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Øines MN, Smith HG, Preisler L, Penninga L. Leiomyosarcoma of the abdomen and retroperitoneum; a systematic review. Front Surg 2024; 11:1375483. [PMID: 39086921 PMCID: PMC11288885 DOI: 10.3389/fsurg.2024.1375483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Intraabdominal and retroperitoneal leiomyosarcomas are rare cancers, which cause significant morbidity and mortality. Symptoms, treatment and follow up differs from other cancers, and proper diagnosis and treatment of intraabdominal and retroperitoneal leiomyosarcomas is of utmost importance. We performed a systematic review to collect and summarize available evidence for diagnosis and treatment for these tumours. Methods We performed a systematic literature search of Pubmed from the earliest entry possible, until January 2021. Our search phrase was (((((colon) OR (rectum)) OR (intestine)) OR (abdomen)) OR (retroperitoneum)) AND (leiomyosarcoma). All hits were evaluated by two of the authors. Results Our predefined search identified 1983 hits, we selected 218 hits and retrieved full-text copies of these. 144 studies were included in the review. Discussion This review summarizes the current knowledge and evidence on non-uterine abdominal and retroperitoneal leiomyosarcomas. The review has revealed a lack of high-quality evidence, and randomized clinical trials. There is a great need for more substantial and high-quality research in the area of leiomyosarcomas of the abdomen and retroperitoneum. Systematic Review Registration PROSPERO, identifier, CRD42023480527.
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Affiliation(s)
- Mari Nanna Øines
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Louise Preisler
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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Annicchiarico A, Montali F, Baldinu M, Casali L, Virgilio E, Costi R. Leiomyosarcoma of the rectum: A systematic review of recent literature. J Surg Oncol 2024; 129:365-380. [PMID: 37814590 DOI: 10.1002/jso.27481] [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: 07/11/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Leiomyosarcomas (LMSs) are rare tumors originating from the muscular layer. We performed a literature review of cases of confirmed rectal leiomyosarcomas (rLMSs) to clarify the history of such an infrequent tumor arising at such an uncommon location. In this research local recurrence was related to poorly differentiated rLMS and no other association between recurrence and any criteria was found. Concerning overall survival (OS), rLMS patients developing recurrence presented shorter longevity compared with the group without.
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Affiliation(s)
- Alfredo Annicchiarico
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Filippo Montali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Manuel Baldinu
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Lorenzo Casali
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Edoardo Virgilio
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma, Italy
- Department of General Surgery, Vaio Hospital, Fidenza, Italy
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Sahli N, Khmou M, Khalil J, Elmajjaoui S, El Khannoussi B, Kebdani T, Elkacemi H, Benjaafar N. Unusual evolution of leiomyosarcoma of the rectum: a case report and review of the literature. J Med Case Rep 2016; 10:249. [PMID: 27633779 PMCID: PMC5025574 DOI: 10.1186/s13256-016-1047-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2016] [Accepted: 08/29/2016] [Indexed: 01/01/2023] Open
Abstract
Background Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment. Case presentation This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors. Conclusion The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.
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Affiliation(s)
- N Sahli
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
| | - M Khmou
- Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - J Khalil
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - S Elmajjaoui
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - B El Khannoussi
- Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - T Kebdani
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - H Elkacemi
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
| | - N Benjaafar
- Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco
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Abstract
About 2/3 of gastrointestinal stromal tumors occur in the stomach and about 1/5 in the small intestine with few in the rectum, colon, and esophagus. Their cells are related to the interstitial cells of Cajal. They differ by site in terms of cell type and growth pattern. Benign and malignant tumors are separated based on their light microscopic appearances, size as measured by innumerable pathologists and assistants and mitotic counts.
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Affiliation(s)
- Henry D Appelman
- Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-5602, USA.
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Abstract
Leiomyosarcoma of the anal canal is an uncommon neoplasm of the gastrointestinal tract. We report a 45-year-old lady with anal canal leiomyosarcoma. In view of its rarity, we report its presentation and management. In the setting of a recurrent tumor with high-grade histological appearance, local excision would be deemed unsafe.
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Affiliation(s)
- G. Krishna Kumar
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India,Address for correspondence: Dr. G. Krishna Kumar, Hospital Tengku Ampuan Afzan Kuantan, Malaysia. E-mail:
| | - Sarath S. Chandra
- Department of General Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - R. Krishnan
- Department of Pathology, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
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6
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Thalheimer L, Richmond B, Lohan J. Leiomyosarcoma of the Anal Canal: Case Report and Review of the Literature. Am Surg 2008. [DOI: 10.1177/000313480807400118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A rare case of a leiomyosarcoma of the anal canal is presented. A 68-year-old male presented with painful defecation and rectal bleeding. Endorectal ultrasound revealed a mass invading both sphincters (T4 lesion), and extending 6 cm into the anal canal. Colonoscopy revealed an ulcerated area in the anal canal, of which biopsies revealed high-grade leiomyosarcoma–only the eighteenth such case at the time of this submission. The details of the case and teaching images are presented in detail, as is a comprehensive review of the relevant literature.
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Affiliation(s)
- Liza Thalheimer
- West Virginia University School of Medicine, Morgantown, West Virginia and
| | - Bryan Richmond
- Department of Surgery, West Virginia University, Charleston Division, Charleston, West Virginia
| | - Jay Lohan
- Department of Surgery, West Virginia University, Charleston Division, Charleston, West Virginia
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Rowe NM, Meisher IE, Sheka KP, Bopaiah V. Leiomyosarcoma of the anal canal: A case report. Int J Surg 2007; 5:345-50. [PMID: 17561465 DOI: 10.1016/j.ijsu.2007.04.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 04/24/2007] [Indexed: 11/17/2022]
Abstract
BACKGROUND Leiomyosarcoma (LMS) of the colon, rectum, and anus comprise less than 0.1% of all rectal malignancies with isolated leiomyosarcomas of the anal canal representing only eight reported cases. We report one more case and a review of the world literature. CASE REPORT An 80-year-old male presented with a complaint of bright red blood per rectum, constipation, and a subjective history of a rectal mass diagnosed 3 years prior. Pertinent findings on physical exam included a hard, non-mobile mass in the anus which biopsy showed to be a LMS. The patient only wished to have a local excision of the mass performed. At the time of operation the perianal mass extended from the external sphincters into the anal canal. The mass was excised with clean margins. The patient refused adjuvant therapy. Approximately 7 months later, the patient was found to have a local recurrence. At this time the patient opted for local excision and radiotherapy. CONCLUSION Isolated LMS of the anus is an extremely rare finding with only eight previous reports in the world literature. LMS is an aggressive tumor with a high local recurrence rate as well as significant hematogenous spread. Due to its rarity, there is insufficient data regarding the optimal treatment. Our literature review has displayed some limited preference for radical surgery over local excision, which may in turn lead to a better outcome.
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Affiliation(s)
- Norman M Rowe
- Department of Surgery, 7 North-32, Coney Island Hospital, 2601 Ocean Parkway, Brooklyn, NY 11235, USA.
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Cuffy M, Abir F, Longo WE. Management of Less Common Tumors of the Colon, Rectum, and Anus. Clin Colorectal Cancer 2006; 5:327-37. [PMID: 16512991 DOI: 10.3816/ccc.2006.n.002] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
The majority of colorectal and anal malignancies are adenocarcinomas and squamous cell cancers, respectively. Despite the predominance of these neoplasms in these locations, rare histiotypes of the colon, rectum, and anus do occur. These histotypes include but are not limited to lymphoma, melanoma, diffuse cavernous hemangioma, and sarcomas, such as leiomyosarcoma or Kaposi's sarcoma. These tumors often present challenges to clinicians with respect to diagnosis, staging, management, and pathology because of their unfamiliarity. A Medline search using "colon," "rectum,""anus," "lymphoma," "melanoma," "diffuse cavernous hemangioma," "squamous cell carcinoma," "carcinoid," "sarcoma," "leiomyosarcoma," "Kaposi's sarcoma," "Paget's disease," "Bowen's disease," and "basal cell carcinoma" as key words was performed as well as a cross-referencing of the bibliography cited in each work. Rare tumors of the colon, rectum, and anus present diagnostic and management dilemmas for clinicians. Because of their infrequency and poor prognosis, the optimal management of these tumors is controversial. For some histotypes, such as squamous cell carcinoma and carcinoids of the rectum, treatment depends on location and size of the tumor. For uncommon anal lesions, such as Bowen's disease, Paget's disease, and basal cell carcinoma, wide local excision (WLE) with negative margins is the standard of care. For other lesions such as anorectal melanoma or leiomyosarcoma, abdominal perineal resection versus WLE is still being debated. Because the optimal treatment of these tumors is still unclear, we recommend a multidisciplinary approach including a surgeon, primary care physician, medical oncologist, radiation oncologist, and pathologist to offer the patient the best outcome.
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Affiliation(s)
- Madison Cuffy
- Yale University School of Medicine, Department of Surgery, New Haven, CT 06520-8062, USA
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Sebastián JJ, Soria MT, Vicente J, Maurel J. Rectal leiomyosarcoma in a young male with a history of Wilms' tumor. J Clin Gastroenterol 1998; 27:370. [PMID: 9855276 DOI: 10.1097/00004836-199812000-00023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
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Abstract
PURPOSE Perineal sarcomas are rare tumors that are typically of an extensive nature by the time of diagnosis. In this article, two case reports are followed by a brief review of different types of sarcomas that may occur in the perineal and perirectal region. STUDY PATIENTS This study consists of two cases that are representative of the many types of perineal/perirectal sarcomas. PRINCIPLE CONCLUSIONS Perineal and perirectal sarcomas are generally of poor prognosis mainly because of delayed diagnosis. Computed tomography and magnetic resonance imaging can be extremely useful to help assess these tumors. It is well known that the most important criterion for diagnosing leiomyosarcomas appears to be the presence of mitotic activity. Anorectal stromal tumors having five or more mitoses per 50 high powered fields are considered to be malignant. The mainstay of treatment is surgical excision with wide margins. Currently, chemotherapeutic and radiotherapy trials are under way.
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Affiliation(s)
- K J Kessler
- Department of Surgery, Good Samaritan Hospital, Cincinnati, Ohio, USA
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