare. Case A 57-year-old woman underwent a hysterectomy and bilateral salpingo-oophorectomy for a grade T2N0M0 uterine leiomyosarcoma. There was no evidence of other lesions. Three months later a total-body PET scan demonstrated the presence of metastases in both lungs, and the patient was started on chemotherapy. One year later a cranial MRI demonstrated a brain metastasis to the temporal lobe. Emergency complete resection of the recurrence was performed, followed by whole-brain radiation and adjuvant chemotherapy. Conclusions Given the limited treatment options, the gold standard for uterine leiomyosarcoma brain metastasis is total surgical removal. Chemotherapy and radiation therapy may provide only palliative benefit.
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Affiliation(s)
- Graziella Angelina Melone
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Alessandro D'Elia
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Christian Brogna
- Department of Neurological Sciences, Neurosurgery, Policlinico Umberto I, University of Rome “La Sapienza”, Rome
| | - Maurizio Salvati
- Department of Neurosurgery-INM Neuromed IRCCS, Pozzilli (Is), Italy
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Agaimy A, Semrau S, Koch M, Thompson LDR. Sinonasal Leiomyosarcoma: Clinicopathological Analysis of Nine Cases with Emphasis on Common Association with Other Malignancies and Late Distant Metastasis. Head Neck Pathol 2017; 12:463-470. [PMID: 29270859 PMCID: PMC6232217 DOI: 10.1007/s12105-017-0876-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
Sinonasal tract (SNT) leiomyosarcoma (LMS) is exceedingly rare with < 100 cases reported. Their relationship to retinoblastoma and other malignancies, along with previous irradiation has not been clarified. Routine and consultation cases were reviewed for histologically and immunohistochemically proven SNT LMS. The tumors were tested with antibodies against α-smooth muscle actin, desmin, h-caldesmon, HMB45, S100 protein, Rb1, MDM2, CDK4 and EBV (EBER-ISH). Nine tumors affecting 5 males and 4 females aged 26 to 77 years (median: 48 years) were identified in the maxillary sinus (n = 4), nasal cavity (n = 3) and combined SNT (n = 2). Three patients had previous irradiation (2 for retinoblastoma, 1 for fibrous dysplasia) and 1 patient had chemotherapy and stem cell transplantation for Hodgkin lymphoma. One patient had prostatic adenocarcinoma (prior) and rectal adenocarcinoma (post) to the LMS. All patients with follow-up developed either local recurrences and/or metastases, principally to lung (time to metastasis: 16-156 months, mean 62 months). Histologically, 6 tumors were conventional high-grade LMS, two had glycogen-rich clear cell (PEComa-like) morphology and one was spindle cell low-grade. The latter showed grade 2 in the recurrence and grade 3 in the lung metastases. Two cases showed dedifferentiation to anaplastic pleomorphic (inflammatory MFH-like) phenotype. Immunohistochemistry revealed diffuse expression of at least 2 smooth muscle markers in 8 and only actin in one case/s. All other markers were negative. RB1 loss was observed in 6/8 cases tested. Sinonasal tract leiomyosarcomas are rare aggressive sarcomas that frequently develop in a background of previous cancer therapy (4/9), most frequently irradiation. Their varied morphology underlines the wide differential diagnostic considerations. Long-term survival may be achieved with aggressive multimodal therapy.
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Affiliation(s)
- Abbas Agaimy
- 0000 0000 9935 6525grid.411668.cInstitute of Pathology, University Hospital, Krankenhausstrasse 8-10, 91054 Erlangen, Germany
| | - Sabine Semrau
- 0000 0000 9935 6525grid.411668.cDepartment of Radiation Oncology, University Hospital, Erlangen, Germany
| | - Michael Koch
- 0000 0000 9935 6525grid.411668.cDepartment of Otorhinolaryngology, Head and Neck Surgery, University Hospital, Erlangen, Germany
| | - Lester D. R. Thompson
- 0000 0004 0445 0789grid.417224.6Department of Pathology, Woodland Hills Medical Center, 5601 De Soto Avenue, Woodland Hills, CA 91367 USA
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Kenea TT, Kebede BA, Gozjuze FM, Kiros H, Wilde F. Primary Leiomyosarcoma of the Mandibular Alveolar Mucosa of a 12-Year-Old Child from Ethiopia: A Case Report. Craniomaxillofac Trauma Reconstr 2017; 10:56-59. [PMID: 28210409 DOI: 10.1055/s-0036-1582459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Accepted: 12/06/2015] [Indexed: 10/21/2022] Open
Abstract
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.
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Affiliation(s)
- Tewodros Tefera Kenea
- Department of Cranio-Maxillofacial and Oral Surgery, Yekatit 12 Hospital Medical College, Addis Ababa, Ethiopia
| | - Betel Abebe Kebede
- Department of Pediatrics and Child Health, Addis Ababa University, Addis Ababa, Ethiopia
| | | | - Hagos Kiros
- Department of Pathology, Addis Ababa University, Addis Ababa, Ethiopia
| | - Frank Wilde
- Department of Oral and Maxillofacial Surgery, Military Hospital Ulm, Academic Hospital Ulm University, Ulm, Germany
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Adishesh M, Terefenko H, Taylor S, Decruze B, Lord R, Herod J. Adjuvant treatment after hysterectomy for uterine leiomyosarcoma. Hippokratia 2015. [DOI: 10.1002/14651858.cd011527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Meera Adishesh
- Warrington Hospital; Obstetrics and Gynaecology; Lovely Lane Warrington UK WA5 1QG
| | - Hannah Terefenko
- Warrington Hospital; Obstetrics and Gynaecology; Lovely Lane Warrington UK WA5 1QG
| | - Sian Taylor
- Liverpool Women's NHS Foundation Trust; Gynaecology; Crown Street Liverpool UK L8 7SS
| | - Bridget Decruze
- Liverpool Women's NHS Foundation Trust; Gynaecology; Crown Street Liverpool UK L8 7SS
| | - Rosemary Lord
- Clatterbridge Cancer Centre; Oncology; Clatterbridge Rd Bebington Wirral Merseyside UK CH6 34JY
| | - Jonathan Herod
- Liverpool Women's NHS Foundation Trust; Gynaecology; Crown Street Liverpool UK L8 7SS
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9
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Metastatic uterine leiomyosarcoma in the upper buccal gingiva misdiagnosed as an epulis. Case Rep Oncol Med 2014; 2014:402342. [PMID: 25386373 PMCID: PMC4214049 DOI: 10.1155/2014/402342] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Accepted: 09/29/2014] [Indexed: 11/25/2022] Open
Abstract
Uterine leiomyosarcoma (LMS) is a rare tumor constituting 1% of all uterine malignancies. This sarcoma demonstrates an aggressive growth pattern with an high rate of recurrence with hematologic dissemination; the most common sites are lung, liver, and peritoneal cavity, head and neck district being rarely interested. Only other four cases of metastasis in the oral cavity have been previously described. The treatment of choice is surgery and the use of adjuvant chemotherapy and radiation has limited impact on clinical outcome. In case of metastases, surgical excision can be performed considering extent of disease, number and type of distant lesions, disease free interval from the initial diagnosis to the time of metastases, and expected life span. We illustrate a case of uterine LMS metastasis in the upper buccal gingiva that occurred during chemotherapy in a 63-year-old woman that underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy for a diagnosis of LMS staged as pT2bN0 and that developed lung metastases eight months after primary treatment. Surgical excision of the oral mass (previously misdiagnosed as epulis at a dental center) and contemporary reconstruction with pedicled temporalis muscle flap was performed in order to improve quality of life. Even if resection was achieved in free margins, “local” relapse was observed 5 months after surgery.
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Stofko DL. Undifferentiated uterine sarcoma metastatic to the brain. Surg Neurol Int 2013; 4:127. [PMID: 24231690 PMCID: PMC3815079 DOI: 10.4103/2152-7806.119054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2013] [Accepted: 08/01/2013] [Indexed: 12/02/2022] Open
Abstract
Background: Undifferentiated uterine sarcoma (UUS) is a rare tumor with an aggressive growth pattern. They occur in women from 40 to 60 years and are generally characterized by poor prognosis, a high rate of local recurrence, and distant metastases. UUS accounts for 0.2% of all gynecological malignancies. Possible treatments include surgery, radiotherapy, and chemotherapy. Case Description: A 65-year-old female with postmenopausal bleeding was found to have a uterine mass for which she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The pathologic evaluation was consistent with undifferentiated endometrial sarcoma. She began experiencing headaches with associated visual disturbances. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm. Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Histopathology confirmed UUS metastases. Conclusion: Randomized trials analyzing these treatment options are limited due to the rarity of this disease; therefore, a standard therapy is not established. Based on a review of the literature, this is only the fourth case reported of UUS metastatic to the brain.
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Affiliation(s)
- Douglas L Stofko
- Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA
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11
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Primary and secondary leiomyosarcoma of the oral and perioral region--clinicopathological and immunohistochemical analysis of a rare entity with a review of the literature. J Oral Maxillofac Surg 2013; 71:1132-42. [PMID: 23434173 DOI: 10.1016/j.joms.2012.12.011] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Revised: 12/04/2012] [Accepted: 12/04/2012] [Indexed: 11/23/2022]
Abstract
PURPOSE Leiomyosarcoma (LMS) rarely occurs in the head and neck region. These tumors present with a wide range of clinical features, so the diagnosis is predicated on conventional microscopic findings coupled with immunohistochemical analysis. PATIENTS AND METHODS Clinical and histologic data of 7 patients with LMS of the head and neck were recorded retrospectively. In addition to routine immunohistochemistry, staining for cell cycle regulator proteins p16 and p21 was performed. RESULTS Five LMSs (4 intraoral, 1 dermal cheek) occurred primarily in the oral and perioral region. Two LMSs (parietal and sinonasal) were diagnosed as metastases originating from the uterus and pelvis. Treatment of the primary LMSs consisted of radical tumor resection with clear margins. Distant metastases from LMSs were irradiated or excised as palliative treatment. Three of 5 patients (60%) with primarily excised LMS developed recurrence after an average of 7 months, with lung metastases occurring after 17 months. In 1 patient, cervical lymph node metastases were detected after 10 months. Of all patients, 5 died after an average survival period of 2.4 years. The mean survival period of the 5 patients with primary LMS of the head and neck was 3.3 years. All tumors were positive for vimentin and α-smooth muscle actin, with 57% of tumors showing positive nuclear expression of p16 and 71% of p21. Lack of p16 nuclear expression was associated with a shorter mean survival time (1.3 vs 4.3 yr for p16 positivity). CONCLUSION Lung and cervical lymph node metastases often occur in LMS of the head and neck. Presurgical staging, including gynecologic examination, whole-body computed tomography, and sometimes positron-emission or computed tomography, to rule out LMS metastasis is mandatory. Surgical resection of the tumor should be given top priority. Lack of p16 reactivity may have a prognostic value for LMS because it was related to a trend toward poorer survival.
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12
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Two patients with primary sellar leiomyomas, a rare entity. J Clin Neurosci 2012; 20:897-901. [PMID: 23219820 DOI: 10.1016/j.jocn.2012.07.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2012] [Accepted: 07/04/2012] [Indexed: 02/04/2023]
Abstract
Leiomyomas are benign smooth muscle tumors commonly found in the genitourinary or gastrointestinal tracts. Rarely, they present as primary intracranial extra-axial brain tumors. Most of these lesions have been described in immunocompromised patients, but have been found very rarely in the immunocompetent patient. We present two patients with sporadic sellar leiomyomas. The first patient is a 25-year-old woman who presented with a 2-year history of amenorrhea and a heterogeneous lesion. The second is a 53-year-old man who presented with headaches and progressive panhypopituitarism, and a large cystic lesion expanding the sella. In both patients, transnasal transphenoidal surgery was performed for resection of the tumor. We review the intraoperative findings, neuropathology and immunohistochemistry and the clinical follow-up. A literature search, which revealed only two prior reported cases of sporadic sellar leiomyomas, and subsequent review led us to conclude that the natural history of sellar leiomyomas relates to the immune status of the patient and that these tumors may cause pituitary dysfunction through infiltration of the gland, mass effect and compression, or even potentially as a byproduct of prolactin secretion intrinsic to the tumor itself. Complete surgical resection of these infiltrating tumors may not be advisable when pituitary function is intact. Long-term endocrine follow-up in these patients is advised.
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Fluorodeoxyglucose positron emission tomography in leiomyosarcoma: imaging characteristics. Nucl Med Commun 2009; 30:546-9. [PMID: 19440162 DOI: 10.1097/mnm.0b013e32832bcaec] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Leiomyosarcoma, a malignant neoplasm of smooth muscle, accounts for 7% of the sarcomas. Patients with leiomyosarcoma tumors have an average survival of 5 years. These tumors, which are derived from mesenchymal tissues, are difficult to diagnose, and treatment options remain controversial. The relatively rare incidence of this soft tissue sarcoma subtype has limited the number of patients available for studies and research. This study examines whether the imaging characteristics of positron emission tomography (PET) with radiolabeled fluorodeoxyglucose (FDG) provide a reliable, noninvasive means to predict tumor behavior in patients with leiomyosarcomas. METHODS [18F]-FDG-PET was performed on the tumors of participating patients before the neoadjuvant chemotherapy or resection, and a maximum tumor standard uptake value (SUVmax) was calculated. RESULTS The SUVmax was correlated with tumor grade (P=0.001) and tumor size as greatest dimension (P=0.004). Analysis of these data indicated the potential effectiveness of FDG-PET imaging in predicting tumor grade. CONCLUSION In leiomyosarcoma, the SUVmax from FDG-PET is a likely predictor of tumor behavior. The results of this study suggest that a large (by greatest dimension) intermediate grade tumor is expected to have the same predicted outcome as a high-grade tumor and should be treated in the same manner, as they share the same prognosis by definition of tumor grade. Improvements made in the clinical treatment of leiomyosarcomas by use of FDG-PET imaging data may lead to an increase in patient survival.
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M'sakni I, Bouraoui S, Ben slama S, Lahmar-boufaroua A, Goutallier ben fadhel C, Ben sassi L, Arfa N, Khalfallah MT, Mzabi-regaya S. Métastase duodénale d'un leiomyosarcome utérin. À propos d'une observation. ACTA ACUST UNITED AC 2005; 130:584-6. [PMID: 16202885 DOI: 10.1016/j.anchir.2005.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2005] [Accepted: 06/17/2005] [Indexed: 10/25/2022]
Abstract
The digestive metastases of uterine leiomyosarcoma are rare. We report a case of a duodenal tumor detected in a 50 year-old woman, 3 years after she underwent a total hysterectomy for uterine leiomyosarcoma. The stenosing duodenal mass was thought to be a mesenchymal tumor. A pancreaticoduodenectomy was performed. The resected lesion was morphologically similar to the uterine leiomyosarcoma. In fact, the histopathological study confirmed a submucosal tumor with typical features of the uterine leiomyosarcoma. Immunohistochemistry was performed and it showed negative CD117 and CD 34. Markers displayed positivity for actin smooth muscle and desmin. Considering the patient history and the immunohistochemical observations, we diagnosed a duodenal metastasis of uterine leiomysarcoma. Through this exceptional observation we want to emphasize the epidemiological and the pathological features of the metastatic uterine leiomyosarcoma. We will also point out the progress of tumoral cells and the histopathological distinctive criteria with a primitive digestive mesenchymal tumor.
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Affiliation(s)
- I M'sakni
- Service d'anatomie et de cytologie pathologiques, hôpital Mongi-Slim, 2046 Sidi Daoud, La Marsa, Tunis, Tunisie.
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