Primary leiomyosarcoma of bone

Proximal Tibia Primary Leiomyosarcoma: A Case Report and Review of Literature

The paper at hand presents a unique case of leiomyosarcoma (LMS) involving the left leg in a 56-year-old patient. This individual experienced pain and the presence of a mass for approximately eight months before seeking medical attention. A diagnostic biopsy revealed the presence of multinucleated pleomorphic cells arranged in intersecting fascicles upon immunohistochemistry (IHC) staining for vimentin, caldesmon, and smooth muscle actin. The rarity of LMS in the extremities highlights the need for further understanding and research to determine the most suitable treatment approaches for such patients. In this specific case, the patient underwent tumor excision followed by reconstruction using a megaprosthesis. This report emphasizes the importance of considering unique treatment strategies when dealing with rare neoplasms like LMS in the extremities. As medical knowledge continues to evolve, gaining insights into the optimal management of such cases will be crucial for improving patient outcomes and overall prognosis.

Primary leiomyosarcoma of the distal fibula: A case report and review of the literature

We describe a primary leiomyosarcoma of bone located in the distal fibula in a 67- year-old man. Plain radiographs and computer tomography scan revealed a lytic destructive lesion in the distal metaepiphyseal region of the left fibula with little involvement of the surrounding soft tissues. The lesion was composed of proliferating spindle-shaped cells with very slim cytoplasm and narrow oval cigar shaped nuclei. Immunohistochemistry studies demonstrated a strong positivity for actin and desmin, and weak positivity for caldesmon.

Primary vertebral leiomyosarcoma masquerading as a nerve sheath tumour

A 47-year-old woman presented with symptoms of low back pain and weakness in bilateral lower limbs. MRI of the spine revealed a mass arising from T11 vertebra involving neural foramina at bilateral T11-12 and right T10-11 levels with extension to the right paravertebral region. Suspecting a nerve sheath tumour, she underwent posterior spinal decompression, stabilisation and debulking, following which her neurological symptoms resolved. Histopathological and immunohistochemical evaluation revealed a leiomyosarcoma. A month later she developed sudden paraparesis and MRI revealed an increase in size of the tumour with cord compression and displacement. She underwent a repeat spinal decompression and debulking procedure after which she received adjuvant radiotherapy via volumetric modulated arc therapy, to a total dose of 45 Gy in 25 fractions over 5 weeks. MRI performed 2 months later revealed complete response and she is disease free for the past 5 months.

Primary leiomyosarcoma of femur

Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.

Primary leiomyosarcoma of bone: analysis of prognosis

Leiomyosarcoma of bone is just one of the variants of spindle cell sarcoma of bone characterised by the expression of desmin and other markers indicating a significant element of smooth muscle in the tumour, without osteoid production we have investigated the management and outcome of this rare type of primary malignant bone tumour. Method. Retrospective review of data stored on a prospective database. Results. In a database of 3364 patients with primary malignant bone sarcomas, 31 patients were identified with a primary leiomyosarcoma of bone. There were 12 males and 19 females with a mean age of 46 and tumour size of 8 cm. The most common site was the distal femur followed by the proximal tibia. Treatment was with chemotherapy and surgical resection. Seven of the patients had metastases at diagnosis. Surgery was carried out in 28 patients, 8 having amputation and 20 limb salvage. Three patients developed local recurrence, but half developed metastases. All patient disease-specific survival was 57% at five years and 44% at 10 yrs but for those without metastases was 82% and 60%, respectively. The only prognostic factors were metastases at diagnosis. Conclusion. Leiomyosarcoma of bone is a very rare primary malignant bone tumour affecting a predominantly older population. Despite the high incidence of metastases, survival is better than for other bone sarcomas for those without metastases at diagnosis.

Leiomyosarcoma of bone arising in association with a bone infarct

Both primary leiomyosarcoma of bone and sarcoma arising in association with a bone infarct are rare events. In this case report we describe for the first time a case of leiomyosarcoma arising in a bone infarct. The tumour arose in a medullary infarct in the proximal femur of an elderly patient. As in other cases of sarcoma arising in a bone infarct, the prognosis was poor, the patient dying within 6 months of diagnosis.

Primary leiomyosarcoma of extragnathic bone: clinicopathologic features and reevaluation of prognosis

CONTEXT

Leiomyosarcoma most commonly involves the female genital tract and occasionally arises within the retroperitoneum, abdominal cavity, or the soft tissues of the extremity. Presentation as a primary bone tumor is extraordinarily uncommon, potentially leading to misdiagnosis. The prognosis is traditionally thought to be dismal. However, this conclusion is largely based on individual case reports and small series, in some of which the pathologic diagnosis is not well documented.

OBJECTIVE

To review the clinicopathologic features of well-established cases of primary skeletal leiomyosarcoma and reevaluate the prognostic implications thereof.

DATA SOURCES

A National Center for Biotechnology Information PubMed search of the English language literature identified 104 authenticated cases of primary leiomyosarcoma of extragnathic bone. An additional 3 cases are reported and illustrated herein.

CONCLUSIONS

Approximately half of all patients with primary skeletal leiomyosarcoma either presented with metastatic disease or developed metastases within 1 year of diagnosis. The 5-year overall and disease-free survival rates were 59% and 41%, respectively, comparable to that of other skeletal sarcomas. As for other bone and soft tissue sarcomas, high histologic grade and tumor stage are predictive of poor outcome.

A primary leiomyosarcoma of bone containing pseudoepithelial plexiform elements

A rare but distinctive variant of smooth muscle tumours that occurs almost exclusively in the uterus is characterised by the presence of plexiform tumourlets, which are composed of clumps and cords of tumour cells that form a discrete pseudoepithelial component. We report on a case of a primary leiomyosarcoma of the proximal humerus, which, in addition to characteristic histological and immunophenotypic features of leiomyosarcoma, contained plexiform tumourlets. Tumour cells in the plexiform component focally expressed muscle/smooth muscle actin, calponin and cytokeratin. Spindle-shaped and epithelioid smooth muscle tumour cells also expressed the above antigens. This is the first report of a plexiform smooth muscle tumour arising in bone. This case is remarkable, not only for being only the second reported case of a malignant plexiform smooth muscle tumour, but also for being one of very few examples of this type of tumour arising outside the uterus; it also is unique in having arisen in a male patient. This variant of primary leiomyosarcoma needs to be distinguished from other bone tumours containing epithelial elements, notably metastatic carcinoma.

Primary leiomyosarcoma of the femur

Leiomyosarcoma usually arises in the uterus, gastrointestinal tract, retroperitoneum, or soft tissue. Primary leiomyosarcoma of bone is rare. We encountered two patients with primary leiomyosarcoma of the femur; one was a 24-year-old woman and the other, a 41-year-old woman. Bone destruction observed on plain radiographs was minimal in both patients. Magnetic resonance imaging (MRI) showed low signal intensity on T1-weighted images and high signal intensity on T2-weighted images, with these areas being much larger than the findings to be expected from the plain radiographs. Histological examination revealed spindle-cell sarcoma, with an interlacing pattern, acidophilic cytoplasm and blunt-ended or "cigar-shaped" nuclei, in both patients. In both patients, immunohistochemical examination showed positive staining for vimentin, desmin, and alpha-smooth muscle actin. Extensive examination of the gastrointestinal tract and uterus revealed no primary lesion. Therefore, the leiomyosarcoma in the femur was considered to be primary rather than metastatic. Histological examination, including immunohistochemistry, and the exclusion of an extraskeletal primary lesion, is necessary in diagnosing primary leiomyosarcoma of bone.

Leiomyosarcoma of the lumbar spine: case report

STUDY DESIGN

A primary leiomyosarcoma in the L2 vertebral body without any neurologic deficit is reported. The radiologic diagnosis was a metastasis, and the histologic diagnosis was confirmed by transpedicular needle biopsy.

OBJECTIVE

To emphasize the occurrence of primary leiomyosarcoma in the lumbar spine.

SUMMARY OF BACKGROUND DATA

Leiomyosarcoma is a rare malignant neoplasm of the bone, and only one report of the primary spinal tumor exists. In the case of leiomyosarcoma of the bone, metastasis, most commonly of the uterus or gastrointestinal tract, must be carefully ruled out before the diagnosis of primary leiomyosarcoma in the bone is confirmed.

METHODS

Leiomyosarcoma of the second lumbar vertebra in a 47-year-old woman with no neurologic deficit is reported. Imaging findings indicated a nonspecific high-grade lesion. A total spondylectomy of L2 with en bloc excision of the lower half of L1 and the upper third of L3 vertebral bodies was performed after preoperative radiation therapy. The defect of the vertebral body was reconstructed by titanium mesh cage, and T11 to S1 vertebrae were instrumented by the pedicle screw and rod system.

RESULTS

The surgical margin was marginal. Histologically, the tumor cells were elongated, with abundant cytoplasm and cigar-shaped nuclei, showing proliferation in fascicles and bundles. No sign of local recurrence or metastasis was evident 2 years and 1 month after surgery.

CONCLUSIONS

Leiomyosarcoma should be included in the differential diagnosis of spindle cell tumor of the spine, and it should be confirmed or excluded by immunohistochemical and/or ultrastructural studies. If the expected surgical margin is definitive, a total en bloc spondylectomy should be performed.

Primary leiomyosarcoma with the invasion into the intertrabecular space of bone: a case report and the review of the literatures

Primary leiomyosarcoma of bone is very rare. Most of reported cases were osteolytic. We report a primary leiomyosarcoma arising from the neck of the femur of a 43-year-old woman who had no remarkable abnormalities on plain radiographs. Magnetic resonance imaging (MRI) clearly depicted the lesion. Biopsy revealed it leiomyosarcoma. Gynecological and gastrointestinal examinations ruled out metastatic leiomyosarcoma. Wide excision of the tumor was performed and followed by endoprosthetic replacement of the proximal femur. Microscopic examination revealed tumor cells infiltrating into the intertrabecular space.

Primary leiomyosarcoma of bone: report of two cases in extragnathic bones

Primary leiomyosarcoma of extragnathic bone is rare; fewer than 50 cases are found in the literature. We report on two patients, adult men, with tumors located on the long bones (close to the knee joint). Radiographically, the tumors were shown as purely destructive, osteolytic, and infiltrative lesions. The diagnosis was based on light microscopy, including immunohistochemistry and ultrastructural examination. The tumor cells were uniformly positive for vimentin and muscle actin, but not for desmin. In one case, the cells were also positive for alpha-smooth muscle actin. Electron microscopy showed definitive smooth muscle differentiation, including cytoplasmic filaments with focal densities. Both patients died of pulmonary metastases.

Primary leiomyosarcoma of bone: a clinicopathologic, immunohistochemical, and ultrastructural study of 33 patients and a literature review

Leiomyosarcoma of bone is a rare tumor in an unusual location. Previous analysis of this entity mostly involved small numbers of cases with limited follow-up. Thirty-three patients with leiomyosarcoma of bone between 1977 and 1996 were studied, and the histologic appearance and grade were correlated with subsequent treatment and clinical behavior. To be included in this study the tumor had to be intraosseous, with other primary sites of origin clinically excluded. Also, most of the sarcomatous tissue (> or =70%) had to be of intramedullary location with only limited extraosseous extension. The patient's age at diagnosis ranged from 13 to 77 years (average 44.4). The gender distribution was equal. The long bones were preferentially affected (64%), with the lower extremity, around the knee joint, predominantly involved. Five patients (15%) developed postradiation leiomyosarcomas. The histologic analysis showed that the osseous leiomyosarcomas are most commonly of the classic type, followed by the epithelioid, myxoid, and pleomorphic variants. Immunoreactivity for smooth muscle markers (smooth muscle actin, common muscle actin, desmin) was positive in all tumors, and ultrastructural confirmation was obtained in 21% of cases. All sarcomas were histologically graded, which accurately reflected the subsequent prognosis. Seventy-five percent of the lesions were high-grade and the rest low-grade. The histologic grade of the tumors correlated with both the recurrence as well as the metastatic rates and together with the clinicopathologic stage of disease represented the cornerstone on which prudent therapy should be based.

Primary leiomyosarcoma of bone: report of eight cases

Eight primary leiomyosarcomas of bone were registered in the files of the Basel Bone Tumor Reference Center, Basel, Switzerland, for the period 1972 to 1990. The mean age of the patients (six males and two females) was 43.7 years (range, 11 to 87 years). The tumors were located in the long bones, the fingers, and the clavicle, and presented radiologically mainly as slightly to moderately aggressive lesions (grades IB to II according to Lodwick). They reacted immunohistochemically with antibodies against alpha-smooth muscle actin (alpha-SMA), and total muscle actins (eight of eight), vimentin (seven of eight), desmin (three of eight), keratin (four of eight), type IV collagen (six of eight), laminin (five of eight), and S-100 (one of eight). Seven patients underwent surgery (five, resection; two, amputation). Some of them had received preoperative or adjuvant chemotherapy or radiation therapy. One patient with a metastasized tumor had received chemotherapy only. Tumor recurrences were observed in two cases. Four patients developed metastases of whom two were treated with chemotherapy or tumor resection. During a follow-up period of 1 to 72 months (mean, 46.5 months) four of the eight patients survived for up to 72 months, among them the only patient with grade 3 tumor and treated metastases.

Primary bone sarcoma with rhabdomyosarcomatous component

We present three cases of primary bone sarcoma with rhabdomyosarcomatous component which in one case appeared in a pure form, i.e., as rhabdomyosarcoma; in the other two cases it presented as one of multiple components of the tumor. The first patient was a 70-year-old man with a tumor of the left femur involving surrounding soft tissue of the thigh. Histologically, this was a case of so-called dedifferentiated chondrosarcoma with pleomorphic rhabdomyosarcoma representing high grade malignant component. The second patient, a 31-year-old man, developed a tumor in the left tibia which was a rare, fibrosarcoma-like type of rhabdomyosarcoma. The third patient was a 43-year-old woman with a tumor in the left tenth rib which was shown to be osteo- and chondrosarcoma with a minor rhabdomyosarcomatous component and was classified as malignant mesenchymoma. All patients were treated by surgery and chemotherapy. The first two of them died of metastatic disease 3 months, and 3 years and 4 months following surgery, respectively. Light microscopical diagnosis of rhabdomyosarcoma of hematoxylin-eosin sections was confirmed immunohistochemically in each case using reactions to desmin, muscle specific actin and myoglobin, and ultrastructurally in two cases. Rhabdomyosarcomatous component in primary bone tumors appears to be rarely present but more cases may be diagnosed in the future, if immunohistochemical and ultrastructural examinations are to be employed.