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Dermawan JK, Chiang S, Singer S, Jadeja B, Hensley ML, Tap WD, Movva S, Maki RG, Antonescu CR. Developing Novel Genomic Risk Stratification Models in Soft Tissue and Uterine Leiomyosarcoma. Clin Cancer Res 2024; 30:2260-2271. [PMID: 38488807 PMCID: PMC11096044 DOI: 10.1158/1078-0432.ccr-24-0148] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2024] [Revised: 03/04/2024] [Accepted: 03/13/2024] [Indexed: 05/16/2024]
Abstract
PURPOSE Leiomyosarcomas (LMS) are clinically and molecularly heterogeneous tumors. Despite recent large-scale genomic studies, current LMS risk stratification is not informed by molecular alterations. We propose a clinically applicable genomic risk stratification model. EXPERIMENTAL DESIGN We performed comprehensive genomic profiling in a cohort of 195 soft tissue LMS (STLMS), 151 primary at presentation, and a control group of 238 uterine LMS (ULMS), 177 primary at presentation, with at least 1-year follow-up. RESULTS In STLMS, French Federation of Cancer Centers (FNCLCC) grade but not tumor size predicted progression-free survival (PFS) or disease-specific survival (DSS). In contrast, in ULMS, tumor size, mitotic rate, and necrosis were associated with inferior PFS and DSS. In STLMS, a 3-tier genomic risk stratification performed well for DSS: high risk: co-occurrence of RB1 mutation and chr12q deletion (del12q)/ATRX mutation; intermediate risk: presence of RB1 mutation, ATRX mutation, or del12q; low risk: lack of any of these three alterations. The ability of RB1 and ATRX alterations to stratify STLMS was validated in an external AACR GENIE cohort. In ULMS, a 3-tier genomic risk stratification was significant for both PFS and DSS: high risk: concurrent TP53 mutation and chr20q amplification/ATRX mutations; intermediate risk: presence of TP53 mutation, ATRX mutation, or amp20q; low risk: lack of any of these three alterations. Longitudinal sequencing showed that most molecular alterations were early clonal events that persisted during disease progression. CONCLUSIONS Compared with traditional clinicopathologic models, genomic risk stratification demonstrates superior prediction of clinical outcome in STLMS and is comparable in ULMS.
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Affiliation(s)
- Josephine K Dermawan
- Department of Pathology and Laboratory Medicine, Diagnostics Institute, Cleveland Clinic, Cleveland, Ohio
| | - Sarah Chiang
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Samuel Singer
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Bhumika Jadeja
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Martee L Hensley
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - William D Tap
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Sujana Movva
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Robert G Maki
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, New York; Department of Medicine, Weill Cornell Medical College, New York, New York
| | - Cristina R Antonescu
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Cancer Center, New York, New York
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Grimaudo MS, Renne SL, Colombo P, Giordano L, Gennaro N, Laffi A, Cariboni U, Cananzi FCM, Ruspi L, Santoro A, Bertuzzi AF. Prognostic value of mitotic count in leiomyosarcoma: A comprehensive monocentric retrospective study. Hum Pathol 2024; 143:17-23. [PMID: 38000682 DOI: 10.1016/j.humpath.2023.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Revised: 11/03/2023] [Accepted: 11/17/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND Leiomyosarcomas (LMSs) include heterogeneous entities with different clinical courses not entirely predicted by known prognostic factors. In particular, the value of mitotic count as independent prognostic factor in LMS has been poorly investigated. METHODS We retrospectively analyzed all patients with a diagnosis of LMS who accessed to our Institution from June 1999 to May 2022 for which mitotic count was numerically expressed within the pathology report. Univariate and multivariate analyses were conducted to explore the prognostic value of mitotic count along with other clinical and histological variables. RESULTS We identified 121 eligible patients, with a median follow-up of 91.03 months (range 0.62-275.2 months). Median progression-free survival (mPFS) was 16.7 months, and median overall survival (mOS) was 105.6 months. In univariate analysis, mitotic count showed a significant impact on PFS and OS, with an hazard ratio per mitotic unit of 1.03 (1.01-1.04, p < 0.001) and 1.03 (1.01-1.04, p = 0.007), respectively. Similar results were found for locally advanced and metastatic patients, separately. Other significant prognostic factors for PFS were stage at diagnosis, performance status, tumor size and Ki-67, while differentiation, necrosis, grade, stage at diagnosis, tumor size, performance status and age at diagnosis were identified for OS. In multivariate analysis, the only significant factors were mitotic count and the presence of metastases at diagnosis for PFS, whereas the same two factors plus age at diagnosis were identified for OS. CONCLUSION Mitotic count represented the most important histological prognostic factor for OS and PFS in localized and metastatic LMS.
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Affiliation(s)
- Maria Susanna Grimaudo
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
| | - Salvatore Lorenzo Renne
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Pathology, Rozzano, Italy.
| | - Piergiuseppe Colombo
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Pathology, Rozzano, Italy.
| | - Laura Giordano
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy.
| | - Nicolò Gennaro
- Northwestern University, Department of Radiology, Feinberg School of Medicine, Chicago, USA.
| | - Alice Laffi
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy.
| | - Umberto Cariboni
- IRCCS Humanitas Research Hospital, Department of Thoracic Surgery, Rozzano, Italy.
| | - Ferdinando Carlo Maria Cananzi
- Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy; IRCCS Humanitas Research Hospital, Department of Sarcoma Surgery, Rozzano, Italy.
| | - Laura Ruspi
- IRCCS Humanitas Research Hospital, Department of Sarcoma Surgery, Rozzano, Italy.
| | - Armando Santoro
- IRCCS Humanitas Research Hospital, Department of Oncology & Hematology, Rozzano, Italy; Humanitas University, Department of Biomedical Sciences, Pieve Emanuele, Italy.
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Wei J, Liu L, Li Z, Ren Z, Zhang C, Cao H, Fen Z. A web-based nomogram to predict overall survival for postresection leiomyosarcoma patients with lung metastasis. Medicine (Baltimore) 2023; 102:e35478. [PMID: 37800795 PMCID: PMC10553185 DOI: 10.1097/md.0000000000035478] [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: 06/14/2023] [Accepted: 09/13/2023] [Indexed: 10/07/2023] Open
Abstract
To investigate the overall survival of post-resection leiomyosarcoma (LMS) patients with lung metastasis, data of post-resection LMS patients with lung metastasis between 2010 and 2016 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. The clinical characteristics and survival data for post-resection LMS patients with lung metastasis at Tianjin Medical University Cancer Hospital & Institute (TJMUCH) between October 2010 and July 2018 were collected. Patients derived from the SEER database and TJMUCH were divided into training and validation cohorts, respectively. Univariate and multivariate Cox regression analyses were performed and a nomogram was established. The area under the curve (AUC) and the calibration curve were used to evaluate the nomogram. A web-based nomogram was developed based on the established nomogram. Eventually, 226 patients from the SEER database who were diagnosed with LMS and underwent primary lesion resection combined with lung metastasis were enrolled in the training cohort, and 17 patients from TJMUCH were enrolled in the validation cohort. Sex, race, grade, tumor size, chemotherapy, and bone metastasis were correlated with overall survival in patients with LMS. The C-index were 0.65 and 0.75 in the SEER and Chinese set, respectively. Furthermore, the applicable AUC values of the ROC curve in the SEER cohort to predict the 1-, 3-, 5- years survival rate were 0.646, 0.682, and 0.689, respectively. The corresponding AUC values in the Chinese cohort were 0.970, 0.913, and 0.881, respectively. The calibration curve showed that the nomogram performed well in predicting the overall survival in post-resection LMS patients with lung metastasis. A web-based nomogram (https://weijunqiang.shinyapps.io/survival_lms_lungmet/) was established. The web-based nomogram (https://weijunqiang.shinyapps.io/survival_lms_lungmet/) is an accurate and personalized tool for predicting the overall survival of post-resection LMS with lung metastasis.
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Affiliation(s)
- Junqiang Wei
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Lirui Liu
- Department of Neonatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhehong Li
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhiwu Ren
- Department of bone and soft tissue tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin’s Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chao Zhang
- Department of bone and soft tissue tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin’s Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haiying Cao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhen Fen
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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Feng Z, Li Y. Web-based nomograms for predicting overall survival and cancer-specific survival in retroperitoneal leiomyosarcoma: a population-based analysis. J Cancer Res Clin Oncol 2023; 149:11735-11748. [PMID: 37405479 DOI: 10.1007/s00432-023-05052-y] [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: 05/17/2023] [Accepted: 06/28/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Retroperitoneal leiomyosarcoma is a type of carcinoma with low incidence and poor prognosis, and prognostic factors are currently unknown. Therefore, our study aimed to investigate the predictive factors of RPLMS and establish prognostic nomograms. METHODS Patients diagnosed with RPLMS between 2004 and 2017 were selected from the Surveillance, Epidemiology, and End Results (SEER) database. Prognostic factors were identified by univariate and multivariate COX regression analyses and used to generate nomograms to predict overall survival (OS) and cancer-specific survival (CSS). RESULTS 646 eligible patients were randomly divided into training set (n = 323) and validation set (n = 323). Multivariate COX regression analysis indicated that the independent risk factors for OS and CSS were age, tumor size, grade, SEER stage, and surgery. In the nomogram of OS, the concordance indices (C-index) of the training and validation sets were 0.72 and 0.691, and in the nomogram of CSS, the C-indices of the training and validation sets were 0.737 and 0.737. Furthermore, calibration plots showed that the predicted results of the nomograms in the training and validation sets agree well with the actual observations. CONCLUSION Age, tumor size, grade, SEER stage, and surgery were independent prognostic factors for RPLMS. The nomograms developed and validated in this study can accurately predict the OS and CSS of patients, which could help clinicians make individualized survival predictions. Finally, we make the two nomograms into two web calculators for the convenience of clinicians.
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Affiliation(s)
- Zhile Feng
- General Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People's Republic of China
| | - Yongxiang Li
- General Surgery Department, The First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, 230032, People's Republic of China.
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Wei J, Liu L, Li Z, Ren Z, Zhang C, Cao H, Fen Z, Jin Y. Web-based nomogram to predict postresection risk of distant metastasis in patients with leiomyosarcoma: retrospective analysis of the SEER database and a Chinese cohort. J Int Med Res 2023; 51:3000605231188647. [PMID: 37523501 PMCID: PMC10392527 DOI: 10.1177/03000605231188647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVES This study investigated risk factors and constructed an online tool to predict distant metastasis (DM) risk in patients with leiomyosarcoma (LMS) after surgical resection. METHODS Data regarding patients with LMS who underwent surgical resection between 2010 and 2018 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Data were collected regarding patients with LMS who underwent surgical resection at Tianjin Medical University Cancer Hospital and Institute (TJMUCH) between October 2010 and July 2018. Patients were randomly divided into training and validation sets. Logistic regression analyses were performed; a nomogram was established. The area under the curve (AUC) and calibration curve were used to evaluate the nomogram, which served as the basis for a web-based nomogram. RESULTS This study included 4461 and 76 patients from the SEER database and TJMUCH, respectively. Age, ethnicity, grade, T stage, N stage, radiotherapy, and chemotherapy were associated with DM incidence. C-index values were 0.815 and 0.782 in the SEER and Chinese datasets, respectively; corresponding AUC values were 0.814 and 0.773, respectively. A web-based nomogram (https://weijunqiang-leimyosarcoma-seer.shinyapps.io/dynnomapp/) was established. CONCLUSIONS Our web-based nomogram is an accurate and user-friendly tool to predict DM risk in patients with LMS; it can aid clinical decision-making.
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Affiliation(s)
- Junqiang Wei
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Lirui Liu
- Department of Neonatology, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhehong Li
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
- Department of General Surgery, Beijing Shijitan Hospital, Capital Medical University, Beijing, China
| | - Zhiwu Ren
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin's Medical University Cancer Institute and Hospital, Tianjin, China
| | - Chao Zhang
- Department of Bone and Soft Tissue Tumor, Tianjin Medical University Cancer Institute and Hospital, Tianjin, China
- National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin's Clinical Research Center for Cancer, Tianjin's Medical University Cancer Institute and Hospital, Tianjin, China
| | - Haiying Cao
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Zhen Fen
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
| | - Yu Jin
- Department of Orthopedics, Affiliated Hospital of Chengde Medical University, Chengde, Hebei, China
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Abnormal growth of a pleomorphic leiomyosarcoma originating from the mesenteric vein associated with poor outcome after curative-intent resection: a case report. Surg Case Rep 2022; 8:147. [PMID: 35909190 PMCID: PMC9339445 DOI: 10.1186/s40792-022-01497-4] [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: 04/02/2022] [Accepted: 07/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background A leiomyosarcoma (LMS) is a rare tumor that mainly originates from the urinary tract and digestive system; however, non-visceral organ-derived patterns are rare. Herein, we report that a vessel-derived pleomorphic LMS (PLMS) originating from the mesenteric vein has a poor prognosis even after curative-intent surgery. Case presentation The patient was a 41-year-old woman with no relevant medical history. The patient presented with abdominal pain and an abnormal bulge on the left lower abdomen. Magnetic resonance imaging revealed a large tumor occupying the left abdomen. Enhanced computed tomography revealed a bulky tumor with a maximum size of 13 × 13 cm with impending rupture, and a small amount of ascites was detected around the tumor. As the tumor directly invaded the small intestine and descending colon, left hemicolectomy and partial resection of the small intestine were performed. The patient was discharged on postoperative day 10, without any complications. On histopathological analysis, the tumor was diagnosed as a vessel-derived LMS with a pleomorphic pattern. The patient died due to disseminated intravascular coagulation because generalized peritonitis was induced by the super-early recurrence of the tumor 2 months after the surgery. Conclusions Regardless of curative-intent surgery for a vessel-derived PLMS, super-early local recurrence and distant metastasis were observed. A vessel-derived PLMS requires further investigation to determine its characteristics and therapeutic strategies to improve long-term prognosis.
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Kannan S, Chong HH, Chew B, Ferguson JD, Galloway E, McCulloch T, Rankin KS, Ashford RU. Leiomyosarcoma in the extremities and trunk wall: systematic review and meta-analysis of the oncological outcomes. World J Surg Oncol 2022; 20:124. [PMID: 35436892 PMCID: PMC9014567 DOI: 10.1186/s12957-022-02584-4] [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: 11/25/2021] [Accepted: 03/31/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Leiomyosarcomas are aggressive malignancies which can occur on the trunk and extremities whose pathogenesis is poorly understood. We aim to quantify the prognostic impact of various clinical and pathological markers on survival and recurrence of leiomyosarcomas.
Methods
We conducted a systematic review as per PRISMA protocol. Survival, local recurrence, and metastasis were the outcome measures. Data were extracted from the studies for the outcome variables; the resultant odds ratios (OR) and 95% confidence interval (CI) were used for the synthesis of a forest plot.
Results
Our search revealed thirteen studies comprising 1380 patients. Seven of these 13 publications were since 2012. Our analysis showed that tumor size larger than 5 cm adversely affected the outcome with an OR 3.39 (2.26–5.10, p < 0.01). Other factors which reduced the overall survival were positive margins of excision OR 2.12 (1.36–3.32, p < 0.01). A reduced risk of metastasis has strongly associated the use of radiotherapy with OR 10.84 (4.41–26.61, p < 0.01). Only a few studies analyzed the impact of factors on local recurrence.
Conclusions
Size larger than 5 cm and positive margins of excision are associated with poor overall survival. In comparison, the use of adjuvant radiotherapy was associated with a lower metastatic rate. There is a need for methodically high-quality studies with more uniform study design and reporting to evaluate the impact of various risk factors on local recurrence and metastases.
Level of evidence
Level 1 Prognostic
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Kim MY, Lee JK, Mietelka KA, Han HJ. Case Report: Giant Multiloculated Pseudocystic Jejunal Leiomyosarcoma in a Dog: Atypical Morphologic Features of Canine Intestinal Leiomyosarcoma. Front Vet Sci 2022; 9:791133. [PMID: 35211538 PMCID: PMC8861198 DOI: 10.3389/fvets.2022.791133] [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: 10/08/2021] [Accepted: 01/13/2022] [Indexed: 11/28/2022] Open
Abstract
A 10-year-old intact female Rottweiler dog weighing 29 kg presented with 2 days history of vomiting, anorexia, and lethargy to KonKuk University Teaching Hospital, Seoul, South Korea. Ultrasonography and computed tomography (CT) scannings revealed a well-demarcated, large mass (29 × 19 × 11 cm) with numerous fluid-filled cavities. Metastases to adjacent lymph nodes were also identified on CT. This large mass and the affected intestinal segments were excised for palliative purposes. Postoperatively, the dog recovered uneventfully without any complications. The cut surface of the mass showed an exophytic growth pattern of multiloculated cystic lesions filled with serosanguineous fluid, large cavities filled with necrotic exudate, and fistulous connections between the intestinal lumen and the necrotic cavity in the mass. On histopathology, the mass was a spindle cell neoplasm expanding from the jejunal muscular layer and with pseudocystic changes. Additional immunohistochemical analysis using antibodies against smooth muscle actin, desmin, and CD-117 demonstrated that the mass was consistent with a leiomyosarcoma. Six months post-operatively, plain radiography revealed an abdominal mass, suspected to be recurrence from jejunal leiomyosarcoma. The owner decided to euthanize the dog due to financial constraints. This case report describes the atypical morphology and clinical progression of a large canine jejunal leiomyosarcoma, which had similar clinical features as those of human leiomyoma and leiomyosarcoma.
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Affiliation(s)
- Mu-Young Kim
- Department of Veterinary Surgery, College of Veterinary Medicine, Konkuk University, Seoul, South Korea
| | | | | | - Hyun-Jung Han
- Department of Veterinary Emergency and Critical Care Medcine, Konkuk Veterinary Medical Teaching Hospital, Konkuk University, Seoul, South Korea
- *Correspondence: Hyun-Jung Han
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Avallone G, Pellegrino V, Muscatello LV, Roccabianca P, Castellani G, Sala C, Tecilla M, Valenti P, Sarli G. Canine smooth muscle tumors: A clinicopathological study. Vet Pathol 2021; 59:244-255. [PMID: 34955045 DOI: 10.1177/03009858211066862] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Canine smooth muscle tumors (SMTs) commonly develop in the alimentary and female genital tracts and less frequently in soft tissue. The definition of histological criteria of malignancy is less detailed for SMTs in dogs than in humans. This study evaluated the clinicopathologic features of canine SMTs and compared the veterinary and human medical criteria of malignancy. A total of 105 canine SMTs were evaluated histologically and classified according to both veterinary and human criteria. The Ki67 labeling index was assessed in all SMTs. Estrogen receptor (ER) and progesterone receptor (PR) expression was evaluated for soft tissue SMTs. Follow-up data were available in 25 cases. SMTs were diagnosed in the female genital tract (42%), alimentary tract (22%), and soft tissue (20%). Soft tissue SMTs frequently arose in the perigenital area, pelvic cavity, and retroperitoneum. A subset of soft tissue SMTs expressed ER and/or PR, resembling the gynecologic type of soft tissue SMT in humans. SMTs were less frequently malignant when assessed with human criteria than with veterinary criteria, better reflecting their benign behavior, especially in the genital tract where human criteria tolerate a higher mitotic count for leiomyoma. Decreased differentiation was correlated with increased proliferation, necrosis, and reduced desmin expression. Mitotic count, Ki67 labeling index, and necrosis were correlated with metastases and tumor-related death. Further prognostic studies are warranted to confirm the better performance of the human criteria when assessing SMT malignancy, especially genital cases, to confirm their usefulness in ER/PR-expressing soft tissue SMTs, and to better define the most useful prognostic parameters for canine SMTs.
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Affiliation(s)
- Giancarlo Avallone
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Valeria Pellegrino
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Luisa Vera Muscatello
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Paola Roccabianca
- Department of Veterinary Medicine (DIMEVET), University of Milano, Lodi (LO), Italy
| | - Gastone Castellani
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Claudia Sala
- Department of Physics and Astronomy, University of Bologna, Ozzano dell'Emilia (BO), Italy
| | - Marco Tecilla
- Department of Veterinary Medicine (DIMEVET), University of Milano, Lodi (LO), Italy
| | | | - Giuseppe Sarli
- Department of Veterinary Medical Sciences (DIMEVET), University of Bologna, Ozzano dell'Emilia (BO), Italy
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Tago T, Suzuki S, Kuroda J, Udou R, Nishida K, Oshiro Y, Shimazaki J, Kou K, Morishita Y, Shimoda M. Leiomyosarcoma of the transverse colon with lymph node metastasis and malignant transformation: a case report. Surg Case Rep 2020; 6:256. [PMID: 33006746 PMCID: PMC7532233 DOI: 10.1186/s40792-020-00998-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/18/2020] [Indexed: 11/30/2022] Open
Abstract
Background The concept of GIST was established in 1998, clearly differentiating between gastrointestinal leiomyosarcoma and GISTs among gastrointestinal mesenchymal tumors. Lymph node metastasis is extremely rare in true gastrointestinal leiomyosarcoma, and there are no reports of malignant transformation from leiomyoma. Case presentation The patient was an old woman who had undergone endoscopic mucosal resection for an Is polyp on the left side of the transverse colon at the age of 73. She was diagnosed with leiomyoma with positive surgical margins. Subsequently, she presented to our institution with a sensation of pressure in the upper abdominal region as a chief complaint at the age of 76 years. Abdominal computed tomography and colorectal endoscopy showed a tumor lesion with invagination of the intestines in the transverse colon, the same site as that of the previously resected leiomyoma. A biopsy suggested a smooth muscle tumor, and we performed partial left transverse colectomy and lymph node dissection under a diagnosis of recurrence and enlargement of the previously incompletely resected leiomyoma. Histopathological examination revealed spindle-shaped tumor cells, and the mitotic activity was 30–40/10 high-power field. Tumor cells were immunohistologically positive for α-smooth muscle actin and h-caldesmon; partially positive for desmin; negative for c-kit, CD34, DOG-1, and the S-100 protein; and showed a Ki-67 labeling index of 70–80%. She was diagnosed with leiomyosarcoma malignantly transformed from leiomyoma. Metastasis was found in 1 of the 14 resected lymph nodes. The patient did not undergo adjuvant chemotherapy, but has survived with no recurrence at 2 years after the surgery. Conclusions We have reported a case of leiomyosarcoma of the transverse colon with lymph node metastasis that was malignantly transformed from a leiomyoma.
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Affiliation(s)
- Tomoya Tago
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan.
| | - Shuji Suzuki
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Jun Kuroda
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Ryutaro Udou
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Kiyotaka Nishida
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Yukio Oshiro
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Jirou Shimazaki
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Keni Kou
- Department of Pathology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Yukio Morishita
- Department of Pathology, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
| | - Mitsugi Shimoda
- Department of Gastrointestinal Surgery, Tokyo Medical University Ibaraki Medical Center, 3-20-1 Chuo, AmimachiIbaraki, Inashiki-gun, 300-0395, Japan
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Gaignard E, Bergeat D, Stock N, Robin F, Boudjema K, Sulpice L, Rayar M, Meunier B. Portal vein leiomyosarcoma: A rare case of hepatic hilar tumor with review of the literature. Indian J Cancer 2019; 56:83-85. [PMID: 30950452 DOI: 10.4103/ijc.ijc_199_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Portal vein leiomyosarcoma (LMS) is a very rare entity with poor prognosis. Only few cases have been reported in the literature. We report the case of a 53-year-old man with portal vein LMS presenting as a hilar tumor and causing cholestasis. The tumor measured 10 cm and was responsible for right portal vein thrombosis and compression of the biliary convergence. A right hepatectomy with hilar en bloc resection was performed with portal vein and biliary reconstruction. Pathology confirmed the complete resection of a well-differentiated leiomyosarcoma of the portal vein. The postoperative outcome was uneventful and the patient received no adjuvant treatment. Six months after the procedure, the patient is doing well with a normal quality of life and without any sign of recurrence. Aggressive and radical surgery should be proposed in first intention for the treatment of portal vein LMS.
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Affiliation(s)
- Elodie Gaignard
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Damien Bergeat
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | | | - Fabien Robin
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Karim Boudjema
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Laurent Sulpice
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Michel Rayar
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes; Inserm, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
| | - Bernard Meunier
- Department of Hepatobiliary and Digestive Surgery, CHU Rennes; Univ Rennes, CIC 1414 (Centre d'Investigation Clinique de Rennes), F-35000 Rennes, France
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12
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Muratori F, Greto D, Cenatiempo M, Mazzei G, Frenos F, Roselli G, Livi L, Capanna R, Baldi G, Campanacci DA. Leiomyosarcoma: Clinicopathological study and retrospective analysis of prognostic factors in a series of 100 patients. J Orthop 2019; 16:303-307. [PMID: 30976144 DOI: 10.1016/j.jor.2019.03.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Accepted: 03/01/2019] [Indexed: 12/01/2022] Open
Abstract
The Authors reported a retrospective study of 100 Leiomyosarcoma (LMS), evaluating factors that may influence Overall Survival (OS), Local Recurrence Free Survival (LRFS), Metastasis Free Survival (MFS). Tumor Size (P = 0,0009), Local Recurrence (P = 0,0487), Distant relapse (P < 0,0001), Type of Presentation (P = 0,0213) were significant risk factors affecting overall survival (OS). Tumor Size (P = 0.024), age at diagnosis (P = 0,0086), type of presentation (P < 0,0001) and Local Recurrence (P = 0.0152) affected metastasis free survival (MFS). Type of presentation (P = 0,001) was an independent prognostic factor of local recurrence-free survival (LRFS).
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Affiliation(s)
- Francesco Muratori
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Daniela Greto
- Unità di Radioterapia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Mauro Cenatiempo
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giacomo Mazzei
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Filippo Frenos
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Giuliana Roselli
- Divisione di Radiologia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | - Lorenzo Livi
- Unità di Radioterapia Azienda Ospedaliero Universitaria Careggi Firenze, Italy
| | | | | | - Domenico Andrea Campanacci
- Divisione di Ortopedia Oncologica e Ricostruttiva Azienda Ospedaliero Universitaria Careggi Firenze, Italy
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13
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Qian SJ, Wu JQ, Wang Z, Zhang B. Surgery plus chemotherapy improves survival of patients with extremity soft tissue leiomyosarcoma and metastasis at presentation. J Cancer 2019; 10:2169-2175. [PMID: 31258720 PMCID: PMC6584406 DOI: 10.7150/jca.29874] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 04/07/2019] [Indexed: 11/05/2022] Open
Abstract
Purpose: Extremity soft tissue leiomyosarcoma (LMS) with metastasis is a rare disease with a poor prognosis. The purpose of our study was to define clinical features of extremity soft tissue LMS with metastasis as well as to identify multivariable predictors of survival. Methods: During 1973-2015, 239 patients with metastatic extremity soft tissue LMS were identified from the Surveillance, Epidemiology, and End Results (SEER) program database. The prognostic analysis was performed using the Kaplan-Meier method and a Cox proportional hazards regression model. Results: This group comprised 126 females (52.7%) and 113 males (47.3%), whose ages ranged from 8 to 95 years (median 67 years). The overall survival (OS) and cancer-specific survival (CSS) rates of the entire group at 3 years were 22.6% and 23.4%, respectively. The median OS and CSS were 14.0±1.5 and 15.0±2.3 months, respectively. Multivariate analysis revealed that tumor size >10 cm, no surgery and no chemotherapy were independent risk factors of decreased OS and CSS. Radiotherapy was not significantly associated with OS or CSS. Conclusion: Extremity soft tissue LMS patients who present with metastasis at diagnosis had a poor prognosis. Patients who performed surgery for primary tumors and chemotherapy had a better chance for prolonged survival.
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Affiliation(s)
- Sheng-Jun Qian
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Jia-Qi Wu
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Zhan Wang
- Centre for Orthopaedic Research, Orthopedics Research Institute of Zhejiang University, Department of Orthopaedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, Zhejiang 310000, P.R. China
| | - Bo Zhang
- Department of Orthopedics, Ningbo No.2 Hospital, 41 North West Street, Ningbo, Zhejiang 315010, P.R. China
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14
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Xue M, Chen G, Dai J, Hu J. Development and Validation of a Prognostic Nomogram for Extremity Soft Tissue Leiomyosarcoma. Front Oncol 2019; 9:346. [PMID: 31119101 PMCID: PMC6504783 DOI: 10.3389/fonc.2019.00346] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background: Extremity soft tissue leiomyosarcoma (LMS) is a rare disease with a poor prognosis. The aim of this study is to develop nomograms to predict the overall survival (OS) and cancer-specific survival (CSS) of patients with extremity soft tissue LMS. Methods: Based on the Surveillance, Epidemiology, and End Results (SEER) database, 1,528 cases of extremity soft tissue LMS diagnosed between 1983 and 2015 were included. Cox proportional hazards regression modeling was used to analyze prognosis and obtain independent predictors. The independent predictors were integrated to develop nomograms predicting 5- and 10-year OS and CSS. Nomogram performance was evaluated by a concordance index (C-index) and calibration plots using R software version 3.5.0. Results: Multivariate analysis revealed that age ≥60 years, high tumor grade, distant metastasis, tumor size ≥5 cm, and lack of surgery were significantly associated with decreased OS and CSS. These five predictors were used to construct nomograms for predicting 5- and 10-year OS and CSS. Internal and external calibration plots for the probability of 5- and 10-year OS and CSS showed excellent agreement between nomogram prediction and observed outcomes. The C-index values for internal validation of OS and CSS prediction were 0.776 (95% CI 0.752–0.801) and 0.835 (95% CI 0.810–0.860), respectively, whereas those for external validation were 0.748 (95% CI 0.721–0.775) and 0.814 (95% CI 0.785–0.843), respectively. Conclusions: The proposed nomogram is a reliable and robust tool for accurate prognostic prediction in patients with extremity soft tissue LMS.
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Affiliation(s)
- MingFeng Xue
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - Gang Chen
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JiaPing Dai
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
| | - JunYu Hu
- Department of Orthopaedics, The Second Hospital of Jiaxing, The Second Affiliated Hospital of Jiaxing University, Jiaxing, China
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15
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Papageorgiou K, Goodwin P, Travlos J, Dramis A. Leiomyosarcoma of the Lower Limb Presenting as a Benign Mass: A Case Report. J Orthop Case Rep 2019; 8:13-15. [PMID: 30915285 PMCID: PMC6424323 DOI: 10.13107/jocr.2250-0685.2250-0685.1236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction Soft tissue sarcomas are rare tumors that often present with pain, increasing size and a location deep to the fascia. If they do not present with the aforementioned symptoms and signs, delayed diagnosis can occur. Case Report We present an unusual case of a 51-year-old patient who presented with clinical features of a benign mass of the lower limb that turned out to be a soft tissue sarcoma - a leiomyosarcoma. Conclusion Medical practitioners must consider the possibility of soft tissue sarcoma in patients that present with a benign looking mass. Diagnostic imaging can be inconclusive on these cases and definite diagnosis is made on histological examination. Treatment includes surgery and radiotherapy.
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Affiliation(s)
- Konstantinos Papageorgiou
- Department of Trauma and Orthopaedics, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Peter Goodwin
- Medical Student, Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK
| | - John Travlos
- Department of Trauma and Orthopaedics, The Royal Wolverhampton Hospitals NHS Trust, New Cross Hospital, Wolverhampton, WV10 0QP, UK
| | - Asterios Dramis
- Department of Trauma and Orthopaedics, George Eliot Hospital NHS Trust, Nuneaton, CV10 7DJ, UK
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16
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Harati K, Daigeler A, Lange K, Niggemann H, Stricker I, Steinau HU, Lehnhardt M, Goertz O. Somatic Leiomyosarcoma of the Soft Tissues: A Single-Institutional Analysis of Factors Predictive of Survival in 164 Patients. World J Surg 2018; 41:1534-1541. [PMID: 28116485 DOI: 10.1007/s00268-017-3899-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
BACKGROUND Somatic leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma entity with a high metastatic potential. The purpose of this study was to identify prognostic indicators of survival in patients with somatic LMS of the soft tissues. METHODS We retrospectively assessed the relationship between local recurrence-free survival (LRFS), disease-specific survival (DSS), overall survival (OS) and potential prognostic factors in 164 patients who were suitable for surgical treatment in curative intent. Patients with soft tissue LMS of the extremities, the truncal wall and the head and neck area were included. The median follow-up time was 4.9 years. RESULTS In the entire cohort, the 5-year estimate of the DSS, OS and LRFS rate were 74.5% (95% confidence interval [CI] 65.0-81.8), 70.6% (95% CI: 60.9-78.3) and 63.4% (95% CI 53.4-71.9), respectively. Thirty-eight patients (23.2%) developed distant metastases with a median survival time of 1.5 years after diagnosis of metastasis. Surgical margins attained at the initial oncologic resection and eventual re-excisions did not influence DSS, OS and LRFS significantly. Within the R0 subgroup, close and wide negative margins led to similar outcomes. High histologic grade (P < 0.001), size >5 cm (P = 0.002) and subfascial localisation (P = 0.002) were associated with significantly diminished DSS in univariate analysis. In multivariate analysis, only histologic grade was found to be an independent prognostic factor of DSS. CONCLUSIONS The data from this study could not determine a prognostic significance of surgical margins suggesting that tumour characteristics other than margin status are important. Tumour biology reflected by the histologic grade dictates the final outcome.
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Affiliation(s)
- Kamran Harati
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.
| | - Adrien Daigeler
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Kim Lange
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hiltrud Niggemann
- Statistical Consulting and Data Analysis, Schlehendornweg 24, 07751, Jena, Germany
| | - Ingo Stricker
- Institute of Pathology, Ruhr-University Bochum, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Hans-Ulrich Steinau
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Marcus Lehnhardt
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany
| | - Ole Goertz
- Department of Plastic Surgery, BG-University Hospital Bergmannsheil, Buerkle-de-la-Camp-Platz 1, 44789, Bochum, Germany.,Department of Plastic Surgery, Martin-Luther Hospital, Caspar-Theyss-Strasse 27-29, 14193, Berlin, Germany
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17
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Renne SL, Iwenofu OH. Pathology of retroperitoneal sarcomas: A brief review. J Surg Oncol 2017; 117:12-24. [PMID: 29230829 DOI: 10.1002/jso.24928] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Accepted: 11/01/2017] [Indexed: 12/21/2022]
Affiliation(s)
- Salvatore L. Renne
- Sarcoma and Pediatric Pathology Unit, Department of Diagnostic Pathology and Laboratory Medicine; Fondazione IRCCS Istutito Nazionale dei Tumori; Milano Italy
| | - O. Hans Iwenofu
- Department of Pathology & Laboratory Medicine; Wexner Medical Center at The Ohio State University; Columbus Ohio
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19
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Lee PJ, Yoo NS, Hagemann IS, Pfeifer JD, Cottrell CE, Abel HJ, Duncavage EJ. Spectrum of mutations in leiomyosarcomas identified by clinical targeted next-generation sequencing. Exp Mol Pathol 2017; 102:156-161. [DOI: 10.1016/j.yexmp.2017.01.012] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 01/12/2017] [Indexed: 10/20/2022]
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20
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Öziş SE, Gülpınar K, Şahlı Z, Konak BB, Keskin M, Özdemir S, Ataoğlu Ö. Recurrent renal giant leiomyosarcoma. ULUSAL CERRAHI DERGISI 2016; 32:145-8. [PMID: 27436926 DOI: 10.5152/ucd.2014.2153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2013] [Accepted: 04/06/2014] [Indexed: 11/22/2022]
Abstract
Primary renal leiomyosarcomas are rare, aggressive tumors. They constitute 1-2% of adult malignant renal tumors. Although leiomyosarcomas are the most common histological type (50-60%) of renal sarcomas, information on renal leiomyosarcoma is limited. Local or systemic recurrences are common. The radiological appearance of renal leiomyosarcomas is not specific, therefore renal leiomyosarcoma cannot be distinguished from renal cell carcinoma by imaging methods in all patients. A 74-year-old female patient presented to our clinic complaining of a palpable mass on the right side of her abdomen in November 2012. The abdominal magnetic resonance imaging revealed a mass, 25 × 24 × 23 cm in size. Her past medical history revealed that she has undergone right radical nephrectomy in 2007, due to a 11 × 12 × 13 cm renal mass that was then reported as renal cell carcinoma on abdominal magnetic resonance imaging, but the pathological diagnosis was low-grade renal leiomyosarcoma. The most recent follow-up of the patient was in 2011, with no signs of local recurrence or distant metastases within this four-year period. The patient underwent laparotomy on November 2012, and a 35 cm retroperitoneal mass was excised. The pathological examination of the mass was reported as high-grade leiomyosarcoma. The formation of this giant retroperitoneal mass in 1 year can be explained by the transformation of the lesion's pathology from low-grade to a high-grade tumor.
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Affiliation(s)
- Salih Erpulat Öziş
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Kamil Gülpınar
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Zafer Şahlı
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Baha Burak Konak
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Mete Keskin
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Süleyman Özdemir
- Department of General Surgery, Ufuk University School of Medicine, Ankara, Turkey
| | - Ömür Ataoğlu
- Department of Pathology, Private Mikro-Pat Laboratory, Ankara, Turkey
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21
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Kaur S, Tyagi R, Selhi P, Singh A, Puri H, Sood N. Subcutaneous Axillary and Scalp Metastases from Non-Gynecological Retroperitoneal Leiomyosarcoma: An Unusual Presentation After Surgical Resection. Rare Tumors 2015; 7:5970. [PMID: 26788272 PMCID: PMC4703918 DOI: 10.4081/rt.2015.5970] [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: 04/26/2015] [Revised: 07/20/2015] [Accepted: 07/29/2015] [Indexed: 01/14/2023] Open
Abstract
Retroperitoneal leiomyosarcomas are rare sarcomas, with an incidence of less than 2 per million population. Cutaneous metastases from sarcoma account for only 1-2.6% of metastatic skin lesions. Cutaneous and subcutaneous metastasis from retroperitoneal leiomyosarcoma is a very rare entity. We present a case of 72-year-old male with scalp nodule and subcutaneous swelling in left posterior axillary fold. Fine needle aspiration cytology from both these sites revealed a sarcoma, which was positive for Smooth Muscle Actin and negative for S100 on cell block immuno-histochemistry (IHC). The past history revealed surgical resection of a retroperitoneal mass in 2010 which was diagnosed on histopathology and IHC as leiomyosarcoma. A final diagnosis of metastatic deposits from leiomyosarcoma was made. Retroperitoneal leiomyosarcoma presenting as scalp and subcutaneous metastasis is an unusual presentation. Adequate clinical history and a high index of clinical suspicion is required to detect cutaneous and subcutaneous metastatic deposits occurring five years after surgical resection.
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Affiliation(s)
- Simrandeep Kaur
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Ruchita Tyagi
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Pavneet Selhi
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Aminder Singh
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Harpreet Puri
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
| | - Neena Sood
- Department of Pathology, Dayanand Medical College and Hospital , Ludhiana, India
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Worhunsky DJ, Gupta M, Gholami S, Tran TB, Ganjoo KN, van de Rijn M, Visser BC, Norton JA, Poultsides GA. Leiomyosarcoma: One disease or distinct biologic entities based on site of origin? J Surg Oncol 2015; 111:808-12. [PMID: 25920434 DOI: 10.1002/jso.23904] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2014] [Accepted: 02/28/2015] [Indexed: 11/05/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) can originate from the retroperitoneum, uterus, extremity, and trunk. It is unclear whether tumors of different origin represent discrete entities. We compared clinicopathologic features and outcomes following surgical resection of LMS stratified by site of origin. METHODS Patients with LMS undergoing resection at a single institution were retrospectively reviewed. Clinicopathologic variables were compared across sites. Survival was calculated using the Kaplan-Meier method and compared using log-rank and Cox regression analyses. RESULTS From 1983 to 2011, 138 patients underwent surgical resection for LMS. Retroperitoneal and uterine LMS were larger, higher grade, and more commonly associated with synchronous metastases. However, disease-specific survival, recurrence-free survival, and recurrence patterns were not significantly different across the four sites. Synchronous metastases (HR 3.20, P < 0.001), but not site of origin, size, grade, or margin status, were independently associated with worse DSS. A significant number of recurrences and disease-related deaths were noted beyond 5 years. CONCLUSIONS Although larger and higher grade, retroperitoneal and uterine LMS share similar survival and recurrence patterns with their trunk and extremity counterparts. LMS of various anatomic sites may not represent distinct disease processes based on clinical outcomes. The presence of metastatic disease remains the most important prognostic factor for LMS.
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Affiliation(s)
- David J Worhunsky
- Department of Surgery, Stanford University Medical Center, Stanford, California
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Kim HJ, Cho YJ, Kim SH, Rha SY, Ahn JB, Yang WI, Lee YH, Suh JS, Roh JK, Kim KS, Choi YD, Shin KH, Kim HS. Leiomyosarcoma: investigation of prognostic factors for risk-stratification model. Int J Clin Oncol 2015; 20:1226-32. [PMID: 26123311 DOI: 10.1007/s10147-015-0847-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 05/09/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND We performed this study to define distinctive clinical features of leiomyosarcoma by assessing prognostic factors. METHODS Between 1988 and 2011, 129 leiomyosarcoma patients who underwent surgical resection with curative intent were retrospectively reviewed. RESULTS Of the 129 leiomyosarcoma patients, the distribution of anatomic locations was: extremity (n = 25), pelvis (n = 40), thoracic cavity (n = 11), intra-abdomen (n = 19), retroperitoneum (n = 23), and head/neck (n = 11). We classified the anatomic locations into two categories as abdominal (intra-abdomen and retroperitoneum, n = 42) and extra-abdominal (extremity, pelvis, thoracic cavity, and head/neck, n = 87). Prognosis was worse for the abdominal group than for the extra-abdominal group (median DFS 2.9 9.0 years, P = 0.04). Similarly, overall survival (OS) was also significantly worse for abdominal group (P = 0.027). Independent prognostic factors for survival were primary site (P = 0.041, hazard ratio (HR) 1.7; 95 % CI 1.2-2.8), tumor size (P = 0.038, HR 1.9; 95 % CI 1.13-3.38), margin status (P = 0.019, HR 2.1; 95 % CI 1.13-3.88), and histology grade (P = 0.01, HR 3.59; 95 % CI 1.64-7.87). We identified four different risk groups with different survival outcome: group 1 (n = 8), no adverse factors; groups 2 (n = 37) and 3 (n = 61) with one and two adverse factors, and group 4 (n = 23) with 3 or 4 adverse factors. CONCLUSION Primary site, tumor size, resection margin, and histology subtype were independently associated with survival outcome. A prognostic model for leiomyosarcoma patients revealed four distinct groups of patients with good prognostic discrimination.
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Affiliation(s)
- Hyun Ju Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea.,Yonsei University Graduate School of Medicine, Seoul, Korea
| | - Yong Jin Cho
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea
| | - Soo Hee Kim
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Sun Young Rha
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea
| | - Joong Bae Ahn
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea
| | - Woo Ick Yang
- Department of Pathology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Han Lee
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jin-Suck Suh
- Department of Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Jae Kyung Roh
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea
| | - Kyung Sik Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Young Deuk Choi
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyoo-Ho Shin
- Department of Orthopaedic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea.
| | - Hyo Song Kim
- Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-Gu, Seoul, 120-752, Korea.
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Li Q, Zhuang R, Zhu J, Lu W, Hou Y, Liu J, Zhang Y, Wang Y, Liu T, Wang Z, Zhou Y. Prognostic factors in patients with recurrent or metastatic retroperitoneal leiomyosarcoma. Future Oncol 2015; 11:1759-66. [PMID: 26075444 DOI: 10.2217/fon.15.54] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIMS Factors that predict the prognosis of patients with recurrent or metastatic retroperitoneal leiomyosarcomas after treatment are uncertain. MATERIALS & METHODS Clinical and pathological data on 22 patients with retroperitoneal leiomyosarcomas who were treated by a multidisciplinary abdominal soft-tissue tumor group were analyzed retrospectively to identify prognostic factors for their progression-free survival (PFS). RESULTS & CONCLUSION The median PFS in the 22 patients was 9 months. Microvessel density in tumor tissues, which was evaluated via CD34 expression in 16 cases, and the presence of metastasis on admission were both found to be correlated with PFS in a Kaplan-Meier analysis, but not in a multivariate analysis. The multivariate analysis did, however, show that complete resection of tumors and the FNCLCC (Fédération Nationale des Centres de Lutte Contre Le Cancer) disease grade were independent factors predicting PFS.
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Affiliation(s)
- Qian Li
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Rongyuan Zhuang
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Jun Zhu
- Department of Surgery, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Weiqi Lu
- Department of Surgery, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yingyong Hou
- Department of Pathology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Ju Liu
- Department of Pathology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yong Zhang
- Department of Surgery, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yan Wang
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Tianshu Liu
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Zhiming Wang
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
| | - Yuhong Zhou
- Department of Medical Oncology, Zhong Shan Hospital, Fudan University, Shanghai, People's Republic of China
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Winchester DS, Hocker TL, Brewer JD, Baum CL, Hochwalt PC, Arpey CJ, Otley CC, Roenigk RK. Leiomyosarcoma of the skin: Clinical, histopathologic, and prognostic factors that influence outcomes. J Am Acad Dermatol 2014; 71:919-25. [DOI: 10.1016/j.jaad.2014.07.020] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 07/01/2014] [Accepted: 07/14/2014] [Indexed: 10/24/2022]
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MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients. Skeletal Radiol 2014; 43:615-22. [PMID: 24496586 DOI: 10.1007/s00256-014-1823-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Revised: 12/26/2013] [Accepted: 01/08/2014] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To describe MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas (LMS). MATERIALS AND METHODS In this IRB-approved, HIPAA-compliant retrospective study, we included 47 patients (23 women, 24 men; mean age: 55.3 years, range: 17-85 years) with pathologically confirmed extremity LMS seen at our adult tertiary cancer center between 2000 and 2012. MRI/MDCT of primary tumors in 23 patients and follow-up in all patients were reviewed by two radiologists in consensus. Clinical data were extracted from electronic medical records. RESULTS Primary tumors were distributed in bones (6 out of 47), deep soft tissues (24 out of 47), and superficial soft tissues (17 out of 47). On imaging (bone = 4, deep soft tissue = 11, superficial soft tissue = 8), compared with skeletal muscle, they were T1 iso-hypointense and T2 hyperintense. Bone LMS were metaphyseal tumors with cortical destruction (3 out of 4). Deep soft-tissue LMS were large with hemorrhage (7 out of 11) and necrosis (10 out of 11). Superficial soft-tissue LMS were relatively smaller, homogeneously enhancing (6 out of 8) tumors. Distant metastases developed in 32 out of 47 patients (bone LMS [6 out of 6], deep soft-tissue LMS [18 out of 24], superficial soft-tissue LMS [8 out of 17]), commonly to lung (29 out of 47) and bone (14 out of 47). At the time of writing, 22 out of 36 patients (bone LMS [4 out of 6], deep soft-tissue LMS [15 out of 24], superficial soft-tissue LMS [4 out of 17]) have died. There was no statistically significant correlation between metastatic disease and tumor size or grade. CONCLUSION Extremity LMS arise in bones and in the deep and superficial soft tissues, frequently metastasize to the lungs, and have a poor prognosis. Superficial LMS tend to have a better prognosis than bone or deep soft-tissue LMS.
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Yamamoto H, Handa M, Tobo T, Setsu N, Fujita K, Oshiro Y, Mihara Y, Yoshikawa Y, Oda Y. Clinicopathological features of primary leiomyosarcoma of the gastrointestinal tract following recognition of gastrointestinal stromal tumours. Histopathology 2013; 63:194-207. [PMID: 23763337 DOI: 10.1111/his.12159] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Accepted: 04/08/2013] [Indexed: 12/15/2022]
Abstract
AIMS We aimed to elucidate the clinicopathological and immunohistochemical features of leiomyosarcoma (LMS) of the gastrointestinal (GI) tract. METHODS AND RESULTS We encountered seven cases of GI-LMS in the colon (n = 4), rectum (n = 1), jejunum (n = 1) and stomach (n = 1). They ranged from 1 to 25 cm (median, 8.5 cm) in size and had high mitotic counts (median 38 per 50 high-power fields). Morphologically, the tumours were composed mainly of spindle cells with eosinophilic cytoplasm and various degrees of nuclear atypia and pleomorphism. Immunohistochemically, the tumours were positive for α-smooth muscle actin (86%), muscle-specific actin (71%), desmin (86%), calponin (71%), h-caldesmon (57%) and smoothelin (71%). All were negative for KIT, CD34, protein kinase C theta and DOG1. Local recurrence and distant metastasis occurred in one and three patients, respectively. We then reviewed 55 cases of GI-LMS from the era following the recognition of gastrointestinal stromal tumours. Among 29 of 55 cases for whom follow-up information was available, the estimated 5-year overall survival rate was 51.6%; tumour size ≥5 cm was correlated significantly with shorter overall survival time (P = 0.0016), while mitotic count (≥50 or ≥100 per 50 high-power fields) proved to be no prognostic factor. CONCLUSIONS GI-LMSs have distinctive clinicopathological and immunohistochemical features and exhibit aggressive biological behaviour.
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Affiliation(s)
- Hidetaka Yamamoto
- Department of Anatomic Pathology, Kyushu University, Fukuoka, Japan.
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Abstract
Superficial leiomyosarcomas are rare malignant smooth-muscle tumors accounting for 4-6.5% of all soft-tissue sarcomas, less than 2-3% of cutaneous soft-tissue neoplasms and 0.04% of all cancers. They are divided into cutaneous or dermal and subcutaneous leiomyosarcomas. Subcutaneous tumors have been reported to be associated with an increased risk of local recurrences and distant metastases, compared to their cutaneous counterparts. In this study, we describe a rare case of a recurrent subcutaneous trunk leiomyosarcoma in a 68-year-old male patient. Local recurrence developed two years after the complete surgical resection with wide margins and adjuvant postoperative radiotherapy. The management of the patient is discussed along with a review of the literature. We conclude that subcutaneous leiomyosarcoma is a rare clinical entity which may be associated with an atypical clinical presentation. Physicians should be aware of the misleading features of this tumor in order to avoid delay in diagnosis and treatment. Early complete surgical resection with wide margins of at least 2 cm is the cornerstone of treatment and has been reported to mostly influence the prognosis. However, the tumor has a high tendency to recur locally and metastasize. Recurrence may develop despite wide resection and radiotherapy. Long-term follow-up is mandatory.
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Interobserver Variability in the Interpretation of Tumor Cell Necrosis in Uterine Leiomyosarcoma. Am J Surg Pathol 2013; 37:650-8. [DOI: 10.1097/pas.0b013e3182851162] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Gladdy RA, Qin LX, Moraco N, Agaram NP, Brennan MF, Singer S. Predictors of survival and recurrence in primary leiomyosarcoma. Ann Surg Oncol 2013; 20:1851-7. [PMID: 23354568 DOI: 10.1245/s10434-013-2876-y] [Citation(s) in RCA: 112] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Leiomyosarcoma is a soft tissue sarcoma whose outcome has historically been confounded by the inclusion of gastrointestinal stromal tumors. Thus, we sought to determine the factors that predict survival and recurrence in patients with primary leiomyosarcoma alone. METHODS During 1982-2006, a total of 353 patients with primary resectable leiomyosarcoma were identified from a prospective database. Multivariate analysis was used to assess clinicopathologic factors for association with disease-specific survival (DSS). Competing risk survival analysis was used to determine factors predictive for local and distant recurrence. RESULTS Of 353 patients, 170 (48 %) presented with extremity, 144 (41 %) with abdominal/retroperitoneal, and 39 (11 %) with truncal tumors. Median age was 57 (range, 18-88) years, and median follow-up was 50 (range, 1-270) months. Most tumors were high grade (75 %), deep (73 %), and completely resected (97 %); median size was 6.0 (range, 0.3-45) cm. Abdominal/retroperitoneal location was associated with worse long-term DSS compared to extremity or trunk (P = 0.005). However, by multivariate analysis, only high grade and size were significant independent predictors of DSS. Overall, 139 patients (39 %) had recurrence: 51 % of those with abdominal/retroperitoneal, 33 % of extremity, and 26 % of truncal disease. Significant independent predictors for local recurrence were size and margin, whereas predictors for distant recurrence were size and grade. Site was not an independent predictor of recurrence; however, late recurrence (>5 years) occurred in 9 % of abdominal/retroperitoneal and 4 % of extremity lesions. CONCLUSIONS Grade and size are significant independent predictors of DSS and distant recurrence. Long-term follow-up in leiomyosarcoma is important, as late recurrence continues in 6-9 % patients.
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Affiliation(s)
- Rebecca A Gladdy
- Sarcoma Disease Management Team, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
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31
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Italiano A, Lagarde P, Brulard C, Terrier P, Laë M, Marques B, Ranchere-Vince D, Michels JJ, Trassard M, Cioffi A, Piperno-Neumann S, Chevreau C, Blay JY, Delcambre C, Isambert N, Penel N, Bay JO, Bonvalot S, Le Cesne A, Coindre JM, Chibon F. Genetic Profiling Identifies Two Classes of Soft-Tissue Leiomyosarcomas with Distinct Clinical Characteristics. Clin Cancer Res 2013; 19:1190-6. [DOI: 10.1158/1078-0432.ccr-12-2970] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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32
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Hollmig TS, Sachdev R, Cockerell CJ, Posten W, Chiang M, Kim J. Spindle Cell Neoplasms Encountered in Dermatologic Surgery: A Review. Dermatol Surg 2012; 38:825-50. [DOI: 10.1111/j.1524-4725.2012.02296.x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Classification, molecular characterization, and the significance of pten alteration in leiomyosarcoma. Sarcoma 2012; 2012:380896. [PMID: 22448121 PMCID: PMC3289834 DOI: 10.1155/2012/380896] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2011] [Accepted: 11/30/2011] [Indexed: 12/02/2022] Open
Abstract
Leiomyosarcoma is a malignant smooth muscle neoplasm with a complicated histopathologic classification scheme and marked differences in clinical behavior depending on the anatomic site of origin. Overlapping morphologic features of benign and borderline malignant smooth muscle neoplasms further complicate the diagnostic process. Likewise, deciphering the complex and heterogeneous patterns of genetic changes which occur in this cancer has been challenging. Preliminary studies suggest that reproducible molecular classification may be possible in the near future and new prognostic markers are emerging. Robust recapitulation of leiomyosarcoma in mice with conditional deletion of Pten in smooth muscle and the simultaneous discovery of a novel role for Pten in genomic stability provide a fresh perspective on the mechanism of leiomyosarcomagenesis and promise for therapeutic intervention.
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Ipach I, von Weyhern CH, Kopp HG, Kunze B, Kluba T. Extremity leiomyosarcoma metastasizing to the large bowel as a pedunculated colon polyp. J Clin Oncol 2011; 29:e799-802. [PMID: 22010011 DOI: 10.1200/jco.2011.37.0221] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Ingmar Ipach
- University Hospital of Tübingen, Tübingen, Germany
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Starling J, Coldiron BM. Mohs micrographic surgery for the treatment of cutaneous leiomyosarcoma. J Am Acad Dermatol 2011; 64:1119-22. [DOI: 10.1016/j.jaad.2010.11.051] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2010] [Revised: 11/12/2010] [Accepted: 11/18/2010] [Indexed: 10/18/2022]
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36
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Abdominal soft tissue sarcoma: a multicenter retrospective study. Int J Clin Oncol 2010; 15:399-405. [DOI: 10.1007/s10147-010-0075-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2009] [Accepted: 03/09/2010] [Indexed: 10/19/2022]
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Abstract
Cutaneous leiomyosarcoma is a soft tissue neoplasm exhibiting an aggressive local behavior and a potential for distant metastases. It is rare during childhood and diagnosis can be challenging both clinically and histologically. Surgical excision with wide lateral and deep margins is the treatment of choice, whereas radiotherapy and chemotherapy are contraindicated. Long-term follow-up is necessary as recurrences are not infrequent.
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Affiliation(s)
- Géraldine Blaise
- Department of Dermatopathology, University Hospital of Liège, Liège, Belgium
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Vujevich JJ, Goldberg LH, Kimyai-Asadi A, Law R. Recurrent nodule on the nasal columella: a good reason to re-biopsy. Int J Dermatol 2008; 47:728-31. [PMID: 18613884 DOI: 10.1111/j.1365-4632.2008.03536.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A 15-year-old Caucasian male presented with 9-month history of a recurrent nodule on the nasal columella. The previous biopsy was reported as a neurofibroma. METHODS Frozen sections revealed a spindle cell neoplasm. Permanent section immunohistochemistry sections stained positive for vimentin and smooth muscle actin and negative for S100 and CD34, confirming the diagnosis of leiomyosarcoma. RESULTS The tumor was removed using Mohs micrographic surgery. Radiological work-up revealed no distant metastasis. There has been no local recurrence to date. CONCLUSIONS Leiomyosarcoma is a difficult diagnosis to make clinically and requires histological confirmation. Re-biopsy of a "benign" growth may be necessary if clinicopathological correlation does not match with the clinical behavior of the tumor in question. Finally, Mohs micrographic surgery is a useful treatment modality for leiomyosarcomas, particularly those located in cosmetically-sensitive regions of the body such as the nose.
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Affiliation(s)
- Justin J Vujevich
- DermSurgery Associates, Houston, and ProPath Laboratories, Dallas, Texas 77030, USA
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40
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Angeloni M, Muratori F, Magarelli N, Chalidis BE, Ricci R, Rossi B, Maccauro G. Exophytic growth of a neglected giant subcutaneous Leiomyosarcoma of the lower extremity. A case report. INTERNATIONAL SEMINARS IN SURGICAL ONCOLOGY 2008; 5:11. [PMID: 18495007 PMCID: PMC2409359 DOI: 10.1186/1477-7800-5-11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2007] [Accepted: 05/21/2008] [Indexed: 11/10/2022]
Abstract
Background Superficial leiomyosarcoma is an exceedingly uncommon malignant tumor which could be located either to cutaneous or subcutaneous tissues. Increased mass size and depth, advanced tumor staging and inadequate surgical excision are the main prognostic factors for poor result. Case presentation We report a rare case of a 71-year-old man with an extensive exophytic lesion (12 × 10 cm) in the anterior-medial side of the proximal right tibia. The lesion was painless and consistently neglected by the patient until a skin trauma caused ulceration of the affected area. Magnetic Resonance Imaging revealed a soft-tissue mass which was well defined from the surrounding bone and muscles. As initial biopsy in another hospital hadn't clarified the true nature of the lesion, new samples were taken and the diagnosis of leiomyosarcoma was established. Laboratory examination showed no distant metastasis and wide excision of the neoplasm was decided. After tumor resection, the remaining soft tissue and skin defect was covered with a gastrocnemius myocutaneous flap. The postoperative period was uneventful and wound healing was followed by local radiotherapy and systemic chemotherapy. At 3 years follow up, no recurrence or metastasis was identified and the patient was able to walk and stand without impairment of his ambulatory status. Conclusion Proper surgical management of soft tissue leiomyosarcoma continues to remain the cornerstone of treatment efficacy and the most important prognostic factor for patients' survival. Reconstruction of the remaining soft tissue defect should be always performed at the same operative time when removal of giant size tumors leaves an uncovered cavity with an inadequate sleeve of muscular and skin tissues.
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Cibull TL, Thomas AB, Badve S, Billings SD. Leiomyosarcoma of the penis presenting as a cutaneous lesion. J Cutan Pathol 2007; 35:585-7. [PMID: 18005170 DOI: 10.1111/j.1600-0560.2007.00846.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
We report a case of a 68-year-old man with cutaneous leiomyosarcoma of the penis. Leiomyosarcoma of the penis is an extremely rare neoplasm that usually presents in middle to old age, and to our knowledge only approximately 30 cases have been reported in the literature to date. This is an important diagnosis in the differential diagnosis of cutaneous spindle cell neoplasms of the male genital tract.
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Affiliation(s)
- Thomas L Cibull
- Department of Pathology and Laboratory Medicine, Indiana University, Indianapolis, IN, USA.
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42
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Binh MBN, Guillou L, Hostein I, Château MC, Collin F, Aurias A, Binh BN, Stoeckle E, Coindre JM. Dedifferentiated Liposarcomas With Divergent Myosarcomatous Differentiation Developed in the Internal Trunk. Am J Surg Pathol 2007; 31:1557-66. [PMID: 17895758 DOI: 10.1097/pas.0b013e31804b4109] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Dedifferentiated liposarcoma (DLPS) is one of the most frequent sarcomas of the retroperitoneum and represents most undifferentiated sarcomas of the internal trunk. In about 5% cases, the dedifferentiated component is an heterologous sarcoma such as leiomyosarcoma or rhabdomyosarcoma. We reviewed a series of 65 sarcomas with a myogenic differentiation developed in the internal trunk for which initial diagnoses were leiomyosarcoma (37), rhabdomyosarcoma (6), malignant mesenchymoma (6), and DLPS (16). Immunostainings for MDM2, CDK4, alpha smooth actin, desmin, caldesmon, myogenin, c-kit, and progesterone receptor were performed. In 48 cases, the amplification status of MDM2 and CDK4 could be evaluated with quantitative polymerase chain reaction on paraffin-embedded tissues extracted DNAs. After review of the cases, final diagnoses were leiomyosarcoma (35), rhabdomyosarcomatous (20) or leiomyosarcomatous (7) DLPS, probable DLPS (2), and malignant mesenchymoma (1). DLPS were bigger tumors (median: 18.2 cm) than leiomyosarcomas (median: 12 cm). They had a lower 5-year recurrence-free survival than leiomyosarcomas (45% vs. 71%) but a higher 5-year metastasis-free survival (73% vs. 39%). There was no significant difference in overall survival (57% vs. 34%). Outcome of patients with a DLPS with a myosarcomatous component did not differ from conventional DLPS. In conclusion, most sarcomas with a rhabdomyosarcomatous differentiation occurring in the internal trunk of adults are DLPS. Moreover, DLPS with a myogenic component have a low metastatic potential, similar to conventional DLPS and significantly lower to the metastatic potential of leiomyosarcomas.
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Gutierrez JC, Perez EA, Franceschi D, Moffat FL, Livingstone AS, Koniaris LG. Outcomes for Soft-Tissue Sarcoma in 8249 Cases from a Large State Cancer Registry. J Surg Res 2007; 141:105-14. [PMID: 17512548 DOI: 10.1016/j.jss.2007.02.026] [Citation(s) in RCA: 142] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2007] [Revised: 01/30/2007] [Accepted: 02/11/2007] [Indexed: 11/18/2022]
Abstract
BACKGROUND AND OBJECTIVES To date, outcome reports for soft-tissue sarcoma (STS) have largely been limited to single or paired institutional series. To more accurately elucidate population-based outcomes and prognostic factors associated with STS, a large cancer registry was examined. METHODS STS arising in the Florida Cancer Data System were examined (1981-2004). RESULTS A total of 8249 patients were identified, the calculated annual incidence of sarcoma being approximately 38 cases per million in 2003. The tumor histologies among these patients were leiomyosarcoma and gastrointestinal stromal tumor (LMS/GIST) (43.5%), malignant fibrous histiocytoma (MFH) (31.5%), liposarcoma (19.0%), and fibrosarcoma (6.0%). Tumors were situated in the extremities (30.7%), truncal or visceral locations (50.4%), retroperitoneum (11.7%), and head or neck (7.2%). Thirty-three percent of lesions were over 10 cm in greatest dimension, while 50.2% were classified as high grade. Median overall survival was 25 months. Superior survival was observed for liposarcomas and fibrosarcomas as compared to MFH and LMS/GIST (P < 0.001). Retroperitoneal and truncal sarcomas had a more ominous prognosis than did other sites (P < 0.001). Multivariate analysis of pretreatment variables demonstrated that increasing age, male gender, non-Caucasian race, advanced stage, and a truncal or retroperitoneal location were each independently associated with lower survival. Histological subtype was also an independent predictor of outcome. Surgical resection and radiation therapy were the only treatment variables shown to improve survival. CONCLUSIONS Histological subtype, tumor site, and stage are independent prognostic factors in STS. Surgical resection and radiotherapy are unique among treatment modalities in association with a significant survival benefit.
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Affiliation(s)
- Juan C Gutierrez
- DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, Florida, USA
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44
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Abstract
Sarcoma of the kidney is a rare condition. Leiomyosarcoma is the most common of the kidney sarcomas. Renal leiomyosarcoma usually originates from the smooth muscle layers of the kidney, for example, the renal capsule and renal vessels. Renal pelvis neoplasms, however, are primarily transitional cell carcinomas, and renal pelvis leiomyosarcomas are extremely uncommon. Renal pelvis leiomyosarcoma has never been reported in Korea. Moreover, no more than 10 cases have been reported internationally. However, none of these were associated with kidney abnormalities. Here we describe a case of leiomyosarcoma that originated from the blind end of a bifid renal pelvis.
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Affiliation(s)
- Yeun-Goo Chung
- Department of Urology, College of Medicine, Inha University, Incheon, Korea
| | - Seok-Chan Kang
- Department of Urology, College of Medicine, Inha University, Incheon, Korea
| | - Sang-Min Yoon
- Department of Urology, College of Medicine, Inha University, Incheon, Korea
| | - Ji-Young Han
- Department of Pathology, College of Medicine, Inha University, Incheon, Korea
| | - Do-Hwan Seong
- Department of Urology, College of Medicine, Inha University, Incheon, Korea
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45
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Annest NM, Grekin SJ, Stone MS, Messingham MJ. Cutaneous leiomyosarcoma: a tumor of the head and neck. Dermatol Surg 2007; 33:628-33. [PMID: 17451590 DOI: 10.1111/j.1524-4725.2007.33124.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Nicole M Annest
- Scripps Clinic and Research Institute, Green Hospital, 10666 North Torrey Pines Road, La Jolla, CA 92037, USA.
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46
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Affiliation(s)
- Travis Vandergriff
- Department of Dermatology, Baylor College of Medicine, 6620 Main Street, Houston, TX 77030, USA
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47
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Cutaneous Metastasis of Leiomyosarcoma. Dermatol Surg 2007. [DOI: 10.1097/00042728-200705000-00018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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48
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Cutaneous Leiomyosarcoma. Dermatol Surg 2007. [DOI: 10.1097/00042728-200705000-00017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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49
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Primary oral leiomyosarcoma: a clinico-pathologic study and analysis of prognostic factors. Int J Oral Maxillofac Surg 2007; 36:409-16. [PMID: 17395428 DOI: 10.1016/j.ijom.2006.12.015] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2006] [Revised: 11/04/2006] [Accepted: 12/27/2006] [Indexed: 11/21/2022]
Abstract
This clinico-pathologic study of primary oral leiomyosarcomas and analysis of potential prognostic factors involved a literature review of 64 cases and a report of four cases treated in the authors' unit. The demographic details, clinical presentation, diagnosis, treatment and outcome were documented for the whole group and clinico-pathologic variables analysed to detect potential prognostic factors. The most common presentation was that of a painless mass, with peak incidence in the 6th decade and a slight male predeliction (M:F=1.3:1). The maxilla was the most frequently involved site, followed by the mandible and tongue. Surgical excision was most commonly employed with radiotherapy and chemotherapy being reserved for recurrent and metastatic tumours. Local recurrence (34%) and metastasis (35%) were not uncommon and occurred most frequently to the lungs and regional lymph nodes (15%). Age, sex, size and mitotic index were not statistically related to recurrence or metastasis. Site (P=0.0125) was a predictor of metastasis. Metastasis (P=0.010) and lesions involving the maxilla and mandible (P=0.019) were associated with decreased survival. The estimated 5 year survival was 55% for the whole group and 43% and 19% for patients with bony involvement and metastasis respectively.
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Svarvar C, Böhling T, Berlin O, Gustafson P, Follerås G, Bjerkehagen B, Domanski HA, Sundby Hall K, Tukiainen E, Blomqvist C. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group. Cancer 2007; 109:282-91. [PMID: 17154171 DOI: 10.1002/cncr.22395] [Citation(s) in RCA: 89] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Leiomyosarcoma of nonvisceral soft tissues is an uncommon malignant tumor; thus, only small numbers of cases have been reported. This study was based on a large series of patients from the Scandinavian Sarcoma Group Register acquired during a 15-year period (from 1986 to 2001). Follow-up information was available for all patients. METHODS The authors analyzed the clinical features of 225 patients with cutaneous, subcutaneous, or deep-seated leiomyosarcoma of the extremities, trunk wall, and superficial parts of the head and neck region to determine the natural course of the disease. Only patients who received their treatment at a specialist sarcoma center were included. Re-evaluation of histopathology was performed. RESULTS The age of the patients (121 women and 104 men) ranged from 20 years to 98 years (median, 70 years), and the tumors ranged in size from 0.6 cm to 35 cm (median, 4.0 cm). Eighty-two percent of the tumors were classified as high grade. The median follow-up for survivors was 5.5 years. The local treatment was adequate in 154 of 206 patients (75%) who were without metastasis at presentation. At 10 years, 84% of the 206 patients with localized disease at presentation were free from local recurrence, 66% remained metastasis free, and 49% were alive. Multivariate analysis showed that higher malignancy grade (P = .006), larger tumor size (P = .003), and deeper tumor location (P = .002) were correlated significantly with decreased metastasis-free survival, inadequate local treatment was correlated with local recurrence (P = .007), and high malignancy grade was correlated with decreased overall survival (P = .007). CONCLUSIONS The long-term prognosis for patients with subcutaneous and deep-seated soft tissue leiomyosarcoma remains poor despite the ability to achieve adequate local control through nonmutilating surgery with or without radiotherapy.
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Affiliation(s)
- Catarina Svarvar
- Department of Plastic Surgery, Helsinki University Central Hospital, Helsinki, Finland.
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