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Doan TT, Pham DT. Primary leiomyosarcoma of the colon: a report of two cases and review of literature. Ann Med Surg (Lond) 2024; 86:4865-4869. [PMID: 39118704 PMCID: PMC11305721 DOI: 10.1097/ms9.0000000000002277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2024] [Accepted: 06/04/2024] [Indexed: 08/10/2024] Open
Abstract
Introduction Primary leiomyosarcoma (LMS) of the colon is a rare neoplasm and constitutes less than 0.1% of all colon malignancies. These tumors are more aggressive and have poorer prognoses than other gastrointestinal tumors, including gastrointestinal stromal tumors (GIST) or adenocarcinomas. The authors herein report two cases and review the literature to highlight the epidemiology, diagnosis, treatment and prognosis of this uncommon malignancy. Case report The authors reported two very rare cases of LMS of left colon, which referred to our institution with symptoms of abdominal pain. After the initial investigations, patients were diagnosed with primary colonic leiomyosarcoma that underwent laparotomy. In both cases pathological examination revealed a spindle cell tumor growing circumferentially and transmurally in the colon. Final immunohistochemistry were positive with SMA, CK and desmin without the expression of GIST markers (CD117, CD34 and DOG1) that confirmed leiomyosarcoma. One patient was diagnosed with diffused peritoneal metastasis at 6 months postoperatively and he died after 2 months of paliative care, another one is still on active surveillance. Discussion LMS of the colon is a really rare entity and is only presented in clinical case reports. LMS has non-specific symptoms and is commonly diagnosed when it reaches a large size. Surgery is a mainstay treatment option. Nowadays, there is no clear evidence for the effectiveness of chemotherapy and radiation therapy. Conclusion LMS is a rare neoplasm of colon. For the time being, there is no guidelines for treatment, but surgery still plays a fundamental role.
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Affiliation(s)
| | - Duong The Pham
- Department of Abdominal Surgery 2, Vietnam National Cancer Hospital, Hanoi, Vietnam
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2
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Jenkins P, Joiner M, Kumar A, Miller SR. High grade leiomyosarcoma of the transverse colon with positive lymph node metastasis: to treat or not to treat with adjuvant radiation therapy? BMJ Case Rep 2023; 16:e253466. [PMID: 37336627 PMCID: PMC10314409 DOI: 10.1136/bcr-2022-253466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Intra-abdominal leiomyosarcomas (LMSs) are aggressive malignant tumours arising from smooth muscle cells. These neoplasms are extremely rare and account for 10%-20% of primary soft tissue sarcomas and approximately 0.1% of all colorectal malignancies. Intra-abdominal LMS has a very poor prognosis with an estimated 5-year survival rate between 20% and 50% and the size of the tumour being the main determinant of prognosis. Treatment is further complicated by different anatomic variants with differing clinical behaviours impacting prognosis. Newer techniques in radiation treatment such as intensity-modulated, intraoperative electron and proton beam radiotherapies allow for cases with high probability of local recurrence or likelihood of residual microscopic disease after surgical resection to be treated with precise radiation doses to the targeted tumour volume. We present a case of high grade LMS of the distal transverse colon with positive lymph node metastasis treated by surgical excision followed by adjuvant radiotherapy and discuss the current role of radiotherapy.
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Affiliation(s)
- Phillip Jenkins
- Radiation Oncology, Wayne State University, Detroit, Michigan, USA
| | - Michael Joiner
- Oncology, Wayne State University, Detroit, Michigan, USA
| | - Andrew Kumar
- Pathology, Wayne State University, Detroit, Michigan, USA
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Zhou W, Wu H. Unexpected Origin of Lung Metastases: Rare Colon Leiomyosarcoma Detected by 18F-FDG PET/CT. Clin Nucl Med 2023; Publish Ahead of Print:00003072-990000000-00586. [PMID: 37276537 DOI: 10.1097/rlu.0000000000004726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
ABSTRACT A 49-year-old woman was referred to our hospital due to suspected lung metastases for 1 month. She had a history of thyroid micropapillary carcinoma and uterine leiomyomas. An 18F-FDG PET/CT scan, which was performed to search the source of the presumed metastasis of the disease, showed multiple lung metastases and 2 18F-FDG-avid foci in the thyroid and colon. Biopsy of lung and resection of colon lesions were then performed, and the disease was finally identified to be rare primary colon leiomyosarcoma with multiple lung metastases.
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Affiliation(s)
- Wenlan Zhou
- From the PET Center, Nanfang Hospital, Southern Medical University, Guangzhou, China
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Lee SH, Bae SH, Lee SC, Ahn TS, Kim Z, Jung HI. Curative resection of leiomyosarcoma of the descending colon with metachronous liver metastasis: A case report. World J Gastrointest Surg 2023; 15:992-999. [PMID: 37342841 PMCID: PMC10277942 DOI: 10.4240/wjgs.v15.i5.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/23/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Leiomyosarcoma (LMS) has a poor prognosis and rarely originates from the colon. If resection is possible, surgery is the first treatment most commonly considered. Unfortunately, no standard treatment exists for hepatic metastasis of LMS; although, several treatments, such as chemotherapy, radiotherapy, and surgery, have been used. Subsequently, the management of liver metastases remains controversial.
CASE SUMMARY We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon. A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months. Colonoscopy revealed a 4-cm diameter mass in the descending colon, 40 cm from the anal verge. Computed tomography revealed intussusception of the descending colon due to the 4-cm mass. The patient underwent a left hemicolectomy. Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin, and negative for cluster of differentiation 34 (CD34), CD117, and discovered on gastrointestinal stromal tumor (GIST)-1, which are characteristic of gastrointestinal LMS. A single liver metastasis developed 11 mo post-operatively; the patient subsequently underwent curative resection thereof. The patient remained disease-free after six cycles of adjuvant chemotherapy (doxorubicin and ifosfamide), and 40 and 52 mo after liver resection and primary surgery, respectively. Similar cases were obtained from a search of Embase, PubMed, MEDLINE, and Google Scholar.
CONCLUSION Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.
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Affiliation(s)
- Soo-Hyeon Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Sang-Ho Bae
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Sang-Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Tae-Sung Ahn
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Gyeonggi, South Korea
| | - Hae-Il Jung
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
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Nguyen C, Athigaman M, Qureshi A. Giant leiomyosarcoma of the transverse colon. BMJ Case Rep 2021; 14:e246646. [PMID: 34857593 PMCID: PMC8640626 DOI: 10.1136/bcr-2021-246646] [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] [Accepted: 11/11/2021] [Indexed: 11/04/2022] Open
Abstract
Leiomyosarcoma (LMS) of the colon accounts for <1% of all colorectal malignancies. Our patient was a 72-year-old man with a history of aortic valvular disorder and congestive heart failure, who presented with an abdominal mass and no constitutional symptoms. The CT scan finding suggested a large tumour with both solid and cystic components. Intraoperatively, a portion of the involved colon was resected along with the tumour. Microscopically, the tumour was found to invade the muscularis propria layer of the transverse colon. The final diagnosis was LMS, FNCLCC grade 2 of 3 based on the histology and immunochemistry.
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Affiliation(s)
- Crystal Nguyen
- Burrell College of Osteopathic Medicine, Las Cruces, New Mexico, USA
| | | | - Abdul Qureshi
- General Surgery, Carlsbad Medical Center, Carlsbad, New Mexico, USA
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White RZ, Au J, Hunter A, Vather R. A rare colorectal entity: Colonic leiomyosarcoma with peritoneal sarcomatosis. ANZ J Surg 2021; 92:571-573. [PMID: 34288339 DOI: 10.1111/ans.17079] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/06/2021] [Indexed: 12/21/2022]
Affiliation(s)
- Roland Z White
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,School of Medicine, The University of Adelaide, Adelaide, South Australia, Australia
| | - John Au
- Department of Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Hunter
- Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Ryash Vather
- Department of Colorectal Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
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Wang Y, Wang H, Yuan ZL, Zhao JF, Dong DB, Gao Q. A pooled analysis of risk factors of surgically treated leiomyosarcoma of the colon in adults. World J Surg Oncol 2020; 18:61. [PMID: 32222151 PMCID: PMC7103068 DOI: 10.1186/s12957-020-01838-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 03/19/2020] [Indexed: 12/20/2022] Open
Abstract
Background This current systematic review aimed to evaluate the role of surgical management and risk factors by pooled cases from all identified patients with colonic leiomyosarcomas. Methods The authors searched the Ovid MEDLINE, Embase, PubMed, and Cochrane databases using the keywords “colonic,” “colon,” and “leiomyosarcoma.” Risk factors of colonic leiomyosarcoma in the pooled cohort were also evaluated. Results Between 1923 and 2019, 41 cases of colonic leiomyosarcoma were identified in 22 (53.7%) males and 19 (46.3%) females, with a mean and median age of 58.7 ± 2.2 years and 56.0 years. According to univariate analysis, smaller tumor size < 8 cm was significantly associated with longer progression-free survival (HR = 6.957, 95% CI 1.405–34.442; p = 0.017), and younger age < 60 years was trending toward better overall survival (HR = 2.765, 95% CI 0.924–8.272; p = 0.069). Conclusions Colonic leiomyosarcomas are rare neoplasms with aggressive clinical behaviors. Age < 60 years and tumor size < 8 cm were favorable factors for patients’ better survival.
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Affiliation(s)
- Yun Wang
- Department of Digestive System, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, China.,Qinghai University, Xining, 810000, Qinghai, China
| | - Hao Wang
- Department of Intensive Care Medicine, Qinghai Province People's Hospital, Xining, 810007, China
| | - Zhi-Lu Yuan
- Department of General Surgery, Liao Cheng The Third People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Jing-Fei Zhao
- Department of General Surgery, Liao Cheng The Third People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Dian-Bo Dong
- Department of Anorectal Medicine, Liao Cheng People's Hospital, Liaocheng, 252000, Shandong, People's Republic of China
| | - Qian Gao
- Department of Digestive System, Qinghai University Affiliated Hospital, Xining, 810000, Qinghai, China.
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