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Zhao H, Hu Z, Kong L, Zhao Q, Wu W, Duan G. Posterior mediastinal leiomyosarcoma: Case report and literature review. Medicine (Baltimore) 2024; 103:e37704. [PMID: 38579068 PMCID: PMC10994425 DOI: 10.1097/md.0000000000037704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 03/04/2024] [Indexed: 04/07/2024] Open
Abstract
BACKGROUND Posterior mediastinal leiomyosarcoma is an extremely rare malignant mesenchymal tumor with no special clinical symptoms, which is easily confused with some common tumors in the posterior mediastinum, affecting the accuracy of the first diagnosis by clinicians and delaying the treatment of patients. CASE SUMMARY We report a 59-year-old woman with a space-occupying lesion in the posterior mediastinum. The patient was mistakenly diagnosed with lumbar muscle or vertebral body lesions due to chest and back pain and underwent conservative treatment, but her symptoms did not improve significantly and she gradually developed pain in both lower limbs. Chest computed tomography (CT) scan indicated the left lower lung paraspinal space and underwent standard single-aperture video-assisted thoracoscopic surgery (VATS), which was pathologically confirmed as posterior mediastinal leiomyosarcoma. CONCLUSION Complete surgical resection of posterior mediastinal leiomyosarcoma can achieve good clinical results.
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Affiliation(s)
- Hongzhen Zhao
- Hebei Medical University, Shijiazhuang, People’s Republic of China
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Zhonghui Hu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Lingxin Kong
- Hebei Medical University, Shijiazhuang, People’s Republic of China
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Qingtao Zhao
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Wenbo Wu
- Department of Thoracic Surgery, Hebei General Hospital, Shijiazhuang, People’s Republic of China
| | - Guochen Duan
- Department of Thoracic Surgery, Children’s Hospital of Hebei Province, Shijiazhuang, People’s Republic of China
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Posterior mediastinal epithelioid leiomyosarcoma: Case report and literature review. Radiol Case Rep 2022; 17:599-603. [PMID: 34987688 PMCID: PMC8702846 DOI: 10.1016/j.radcr.2021.11.015] [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: 10/05/2021] [Revised: 11/02/2021] [Accepted: 11/10/2021] [Indexed: 11/22/2022] Open
Abstract
Epithelioid type leiomyosarcoma is rarely encountered outside of the abdomen or uterus. We present a case of posterior mediastinal leiomyosarcoma in a 45-year-old male with back pain and bilateral lower extremity weakness. Magnetic Resonance Imaging of the thoracic spine revealed a heterogeneous posterior mediastinal soft tissue mass infiltrating the vertebral body and epidural space with resultant spinal cord compression and edema. Positron Emission Tomography showed no evidence of distant metastatic spread. Histopathological characterization revealed epithelial type leiomyosarcoma. Despite multiple subtotal resections, radiotherapy, and salvage chemotherapy with successful restoration of the patient's neurological function, the tumor burden remained significant. The patient was subsequently lost to follow up and the clinical outcome remains unknown. To our knowledge this is the first reported case of epithelioid type posterior mediastinal leiomyosarcoma presenting with spinal cord compression and edema.
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Abstract
RATIONALE Mediastinal leiomyosarcoma is very rare. In this paper, we report one case of anterior mediastinal leiomyosarcoma and retrospectively review the imaging findings of previously reported cases. PATIENT CONCERNS A 61-year-old male patient was admitted to our hospital due to the presence of a mediastinal space-occupying lesion for two years. Two years previously, chest computed tomography (CT) showed a small nodule in the anterior mediastinum. Twenty days previously, the CT examination was repeated at the local hospital due to respiratory symptoms, which showed a mass in the anterior mediastinum and interstitial inflammation of both lungs. After admission to our hospital, chest contrast-enhanced CT scanning showed a mass in the right anterior mediastinum that was approximately 3.3 × 5.2 cm2 in size that had a clear boundary, slightly heterogeneous internal density and heterogeneous enhancement. INTERVENTIONS The patient underwent a mediastinal lump resection. DIAGNOSES Finally, the pathological diagnosis was anterior mediastinal leiomyosarcoma. OUTCOMES The patient recovered well after the operation. LESSONS Accidental discovery of anterior mediastinal nodules should be followed up. Mediastinal leiomyosarcoma is common in the posterior mediastinum. Imaging shows a heterogeneous mass with a space-occupying effect that may easily involve adjacent mediastinal vessels or infiltrate surrounding organs.
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Affiliation(s)
- Xing Xue
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Wenjie Liang
- Department of Radiology, the First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang
| | - Wenjuan Zhang
- Department of Anesthesiology, the First People's Hospital of Taicang City, Taicang Affiliated Hospital of Soochow University, Taicang, Suzhou, China
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den Bakker MA, Marx A, Mukai K, Ströbel P. Mesenchymal tumours of the mediastinum--part II. Virchows Arch 2015; 467:501-17. [PMID: 26358060 PMCID: PMC4656710 DOI: 10.1007/s00428-015-1832-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 08/06/2015] [Accepted: 08/11/2015] [Indexed: 02/06/2023]
Abstract
This is the second part of a two-part review on soft tissue tumours which may be encountered in the mediastinum. This review is based on the 2013 WHO classification of soft tissue tumours and the 2015 WHO classification of tumours of the lung, pleura, thymus and heart and provides an updated overview of mesenchymal tumours that have been reported in the mediastinum.
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Affiliation(s)
- Michael A den Bakker
- Department of Pathology, Maasstad Ziekenhuis, PO Box 9100, 3007, AC, Rotterdam, The Netherlands.
- Department of Pathology, Erasmus MC, Rotterdam, The Netherlands.
| | - Alexander Marx
- Institute of Pathology, University Medical Center Mannheim, University of Heidelberg, Heidelberg, Germany
| | - Kiyoshi Mukai
- Department of Diagnostic Pathology, Saiseikai Central Hospital, Tokyo, Japan
| | - Philipp Ströbel
- Department of Pathology, Universitätsmedizin Göttingen, Göttingen, Germany
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Affiliation(s)
- C-Y Liao
- Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan
| | - S-T Chien
- Pathology Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan
| | - S-F Huan
- Internal Medicine Department, Kaohsiung Armed Forces General Hospital, Zhongzheng 1st Rd., Lingya Dist., Kaohsiung City, Taiwan
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Complete resection of a giant mediastinal leiomyosarcoma. Ann Thorac Surg 2015; 99:e69-71. [PMID: 25742862 DOI: 10.1016/j.athoracsur.2014.12.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2014] [Revised: 11/19/2014] [Accepted: 12/08/2014] [Indexed: 11/23/2022]
Abstract
Primary mediastinal leiomyosarcoma is an extremely rare malignancy, and the only opportunity for a cure lies with an aggressive surgical approach. We report a 66-year-old woman who underwent complete resection of a giant mediastinal leiomyosarcoma located on the bilateral diaphragm. The tumor encased the inferior vena cava and compressed the adjacent structures. Using cardiopulmonary bypass with 20 minutes of hepatic ischemia, the tumor was completely resected with combined resection and reconstruction of the surrounding structures. Because of the tumor size and location in the boundary area between thoracic and abdominal surgeries, the procedure necessitated the cooperation of many expert surgeons.
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Lee DH, Park CK, Keum DY, Kim JB, Hwang I. Leiomyosarcoma of the posterior mediastinum extending into the adjacent spinal canal. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:192-5. [PMID: 22708090 PMCID: PMC3373978 DOI: 10.5090/kjtcs.2012.45.3.192] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/28/2011] [Revised: 10/26/2011] [Accepted: 11/11/2011] [Indexed: 12/25/2022]
Abstract
Leiomyosarcoma of the mediastinum and primary leiomyosarcoma of the spine are exceedingly rare. In most cases, spinal leiomyosarcoma is metastatic. In this report, we describe the case of a 58-year-old man who presented with a large leiomyosarcoma of the posterior mediastinum that extended into the adjacent spinal canal. The tumor was completely resected from the mediastinum, but only subtotally removed from the spinal canal because the spinal mass had tightly invaded the spinal cord. Because the patient's postoperative condition was poor, no adjuvant radiotherapy or chemotherapy was administered. He expired 3 months after the surgery due to relapse; the spinal and mediastinal tumor remained at the preoperative size.
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Affiliation(s)
- Deok Heon Lee
- Department of Thoracic and Cardiovascular Surgery, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Korea
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Vaziri M. Primary mediastinal leiomyosarcoma. Gen Thorac Cardiovasc Surg 2012; 60:522-4. [PMID: 22610155 DOI: 10.1007/s11748-012-0031-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2011] [Accepted: 08/30/2011] [Indexed: 01/26/2023]
Abstract
Primary leiomyosarcoma of the mediastinum is a very rare malignant mesenchymal tumor, which may arise in the soft tissue of the mediastinum or from the great vessels. Due to its rarity and nonspecific clinical symptoms, the correct diagnosis and proper management are often delayed and not well established. We report a 55-year-old woman with a large right-sided mediastinal leiomyosarcoma with adhesion to the pericardium and right middle lobe, which was completely removed via right thoracotomy along with pericardial resection and right middle lobectomy.
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Affiliation(s)
- Mohammad Vaziri
- Minimally Invasive Surgery Research Center, General Surgery Department of Hazrat Rasool Hospital, Tehran University of Medical Sciences, Shahrara, Niayesh Ave., Tehran, Iran.
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Iwata T, Miura T, Inoue K, Hanada S, Inoue H, Miyamoto Y. Primary leiomyosarcoma of the anterior mediastinum encasing the aortic arch, left common carotid and left subclavian arteries. Ann Thorac Cardiovasc Surg 2011; 18:140-3. [PMID: 22033241 DOI: 10.5761/atcs.cr.11.01710] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
A 66-year-old man presented with a one month history of hoarseness. Left recurrent nerve palsy and a left upper mediastinal mass were observed by an otorhinolaryngologist who referred the patient to our department. Chest computed tomography showed a superior mediastinal mass, which seemed to involve the left common carotid and left subclavian arteries from the greater curvature of the aortic arch. The innominate vein was compressed, and collateral circulation was well developed. The left upper lobe of the lung was also seemed involved. A mediastinal biopsy conducted via left thoracoscopy revealed a malignant spindle cell tumor. The mediastinum was irradiated (40 Gy), and surgical extirpation was subsequently undertaken 3 weeks later. The tumor was successfully removed without the use of extracorporeal circulation. Because only smooth muscle actin was focally but strongly expressed immunohistochemically, leiomyosarcoma was confirmed. The patient was discharged on day 14. A solitary left pleural metastasis was observed and resected 12 months after the surgery and the patient is well without further recurrence 16 months after the initial surgery.
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Affiliation(s)
- Takashi Iwata
- Department of Thoracic and Cardiovascular Surgery, Kansai Rosai Hospital, Amagasaki, Hyogo, Japan.
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Bakaeen FG, Jaroszewski DE, Rice DC, Walsh GL, Vaporciyan AA, Swisher SS, Benjamin R, Blackmon S, Reardon MJ. Outcomes after surgical resection of cardiac sarcoma in the multimodality treatment era. J Thorac Cardiovasc Surg 2009; 137:1454-60. [PMID: 19464464 DOI: 10.1016/j.jtcvs.2008.11.026] [Citation(s) in RCA: 100] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2008] [Revised: 10/28/2008] [Accepted: 11/18/2008] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Primary cardiac sarcomas are rare tumors carrying poor prognosis. Resection remains the primary therapy. Especially in recent years, chemotherapy and radiation have been used adjunctively. METHODS All patients (n = 27) surgically treated for primary cardiac sarcoma at two tertiary referral centers from January 1990 to January 2006 were retrospectively reviewed. RESULTS There were 13 women and 14 men, with 26 resections and 1 palliative debulking performed. Cardiac explantation was necessary in 8 cases because of tumor location. Concomitant valve surgery (repair or replacement) or coronary artery bypass grafting was performed in 9 and 3 patients, respectively. Synchronous or staged resections of associated pulmonary metastases were performed in 6 and 2 patients, respectively. Operative mortality was 7.4% (2/27). Preoperative or postoperative chemotherapy was administered to 16 and 19 patients, respectively. At follow-up (median 22 months, range, 2-119 months), 12 patients were alive, with 7 tumor free. Among patients who underwent resection with curative intent and survived surgery (n = 24), median survival was 23.5 months (range 4-119 months). Patients who underwent surgical resection, radiofrequency ablation, or radiation treatment for tumor recurrence (local or metastatic, n = 7) had median survival of 47 months (range 16-119 months), whereas patients with no further intervention for recurrent disease (n = 7) had median survival of 25 months (range 8-34 months). CONCLUSIONS Multimodal therapy can achieve reasonable survival for patients with resected cardiac sarcomas. Patients with local tumor recurrence or metastatic disease may still benefit from aggressive treatment.
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Affiliation(s)
- Faisal G Bakaeen
- Department of Cardiothoracic Surgery, Baylor College of Medicine, Houston, Tex 77030, USA.
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Zidane A, Atoini F, Arsalane A, Traibi A, Redouane B, Jidal M, El Bouzidi A, Kabiri EH. [Primary leiomyosarcoma of visceral mediastinum]. REVUE DE PNEUMOLOGIE CLINIQUE 2009; 65:93-96. [PMID: 19375048 DOI: 10.1016/j.pneumo.2008.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2007] [Revised: 12/25/2008] [Accepted: 12/28/2008] [Indexed: 05/27/2023]
Abstract
Primary leiomyosarcoma of the thorax is a rare malignant mesenchymatous tumour. Most of those tumours occurring in the mediastinum arise from the oesophagus and great vessels, whereas an appearance in the soft tissue of the mediastinum is extremely rare. The rare incidence of this tumour and its slow growth reflect the difficulties in differential diagnosis according to their histopathology and location. The most common treatment is surgical resection. The authors describe a case of a leiomyosarcoma arising from soft tissue of the mediastinum and present a review of the literature.
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Affiliation(s)
- A Zidane
- Service de chirurgie thoracique, hôpital militaire d'instruction Mohamed V, Hay Riad, 1010 Rabat, Maroc
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12
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Primary leiomyosarcoma of the posterior mediastinum — A case report. Indian J Thorac Cardiovasc Surg 2008. [DOI: 10.1007/s12055-008-0046-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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Abstract
INTRODUCTION Indications and results of salvage surgery in mediastinal tumors are still unclear. This study analyzes a single-center experience to assess its mortality, morbidity, and long-term results. METHODS Mediastinal salvage surgery (MSS) was defined as surgical resection of persistent or recurrent primary mediastinal tumors after previous local treatments with curative intent or exclusive chemotherapy in case of bulky tumors. Clinical data of patients undergoing MSS between 1998 and 2005 were analyzed. Overall and disease-specific long-term survival was calculated. RESULTS Twenty-one patients (15 men and 6 women, mean age 41 years) underwent MSS. Eleven patients suffered from thymic tumors (eight thymomas, three thymic carcinoma) whereas 10 patients suffered from nonthymic tumors (one lung adenocarcinoma + thymoma, two mediastinal monophasic sinovial sarcoma, one mediastinal neuroendocrine tumor, one mediastinal teratoblastoma, one mediastinal disgerminoma, one Hodgkin's lymphoma, one mediastinal atypic carcinoid, two medullary thyroid carcinoma). MSS required extended vascular resection in 10 cases and cardiopulmonary bypass in one case. Median operation time was 215 minutes (range 140-720). One postoperative death and four major complications were recorded (overall mortality 4.7%, morbidity 19.0%). With a median follow-up of 30.6 months, overall 1-, 3-, and 5-year Kaplan-Meier survival was 89.7, 71.2, and 56.6%, respectively. Thymic neoplasms had a better prognosis (1-, 3-, and 5-year survival was 100, 87.5, 87.5%, respectively) when compared with others (1-, 3-, and 5-year survival was 77.8, 53.3, 26.7%, respectively--logrank p = 0.0128). CONCLUSIONS MSS can offer a chance of curative treatment in selected patients with an acceptable morbidity and mortality. Thymic tumors obtain the best results in term of long-term survival.
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Kim WY, Kang GH, Lee JH, Park SH, Kang KW. A Case of Primary Endobronchial Leiomyosarcoma Noticed by Massive Hemoptysis. Tuberc Respir Dis (Seoul) 2006. [DOI: 10.4046/trd.2006.61.5.484] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Woo Youl Kim
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Gu Hyun Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Jin Ho Lee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Sun Hyo Park
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
| | - Kyung Woo Kang
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Masan Samsung Hospital, Sungkyunkwan University School of Medicine, Masan, Korea
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D'Aiuto M, Veronesi G, Pompilio G, Gasparri R, Presicci F, Galetta D, Biglioli P, Spaggiari L. Extended right pneumonectomy with partial left atrial resection for primary leiomyosarcoma of the mediastinum. J Thorac Cardiovasc Surg 2005; 129:694-5. [PMID: 15746766 DOI: 10.1016/j.jtcvs.2004.07.057] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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