Primary Orbital Leiomyosarcoma

Primary Leiomyosarcoma of the Orbit and Conjunctiva: A Report of Four Cases With a Review of the Literature

Leiomyosarcomas (LMS) are common soft tissue tumors in the body. Primary orbital and conjunctival LMS are, however, rare. Herein, we describe the diverse clinical presentations, histopathological features, and management outcomes of three cases of primary LMS of the conjunctiva and one case of primary orbital LMS. The first patient was a 40-year-old female with primary orbital LMS who developed recurrence following wide local excision. The remaining three cases were primary conjunctival LMS. All four patients underwent orbital exenteration and were disease-free at a mean follow-up period of 18.64 months. LMS is known for local recurrences and metastasis. Complete surgical excision and prompt adjuvant radiotherapy can improve the prognosis.

Primary Orbital Leiomyosarcoma in an Adult Male

A 71-year-old male presented with a history of noticing gradual painless progressive proptosis along with a pinkish mass seen on the outer aspect of his left eyeball. Orbital CT revealed a fairly defined homogenous lesion, abutting the left eyeball and involving the lateral orbit reaching almost till orbital apex. Histopathology analysis aided with immunohistochemistry after an incision biopsy was consistent with leiomyosarcoma. Positron emission tomography scan ruled out presence of any distant primary or metastatic tumor. He underwent eyelid sparing total orbital exenteration with confirmed tumor free soft-tissue margins. He is doing well at 5 months of follow-up with no sign of local recurrence or distant metastasis. Primary orbital leiomyosarcoma is a rare tumor. It is mainly found in older woman; it is even rarer in males. Complete surgical excision with tumor free margins is the recommended treatment. Histopathology and immunohistochemistry are valuable in diagnosis and management.

Conjunctival Leiomyosarcoma, a Rare Neoplasm Always Originating at the Limbus? Report of a New Case and Review of 11 Published Cases

PURPOSE OF THE STUDY

To describe the differential diagnosis and management of a rare conjunctival malignancy.

PROCEDURES

A 79-year-old man presented with a conjunctival mass at the limbus. Excisional biopsy revealed a malignant mesenchymal tumor with myogenic differentiation. Six months later, three suspect lesions developed at the border of the previous excision. Pathological diagnosis pointed to a leiomyosarcoma. Adjuvant radiotherapy with strontium-90 brachytherapy was applied. After 3 years, there was neither recurrence nor distant metastases. A literature review revealed 11 cases of conjunctival leiomyosarcoma.

RESULTS

All 12 cases seemed to originate at the limbal conjunctiva. Scleral invasion was found only in one patient with multiple previous resections. Corneal invasion was reported in two patients. Four patients had a globe-sparing resection. In two of them, margins were not tumor free and additional brachytherapy gave a tumor-free follow-up of 1 and 3 years. Four cases underwent an exenteration.

CONCLUSION AND MESSAGE

Primary conjunctival leiomyosarcoma is a rare tumor with a favorable prognosis due to early detection and consequently limited size. Diagnosis involves histopathological investigation including immunohistochemistry. If possible, complete resection has the best prognosis. Adjunctive radiotherapy can be effective when the margins are not free and should be considered.

MRI and FDG PET/CT Findings of Primary Orbit Leiomyosarcoma

Primary leiomyosarcoma of the orbit is extremely rare. Here we report the case of a 32-year-old woman who presented with proptosis and diplopia of the left eye. MRI examination showed a solid mass in the left orbit with invasion to adjacent tissue, and the lesion had intense FDG uptake with SUVmax of 18.7 on F-FDG PET/CT. Primary orbit leiomyosarcoma was diagnosed by surgery-pathology. F-FDG PET/CT has an advantage in excluding secondary or metastatic orbit malignancy.

A Case of Orbital Metastasis of Uterine Leiomyosarcoma With Intracranial Extension Presenting With Proptosis

A 57-year-old woman presented with protrusion of the OS 2 months in duration and decreased vision 1 month in duration. The patient was diagnosed with uterine leiomyosarcoma approximately 3 years before presentation. Lung and liver metastases were diagnosed by biopsy 1 year prior to this visit. CT revealed a solid mass with central necrosis in the left lateral orbit that resulted in orbital shifting, bony destruction, and intracranial extension. The diagnosis was left orbital metastatic leiomyosarcoma, and the patient died 2 months after receiving the diagnosis.

Benign orbital tumors with bone destruction in children

Purpose

To present rare benign orbital tumors with bone destruction in children who could not be diagnosed pre-surgically and may simulate malignant ones.

Methods

A retrospective review of cases. Clinical, operative and pathological records in all children with a diagnosis of benign orbital tumors who showed remarkable bone destruction at a tertiary Ophthalmic Center in China between Jan 1, 2000 and Dec 31, 2009 were reviewed. All patients had definitive histopathologic diagnosis.

Results

Eight patients with benign orbital tumors showed obvious bone destruction, including six cases of eosinophilic granuloma, one case of leiomyoma and one case of primary orbital intraosseous hemangioma. Among them, three patients were females and five patients were males. Tumors were unilateral in all cases, with both the right and left side affected equally. Age ranged from 3 to 7 years (mean 4.1 years). Symptom duration ranged from 1 to 5 weeks (mean 4.8 weeks). Eyelid swelling and palpable mass were the most common complaint. There was no evidence for multifocal involvement in cases with eosinophilic granuloma. Among six patients with eosinophilic granuloma, two were treated with low dose radiation (10 Gy), three received systemic corticosteroid and one was periodically observed only after incisional biopsy or subtotal curettage. There was no postoperative therapeutic intervention in the two patients with leiomyoma and intraosseous hemangioma. All eight patients regained normal vision without local recurrence after a mean follow-up time of 32.8 months.

Conclusion

Benign orbital tumors such as isolated eosinophilic granuloma, leiomyoma and primary orbital intraosseous hemangioma may show remarkable bone destruction.

Orbital metastasis of retroperitoneal leiomyosarcoma

Leiomyosarcoma is a relatively rare form of cancer most commonly found in the uterus, stomach, small intestine, retroperitoneum, and vascular tissue. Metastasis is common and surgery with a wide margin of resection is generally considered the most effective management. Leiomyosarcomas, metastatic or primary, of the orbit have rarely been reported. Herein, we report the case of a 51-year-old female with metastatic orbital leiomyosarcoma. The diagnosis was based on her history of leipmyosarcoma, orbital ultrasonography, and computed tomography and confirmed by postoperative histochemistry. She was treated with surgical excision and has remained without recurrence 1 year after surgery.

Primary orbital leiomyosarcoma

A 79-year-old woman was presented with a 6-month history of painless proptosis in the left eye. On examination, there was a palpable superotemporal mass displacing the left eye inferomedially. Orbital CT revealed a heterogeneous, lobulated mass occupying the left orbital space with no bone erosion or destruction. MRI showed an extraconal, heterogenous, lobulated orbital mass in the lacrimal gland region of the left eye. The lesion was excised, and the diagnosis of leiomyosarcoma was made by histopathologic examination and immunohistochemistry. Systemic examinations were negative for a primary or a metastatic tumor. There was no evidence of tumor recurrence after 12 months of follow-up. Primary orbital leiomyosarcoma is a rare tumor that mainly occurs in older women and presents with painless proptosis. It should be considered in the differential diagnosis of superotemporal extraconal lesions.

Orbital leiomyoma: histopathologic and immunohistochemical findings of a rare tumor

A 51-year-old man was referred for evaluation of a right orbital hemangioma. Ophthalmologic examination was unremarkable except for 1 mm of proptosis OD. CT revealed a 10-mm lesion with evidence of growth from 6 to 10 mm within a year. The tumor did not compromise other orbital structures. An excisional biopsy was performed. On the basis of the histopathologic and immunohistochemical findings, the diagnosis of orbital leiomyoma was established. Orbital leiomyoma is a slow-growing tumor that can be located anywhere in the orbit. Posterior tumors are believed to originate from smooth muscle cells of vessel walls; anterior lesions may arise from the capsulopalpebral or Müller muscle. Although there are no unique features that help the radiologist to exclude other benign lesions of the orbit, the histopathologic diagnosis using immunohistochemical markers is usually straightforward. Attention to the cytologic features that exclude the malignant variant is of utmost relevance for proper diagnosis and patient counseling.