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Schenker A, Gutjahr E, Lehner B, Mechtersheimer G, Wardelmann E, Klotz R, Kalkum E, Schiltenwolf M, Harhaus L, Renkawitz T, Panzram B. A Systematic Review and Illustrative Case Presentation of Low-Grade Myofibroblastic Sarcoma (LGMS) of the Extremities. J Clin Med 2023; 12:7027. [PMID: 38002641 PMCID: PMC10672639 DOI: 10.3390/jcm12227027] [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: 08/17/2023] [Revised: 11/05/2023] [Accepted: 11/07/2023] [Indexed: 11/26/2023] Open
Abstract
INTRODUCTION Low-grade myofibroblastic sarcoma (LGMS) is a rare tumor entity which occurs in the subcutaneous and deep soft tissues; it is less common in the bone with a predilection for the extremities and the head and neck region. As confirming the diagnosis is difficult and treatment strategies are not standardized, we aimed to identify patient and tumor characteristics, and to summarize treatment strategies and their clinical outcomes to guide surgeons. METHODS Included were full articles reporting patients with histology of LGMS in the extremities, excluding tumors of the trunk. All patients underwent surgery but with different extend, from marginal to wide resection. Included studies should inform about local recurrence, metastasis, or evidence of disease, depending on the surgical treatment. We conducted a structured search using MEDLINE (via PubMed), Web of Science, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) to identify studies on low-grade myofibroblastic sarcoma of the extremities. Study designs like randomized controlled trials, systematic reviews, prospective trials, retrospective studies, and case reports were included. Prospective studies and comparative studies were not available at all. Therefore, meta-analysis was not possible and statistical analysis was purely descriptive. RESULTS Of the 789 studies identified from our initial search, 17 studies including 59 cases reported LGMS of the extremities with the surgical treatment and clinical outcome and were therefore analyzed. In addition, we present the rare case and surgical management of a 28-year-old male patient with residual LGMS of the thumb after an initial incomplete resection. The current literature suggests that a wide excision with R0 margins should be considered the standard treatment for LGMS. In cases where surgery leads to significant functional impairment, individual options like free tissue transfer from a donor site have to be considered. Therefore, we also present an illustrative case. For all selected case series and case reports, a high risk of confounding, selection bias, information bias, and reporting bias must be anticipated. Nevertheless, this systematic review provides a comprehensive overview on surgical treatment and clinical outcomes in LGMS surgery of the extremities.
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Affiliation(s)
- Astrid Schenker
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
| | - Ewgenija Gutjahr
- Department of Pathology, University of Heidelberg, 69120 Heidelberg, Germany; (E.G.); (G.M.)
| | - Burkhard Lehner
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
| | - Gunhild Mechtersheimer
- Department of Pathology, University of Heidelberg, 69120 Heidelberg, Germany; (E.G.); (G.M.)
| | - Eva Wardelmann
- Gerhard Domagk Institute of Pathology, University Hospital Muenster, Albert-Schweitzer-Campus 1, Building D17, 48149 Muenster, Germany;
| | - Rosa Klotz
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (R.K.); (E.K.)
- Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, 69118 Heidelberg, Germany
| | - Eva Kalkum
- Study Center of the German Society of Surgery (SDGC), University of Heidelberg, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany; (R.K.); (E.K.)
| | - Marcus Schiltenwolf
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
| | - Leila Harhaus
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
| | - Tobias Renkawitz
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
| | - Benjamin Panzram
- Department for Orthopaedics, University of Heidelberg, Schlierbacher Landstraße 200a, 69118 Heidelberg, Germany; (B.L.); (M.S.); (L.H.); (T.R.)
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Is there a role for chemotherapy and radiation in the treatment of patients with low-grade myofibroblastic sarcoma? Clin Transl Oncol 2020; 23:344-352. [PMID: 32607812 DOI: 10.1007/s12094-020-02425-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 06/10/2020] [Indexed: 10/24/2022]
Abstract
PURPOSE Low-grade myofibroblastic sarcoma (LGMS) is a rare entity with a predilection for the head and neck. There are still no optimal treatment strategies for patients with LGMS. We retrospectively investigated the efficacies of chemotherapy and radiation treatment for patients with LGMS. METHODS/PATIENTS We obtained data from the Surveillance, Epidemiology, and End Result (SEER) database for 96 patients diagnosed with LGMS between 2001 and 2015. We used Kaplan-Meier curves and log-rank tests to estimate overall survival (OS) and Cox proportional hazard regression to identify prognostic factors. RESULTS The median age of the patients was 55.0 years. Twenty-two of the patients had LGMS in the head and neck region. Of the 96 patients, 86 (89.6%) received surgical treatment, 28 (29.2%) received radiation treatment, and 20 (10.4%) received chemotherapy. The mean OS was 125.2 [95% confidence interval (CI) 106.3-144.2] months. The 1, 3, 5, and 10-year OS rates were 88%, 77%, 70%, and 59%, respectively. Age greater than 60 years, positive nodal status, and no surgical treatment were independent prognostic factors for patients with LGMS, whereas chemotherapy and radiation treatment were not. CONCLUSIONS Surgical resection is the most effective therapy for LGMS. Chemotherapy and radiation had limited effects on survival improvement for patients with LGMS. Therefore, chemotherapy and/or radiation therapy should not be routinely performed in LGMS, especially for those with negative margins after surgery.
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Abstract
RATIONALE Low-grade myofibroblastic sarcoma (LGMS) is a malignant lesion composed of myofibroblasts. It is an uncommon tumor of unknown etiology that mainly develops in the bone or soft tissue and is most often reported in the head and neck, particularly in the tongue and oral cavity. PATIENT CONCERNS A 2-year-old girl, previously well and with no significant medical history or family history of other diseases, presented with a 2-week painless swelling of the right orbit. DIAGNOSES Preoperative computed tomography (CT) revealed a large homogeneous enhanced mass, 21 × 13 mm in size, located on lateral wall of the right orbit with bone absorption. The mass was resected and histopathological examination revealed LGMS of the orbit. INTERVENTIONS On May 2016, she underwent surgery without the additional postoperative treatment. OUTCOMES The patient's postoperative course was uneventful, and was discharged on the 6th day after surgery. During a year follow-up period, there was no recurrence of the postoperative CT. The patient and her family were satisfied with the result of the surgery. LESSONS Based on clinical characteristics and postoperative CT, we considered the mass may be a benign tumor. We completely resected along the capsule without an extensive surgical margin. However, postoperative histopathology diagnose LGMS, which shows a strong potential for local recurrence and vascular invasion. So we should close observation of the patient's symptoms and sign. If the tumor has invaded adjacent tissues, we will use adjuvant chemotherapy or radiotherapy.
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Affiliation(s)
| | - Ying Ma
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tie Ma
- Department of Pathology, Shengjing Hospital of China Medical University, Shenyang, China
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Maruyama T, Nakasone T, Nimura F, Matayoshi A, Kawano T, Nishihara K, Arasaki A. Indolent growth of low-grade myofibroblastic sarcoma of the cheek mimics benign lesions: A case report and literature review. Oncol Lett 2017; 13:4307-4314. [PMID: 28588708 PMCID: PMC5452922 DOI: 10.3892/ol.2017.6020] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2015] [Accepted: 01/19/2017] [Indexed: 11/28/2022] Open
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a neoplasm of the soft tissue characterized by myofibroblastic differentiation. This type of tumor has been observed in various sites in the whole body, but frequently occurs in the head and neck region. It typically presents as a slow-growing painless mass, which is often mistaken for a benign lesion due to its indolent growth; however, LGMS is a malignant neoplasm. In the present study, a 43-year-old female presented with a 14-mm LGMS lesion in the buccal subcutaneous tissues of the buccinator muscle. The patient had initially noticed the lesion 2-months prior to presenting at the hospital. Following biopsy, the tumor was surgically resected and no recurrence or metastasis was observed during a follow-up time of 2 years. To the best of our knowledge, this case is the first report of LGMS located in the buccal subcutaneous tissue of the buccinator muscle. The present study a literature review of 55 cases of this tumor type in the head and neck region was conducted, revealing that the indolent growth of these lesions may contribute to a delay in diagnosis. The average time between the onset of clinical symptoms and hospital admission is 3.9 months, and this form of tumor is frequently misdiagnosed as a benign lesion. Therefore, the present study suggests that an incisional biopsy may be performed to rule out LGMS when clinicians encounter patients with the aforementioned indolent lesions anywhere in the body. In addition, the avoidance of radiotherapy is recommended following resection of the LGMS tumor, as it may induce LGMS recurrence.
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Affiliation(s)
- Tessho Maruyama
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshiyuki Nakasone
- Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Fumikazu Nimura
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Matayoshi
- Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Toshihiro Kawano
- Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Kazuhide Nishihara
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
| | - Akira Arasaki
- Department of Oral and Maxillofacial Functional Rehabilitation, Graduate School of Medicine, University of The Ryukyus, Nishihara, Okinawa 903-0215, Japan.,Department of Oral and Maxillofacial Surgery, University Hospital of The Ryukyus, Nishihara, Okinawa 903-0215, Japan
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Han SR, Yee GT. Low Grade Myofibroblastic Sarcoma Occurred in the Scalp. J Korean Neurosurg Soc 2015; 58:385-8. [PMID: 26587195 PMCID: PMC4652002 DOI: 10.3340/jkns.2015.58.4.385] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 06/28/2015] [Accepted: 07/03/2015] [Indexed: 11/27/2022] Open
Abstract
Low-grade myofibroblastic sarcoma (LGMS) is a rare sarcoma with myofibroblastic differentiation. LGMS has a propensity for local recurrence and is associated with a low risk of metastatic spread. A 26-year-old man presented with a 12-month history of a slow growing palpable hard mass in the right parietal scalp. Enhanced CT scan of head showed a 3×4 cm sized well-defined and heterogeneously enhancing scalp mass. The patient underwent excision of the tumor. The histological and immunohistochemical features were consistent with a LGMS. We performed re-operation for remnant tumor removal after diagnosis. After 14 months of surgery, the patient was well-being state.
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Affiliation(s)
- Seong Rok Han
- Department of Neurosurgery, Ilsan Paik Hospital, College of Medicine, Inje University, Goyang, Korea
| | - Gi Taek Yee
- Department of Neurosurgery, Gil Medical Center, Gachon University, Incheon, Korea
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Hojo Y, Tsuchiya T, Shiraki A, Suzuki K, Shibutani M, Mitsumori K. High-grade myofibroblastic sarcoma of inguinal region in a dog. J Vet Med Sci 2011; 74:625-8. [PMID: 22156390 DOI: 10.1292/jvms.11-0459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A subcutaneous tumor in the left inguinal region was present in an 11-year-old female bloodhound. Histopathologically, the tumor showed invasive growth and extensive necroses, and it was composed of spindle-shaped, elongated, and stellate neoplastic cells accompanied by occasional giant cells arranged in fascicular, herringbone, or irregular storiform patterns with abundant production of collagen fibers. The cytoplasm of most tumor cells was positive for vimentin, alpha-smooth muscle actin, and calponin, but was negative for desmin, smoothelin, and S-100. Furthermore, most of the tumor cells were negative for Iba1 while some tumor cells were weakly positive. Thus, this tumor was diagnosed as a high-grade myofibroblastic sarcoma according to the diagnostic criteria for human myofibroblastic sarcomas.
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Affiliation(s)
- Yuri Hojo
- Laboratory of Veterinary Pathology, Tokyo University of Agriculture and Technology, Fuchu-shi, Tokyo 183-8509, Japan
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Covello R, Licci S, Pichi B, Spriano G, Vidiri A, Morelli L, Rosenberg AE. Low-grade myofibroblastic sarcoma of the larynx. Int J Surg Pathol 2011; 19:822-6. [PMID: 21233102 DOI: 10.1177/1066896910393958] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Low-grade myofibroblastic sarcoma is an uncommon sarcoma with myofibroblastic differentiation. It occurs in a wide variety of sites and has a predilection for the head and neck region. Biologically, low-grade myofibroblastic sarcoma has a propensity for local recurrence and is associated with a low risk of metastatic spread. Histologically, it can mimic a variety of different types of benign and malignant processes and often requires immunohistochemical analysis for its accurate identification. This report describes a case and discusses the differential diagnosis of a low-grade myofibroblastic sarcoma that arose in the larynx of a 69-year-old woman with a history of metastatic skin melanoma. To the best of the authors' knowledge this is the first description in the English literature of low-grade myofibroblastic sarcoma originating in the larynx.
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Takahama A, Nascimento AG, Brum MC, Vargas PA, Lopes MA. Low-grade myofibroblastic sarcoma of the parapharyngeal space. Int J Oral Maxillofac Surg 2006; 35:965-8. [PMID: 16829032 DOI: 10.1016/j.ijom.2006.03.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2005] [Revised: 03/03/2006] [Accepted: 03/31/2006] [Indexed: 11/18/2022]
Abstract
Low-grade myofibroblastic sarcoma was recently described as representing malignant mesenchymal tumours that show myofibroblastic differentiation; few cases have been reported. Here, a low-grade myofibroblastic sarcoma of the parapharyngeal space is described. A 42-year-old man presented with swelling on the right side of the temporal bone. Based on histological and immunohistochemical features, the diagnosis of low-grade myofibroblastic sarcoma was established. The tumour had invaded the orbit and the brain, and therefore surgical excision was not possible. There are thought to have been no cases affecting this region reported previously in the English-language literature.
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Affiliation(s)
- A Takahama
- Semiology and Oral Pathology, Department of Oral Diagnosis, Dental School, University of Campinas, Piracicaba/SP, Brazil
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Pereira CM, Jorge J, Di Hipólito O, Kowalski LP, Lopes MA. Primary intraosseous fibrosarcoma of jaw. Int J Oral Maxillofac Surg 2005; 34:579-81. [PMID: 16053882 DOI: 10.1016/j.ijom.2004.10.015] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2003] [Revised: 05/10/2004] [Accepted: 10/22/2004] [Indexed: 11/30/2022]
Abstract
This paper reports one case of primary fibrosarcoma affecting the mandible in a 41-year-old woman. Microscopically, the tumor was cellularized with an intense mitotic activity, and areas of necrosis and hemorrhage, and the cells showed immunoreactivity only for vimentin, establishing the diagnosis of primary intraosseous fibrosarcoma. The patient underwent tumor surgical resection, supraomohyoid neck dissection and mandible reconstruction with fibula flap and titanium bar. She also received post-surgical radiotherapy and is in follow up for 36 months without signs of recurrence or metastases.
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Affiliation(s)
- C M Pereira
- Oral Semiology and Oral Pathology, Department of Oral Diagnosis, School of Dentistry of Piracicaba/UNICAMP, Piracicaba, São Paulo, Brazil
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San Miguel P, Fernández G, Ortiz-Rey JA, Larrauri P. Low-grade myofibroblastic sarcoma of the distal phalanx. J Hand Surg Am 2004; 29:1160-3. [PMID: 15576232 DOI: 10.1016/j.jhsa.2004.05.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Revised: 05/30/2004] [Accepted: 05/30/2004] [Indexed: 02/02/2023]
Abstract
Low-grade myofibroblastic sarcoma is a recently defined tumor that is part of the spectrum of malignant mesenchymal tumors, showing features of myofibroblastic differentiation. These tumors occur most commonly in the head and neck regions, especially in the tongue, and less frequently in the limbs, trunk, and abdominal/pelvic cavity. We describe a 51-year-old woman with a low-grade myofibroblastic sarcoma. The distal phalanx of the finger was amputated with a clear surgical margin. The treatment of this tumor should include a simple local excision with free surgical margins and a long clinical follow-up period with imaging studies. At the 28-month follow-up evaluation the patient was free from this tumor.
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Affiliation(s)
- Pilar San Miguel
- Departments of Pathology, Radiology, and Traumatology (Hand Unit), Centro Médico Povisa Vigo, Pontevedra, Spain
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