Leiomyosarcoma of the forearm: treatment with wide local excision and a lateral arm flap

Distal ulna leiomyosarcoma treated with custom polymethylmethacrylate prosthesis with a 4-year follow-up

BACKGROUND

Intraosseous leiomyosarcoma is a rare neoplasm having an aggressive biologic behavior. The distal end of the ulna is a very uncommon site for this type of primary bone tumor frequently mistaken for benign lesions. En bloc resection of the distal ulna with reconstruction is a valid option as a limb salvage procedure for the treatment of this difficult problem, minimizing local recurrence while preserving hand function.

CASE DESCRIPTION

We present an unusual case of a 63-year-old woman with a primary leiomyosarcoma arising from the distal end of the ulna treated successfully with a wide excision and custom distal ulna, with 4-year follow-up and no recurrence.

LITERATURE REVIEW

Tumors to develop at the distal end of the ulna have been reported as part of large series such as Dahlin and few case reports. According to Cooney, Exner, and Mankin, reconstruction for distal ulnar neoplasms is not necessary to maintain function. However, Noble and Laurentin-Perez disagree because stabilization of the distal ulna following large resection, as in our case, can be a significant problem with associated pain and weakness due to a decreased interosseous space with ulnar stump impingement on the radial metaphysis and ulnar translation of the carpus.

CLINICAL RELEVANCE

Custom methacrylate in situ radioulnar joint prosthesis for reconstruction of a large segment of the distal ulna can be a valid option to reestablish the mechanical continuity of the forearm, reducing pain and improving strength and function.

Angioleiomyoma in the ankle mimicking tarsal tunnel syndrome: a case report and review of the literature

We present the case of a 64-year-old woman with a subcutaneous vascular leiomyoma in the tarsal tunnel in the ankle. The patient presented with pain of several years' duration in the medial aspect of the ankle in the retromalleolar region corresponding to the tarsal tunnel and associated with a subcutaneous mass. We report the clinical manifestation, the imaging and histopathologic features, and a review of the literature. Vascular leiomyomas are part of the differential diagnosis of painful subcutaneous masses in the lower extremity.

Description of new composite tissue transfer for salvage of a complex hand defect

Leiomyosarcoma of the soft tissue involving bones is an extremely rare tumor. In the past, a hand tumor of this type required amputation. Presently, with improved chemotherapy and reconstruction, the hand and its dexterity sometimes can be saved. In this case, after chemotherapy, the authors opted for wide excision including the skin, tendons, muscles, and bones. The large defect was reconstructed with an iliac crest autograft and a dorsalis pedis free flap including tendons. Functional result was excellent in this patient. The pathologic results also were reviewed by histology, immunohistochemistry for muscle marker, and electron microscopy.

Vascular leiomyoma in an index finger undergoing malignant transformation

We report a case of vascular leiomyoma of the pulp of the index finger that recurred twice and underwent malignant change. Ray resection proved to be curative. An extensive literature review is given.