Metastatic uterine leiomyosarcoma in the upper buccal gingiva misdiagnosed as an epulis

Oral Metastatic Undifferentiated Pleomorphic Sarcoma: A Case Report

INTRODUCTION

Oral metastases are rare; nevertheless, they must be considered in the differential diagnosis of lesions in patients with a previous history of malignancy or older adults. The clinical signs of oral metastasis typically comprise pain, dysphagia, ulceration, bleeding, and paresthesia. Soft tissue sarcomas tend to affect the extremities and retroperitoneum. The most common metastases in the oral cavity are carcinomas, and sarcomas rarely metastasize to this area. Undifferentiated pleomorphic sarcoma (UPS) is a mesenchymal malignancy that infrequently affects the head and neck site. It shows a male predilection and occurs in all age groups. The lung is the most common area of distant metastasis in undifferentiated pleomorphic sarcoma.

CASE REPORT

This report presents a 61-year-old female patient with a painful bluish-purple mass of the posterior right mandibular alveolar mucosa. She had a history of thigh UPS about four years ago. An incisional biopsy was performed, and the specimen was stained with hematoxylin and eosin. Immunohistochemical antibodies for CK, S100, desmin, myogenin, MDM2, SOX10, and caldesmon were negative and focally positive for CD68. Ki-67 index was about 70%.

CONCLUSIONS

This report aimed to increase awareness of a rare lesion by describing the clinical, histopathologic, and immunohistochemical findings of metastatic undifferentiated pleomorphic sarcoma of the oral cavity.

Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature

Background

Leiomyosarcoma usually develops in the myometrium and is characterized by a high recurrence rate, frequent hematogenous dissemination, and poor prognosis. Metastasis is usually to lungs, liver, and bone, and occasionally to the brain, but seldom to the head and neck region. Primary leiomyosarcoma very rarely arises in the broad ligament.

Case presentation

A 54-year old woman presented to the otolaryngology department with a mass in the right posterior region of the neck 4 years after surgery for a primary leiomyosarcoma of the right broad ligament. The neck mass was removed and found to be a metastatic leiomyosarcoma. Leiomyosarcoma localizations in lungs and liver were absent. Morphological examination showed both the primary and the secondary leiomyosarcomas to have features of low-grade tumors. One year after excision of the neck mass, the patient presented with tachycardia. Echocardiography detected two intracardiac nodules suggestive of metastatic tumors. Chemotherapy was administered; the disease has been stable since then.

Conclusions

We report the first case of broad ligament leiomyosarcoma with the neck subcutaneous region being the first site of secondary involvement. We speculate that the Batson venous plexus might have been the pathway of dissemination.

Leiomyosarcoma: Prognostic outline of a rare head and neck malignancy

Soft tissue sarcomas (STS) are mesenchymal malignant neoplasms with a broad spectrum of biologic behaviour. Most STS show predilection for extremities with rarity in head and neck. Leiomyosarcoma (LMS) is an extremely rare STS in head and neck due to the paucity of smooth muscles in this anatomical region. Owing to its rarity, diagnosis of LMS is often delayed or is often misdiagnosed. Our study aimed to evaluate clinico-demographic factors determining clinical course of primary head-neck LMS. Further, we also assessed cases of secondary head-neck LMS and LMS due to other causes to compare their clinical outcome with primary head-neck LMS. In primary LMS cases, intraoral LMS showed slightly better prognosis than extraoral LMS. Survival analysis revealed that prognosis of primary LMS was significantly better than secondary LMS. No significant difference in survival was seen between primary LMS and LMS due to other causes. These observations indicate that site of origin appears to determine the clinical behaviour of LMS. Results showed that size, recurrence and metastasis are important prognostic variables. Though large tumor size was associated with poor prognosis, tumor aggressiveness may not be directly proportional to its size. Surgical management with or without adjuvant therapy was associated with favourable outcome. As several factors are associated with prognostic outcome of head-neck LMS, multimodality therapy approach after careful analysis of various prognostic variables in each case on an individual basis is essential.

The Imaging and Pathological Features of Metastatic Leiomyosarcoma in the Gallbladder

Uterine leiomyosarcoma is a rare and aggressive malignancy with poor overall prognosis. There have been few reports of metastatic leiomyosarcoma in the gallbladder. We report a case of a 41-year-old female who underwent total abdominal hysterectomy due to presumed uterine fibroids. The postoperative pathology revealed high-grade pleomorphic leiomyosarcoma, with involvement of the uterine serosal surface. She subsequently underwent exploratory laparotomy, followed by pelvic radiation and chemotherapy. Since initial management she has developed metastatic disease and has been under treatment and surveillance for 11 years. She has undergone multiple surgical procedures and numerous lines of systemic therapy for metastatic leiomyosarcoma, including cholecystectomy for a metastatic lesion in the gallbladder. There have been no previous reports of metastatic leiomyosarcoma in the gallbladder. Despite extensive metastatic disease this patient has had prolonged survival with multi-modality management.