Partial spondylectomy for primary leiomyosarcoma of C2 vertebra

Leiomyogenic Tumor of the Spine: A Systematic Review

The study cohort consisted of 83 patients with a mean age of 49.55 (SD 13.72) with a female preponderance (60 patients). Here, 32.14% of patients had primary LTS; the remaining were metastases. Clinical presentation included nonspecific back pain (57.83%), weakness (21.69%) and radicular pain (18.07%). History of uterine neoplasia was found in 33.73% of patients. LTS preferentially affected the thoracic spine (51.81%), followed by the lumbar (21.67%) spine. MRI alone was the most common imaging modality (33.33%); in other cases, it was used with CT (22.92%) or X-ray (16.67%); 19.23% of patients had Resection/Fixation, 15.38% had Total en bloc spondylectomy, and 10.26% had Corpectomy. A minority of patients had laminectomy and decompression. Among those with resection, 45.83% had a gross total resection, 29.17% had a subtotal resection, and 16.67% had a near total resection. Immunohistochemistry demonstrated positivity for actin (43.37%), desmin (31.33%), and Ki67 (25.30). At a follow-up of 19.3 months, 61.97% of patients were alive; 26.25% of 80 patients received no additional treatment, 23.75% received combination radiotherapy and chemotherapy, only chemotherapy was given to 20%, and radiotherapy was given to 17.5%. Few (2.5%) had further resection. For an average of 12.50 months, 42.31% had no symptoms, while others had residual (19.23%), other metastasis (15.38%), and pain (7.69%). On follow-up of 29 patients, most (68.97%) had resolved symptoms; 61.97% of the 71 patients followed were alive.

Primary leiomyosarcoma of cervical spine invading the vertebra without obvious osteoclasia: Case report and literature review

Context: Primary leiomyosarcomas are malignant tumors of smooth muscles, with few reported cases occurring in the cervical spine. The authors report a case involving a 29-year-old man with primary leiomyosarcoma in the spinal canal posterior to the C3-C5 vertebrae.Findings: No obvious osteolytic lesions could be found in neither X-ray nor computed tomography scan. Because of the confusion of nontypical imaging findings, a decompressive surgery of anterior cervical corpectomy of C4 and reconstruction with a mesh cage filled with allogenic bone grafts were performed. The patient refused a second operation and then was advised to receive the radiotherapy. No recurrence of the symptoms was evident 6 months after surgery.Conclusion: When a patient suffers from upper cervical tumor, the leiomyosarcoma should be kept in mind as possible diagnoses despite its low occurring ratio. Early detection, early diagnosis, and early treatment must be the goal of the strategy.

Presentation, management and outcome of primary leiomyosarcoma of the spine: A systematic review

OBJECTIVE

Primary spinal leiomyosarcoma (PSL) is extremely rare. A case is presented, followed by a systematic review establishing the consensus on presentation, diagnosis, management and outcomes. Comparison being made with metastatic spinal leiomyosarcoma (MSL).

METHODS

A systematic review was conducted in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Eligibility criteria was decided upon before the literature search was conducted. Data were extracted and analysed.

RESULTS

397 articles were identified, 25 articles conformed to the eligibility criteria. 34 cases were included in the analysis. PSL had a female preponderance (69.2%) with back pain being the most common presenting symptom (60.9%). Neurological signs were present in the majority (69.6%) with tumours typically being in the thoracic spine (46.9%). Diagnosis was primarily made using MRI (64.7%) and CT (55.9%), with a histological sample being obtained in all cases. Most patients underwent operative management (91.2%) with variable use of neoadjuvant and adjuvant therapies. Operative approach differed greatly and outcome following surgical management was stated in 48.4% of cases, all noting an improvement from presentation. Patient follow up was limited (median 7 months), with the majority of patients being free of disease (43.8%).

CONCLUSIONS

PSL diagnosis is challenging with PET-CT and histopathological sampling playing an important role. There is a limited evidence base for the treatment strategies employed but surgical management is key with generally good outcomes. Prognosis for PSL would appear to be better than MSL. There is scope for more dedicated research in PSL and MSL.

Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients

OBJECTIVE

Leiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS).

METHODS

Twelve patients presented to the authors' institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant.

RESULTS

The mean patient age was 49.7 ± 12.9 years (range 22-73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0-15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5-21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6-78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS.

CONCLUSIONS

Surgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.

Primary leiomyosarcoma of the spine treated with total en bloc spondylectomy: the first case in Thailand-a case report and literature review

Leiomyosarcoma is a rare type of malignant soft tissue tumor and also one of the most aggressive soft tissue sarcomas. It commonly occurs in uterus, abdominal viscera, retroperitoneal space and soft tissue of the extremities. Primary osseous leiomyosarcoma is a rare condition. Furthermore, primary leiomyosarcoma of the spine is extremely rare. Only few cases have been reported. However, the treatment and outcomes remains controversial. Therefore, the objective of this case report is to illustrate the management of this extremely rare disease by using total en bloc spondylectomy (TES) procedure, which is one of a suitable option for surgical resection of the spinal tumors. In this study, we presented an unusual case of a 61-year-old female, who was diagnosed as primary leiomyosarcoma of the twelfth thoracic spine with liver metastasis, treated with total en bloc spondylectomy of the twelfth thoracic vertebra followed by chemotherapy. On last follow-up, 6 months after the surgery, the clinical outcome remained in good condition and no signs of local recurrence. In conclusion, primary leiomyosarcoma of the spine is an extremely rare and difficult to diagnosis. Immunohistochemistry studies are very important for confirmation of the diagnosis. Standard treatment remains controversial. However, surgical resection is still treatment of choice. One of the most effective surgical options is TES, which give the better outcome and minimize local recurrence, if indicate.

Primary leiomyosarcoma of the spine: A case report and literature review

RATIONALE

Primary leiomyosarcoma of the bone was firstly reported by Evans and Sanerkin in 1965, whereas primary leiomyosarcoma of the vertebra is extremely rare. Because of the rarity of primary vertebral leiomyosarcoma, the diagnosis, treatment, and clinical outcome still remain controversial. Here we report a special case of primary leiomyosarcoma in the thoracic vertebra.

PATIENT CONCERNS

A 47-year-old female patient was admitted to our institution with the chief complaint of persistent back pain for 4 weeks. She had no symptoms of numbness, weakness, pain, and abnormal sensation in her extremities.

DIAGNOSES

Neurological examination on admission revealed no obvious abnormality. Magnetic resonance imaging showed a bone destruction of the T11 vertebral body and the right pedicle. Therefore, primary vertebral leiomyosarcoma was suspected. Pathological hematoxylin and eosin staining of the resected tumor revealed a diagnosis of polymorphic undifferentiated sarcoma. Furthermore, to identify the subtype of this sarcoma, the immunohistochemical staining of the tumor was performed with each of the various antibodies and the results are epithelial membrane antigen (-), H-caldesmon (-), desmin (+), smooth muscle actin (+), S-100 (-), myogenin (-), pan-keratin (-), and Ki-67 (positive rate: 20%). Finally, the patient was diagnosed as primary vertebral leiomyosarcoma.

INTERVENTIONS

the anterior corpectomy and autogenous iliac bone graft with instrumentation combined with the posterior spinal canal decompression and fusion with the pedicle screw system were performed through an anterior-posterior union approach.

OUTCOMES

Neither clinical symptoms nor signs of tumor recurrence were detected within the follow-up of 6 months. In addition, 11 cases of the primary vertebral leiomyosarcoma reported in the literature were reviewed and summarized.

LESSONS

Exclusion of metastatic leiomyosarcoma by various imaging modalities and histopathological examinations, especially the immunohistochemical staining with various antibodies against the epithelial and mesenchymal cell markers, are critical for establishing the correct diagnosis of the primary vertebral leiomyosarcoma. Surgical resection, especially the total en bloc spondylectomy, is the main treatment option with a good outcome, albeit with a limited follow-up duration.

Primary multiple osseous leiomyosarcomas of the spine metastasizing to the skull

Primary osseous leiomyosarcoma of the spine is a very unusual condition, with only few cases being reported in the literature. In fact, this type of tumors arises from the smooth muscle cells and occurs usually in the uterus and the gastrointestinal tracts. If the spine should be involved, it occurs generally as a metastatic location. Location to the spine as a primary site is exceedingly rare. We present the case of a 37 years old female patient, with multiple spine levels involvement - to vertebral body and to posterior aspects of Vertebra, causing spinal cord compression syndrome. A secondary location to the skull was diagnosed one month later. Through a literature review, we analyze various aspects in the diagnosis and management of this rare entity.

Leiomyosarcoma metastatic to the cervical spine causing a C6 compression fracture: A case report

Leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells, which commonly metastasizes to the lungs, liver, kidney, brain and skin. The current study presents the case of a 42-year-old male who presented with progressive neck pain and numbness of the left arm. Spinal computed tomography and magnetic resonance imaging revealed osteolytic lesions of numerous vertebrae (C2, C3, C4, C5, C6, C7, T1 and T2). With regard to the C6 vertebra, total destruction of the vertebral body resulted in vertebral collapse and subsequent spinal cord compression. The patient underwent an anterior C6 corpectomy, reconstruction with a mesh cage filled with polymethyl methacrylate (PMMA) and open PMMA infusion to C5 and C7. The surgical procedure significantly alleviated the symptoms and obtained a reliable reconstruction. The clinical follow-up examination at 13 months was uneventful with the exception of mild numbness of the left hand since the surgery. To the best of our knowledge, this is the first case of leiomyosarcoma recurrence presenting in the cervical spine, and the present study provides insight into the use of a surgical technique that has rarely been used in the cervical spine.

Axial spondylectomy and circumferential reconstruction via a posterior approach

BACKGROUND

Spinal metastases of the second cervical vertebra are a subset of tumors that are particularly difficult to address surgically. Previously described techniques require highly morbid circumferential dissection posterior to the pharynx for resection and reconstruction.

OBJECTIVE

To perform a biomechanical analysis of instrumented reconstruction configurations used after axial spondylectomy and to demonstrate safe use of a novel construct in a patient case report.

METHODS

Several different published and novel reconstruction configurations were inserted into 7 occipitocervical spines that underwent axial spondylectomy. A biomechanical analysis of the stiffness of the constructs in flexion and extension, lateral bending, and rotation was performed. A patient then underwent a posterior-only approach for axial spondylectomy and circumferential reconstruction.

RESULTS

Biomechanical analysis of different constructs demonstrated that anterior column reconstruction with bilateral cages spanning the C1 lateral mass to the C3 facet in combination with occipitocervical instrumentation was superior in flexion-extension and equivalent in lateral bending and rotation to currently used constructs. The patient in whom this construct was placed via a posterior-only approach for axial spondylectomy and instrumentation remained at neurological baseline and demonstrated no recurrence of local disease or failure of instrumentation to date.

CONCLUSION

When C1 lateral mass to C3 facet bilateral cage plus occipitocervical instrumentation is compared with existing anterior and posterior constructs, this novel reconstruction is biomechanically equivalent if not superior in performance. In a patient, the posterior-only approach for C2 spondylectomy with the novel reconstruction was safe and durable and avoided the morbidity of the anterior approach.

Outcomes after surgery for spinal metastatic leiomyosarcoma

OBJECT

Leiomyosarcoma is a smooth-muscle sarcoma that rarely metastasizes to the spine. Its clinical course is variable, although patients with metastatic leiomyosarcoma can experience prolonged survival as compared with patients with more aggressive metastatic tumors. The authors report their single-institution experience in the surgical treatment of patients with leiomyosarcoma metastatic to the spine.

METHODS

A retrospective review of the electronic medical records was performed to obtain details on clinical management and outcomes for patients who had undergone surgical intervention for metastatic leiomyosarcoma of the spine. The few articles available in the current literature on this topic were also analyzed.

RESULTS

Eight patients with metastatic leiomyosarcoma of the spine underwent surgical management between 2005 and 2011. Six patients (75%) had improvement in their Nurick grade. Patients who had presented with pain as a primary symptom experienced significant relief. Five patients (63%) had lesion recurrence, and 4 underwent repeat surgery at a mean of 10.2 months after their initial surgery. The mean duration of survival was 11.7 months (range 3.3-23.0 months).

CONCLUSIONS

Leiomyosarcoma rarely metastasizes to the spine. However, surgical intervention can relieve pain and improve neurological function. Given the potential for prolonged survival, aggressive management should be considered in well-selected patients.