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Kharbat AF, Balasubramanian K, Sankarappan K, Morgan RD, Hassan KM, Palmisciano P, Pelargos PE, Chukwu M, Bin Alamer O, Haider AS, El Ahmadieh TY, Burke JF. Leiomyogenic Tumor of the Spine: A Systematic Review. Cancers (Basel) 2024; 16:748. [PMID: 38398139 PMCID: PMC10887395 DOI: 10.3390/cancers16040748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 01/28/2024] [Accepted: 01/29/2024] [Indexed: 02/25/2024] Open
Abstract
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.
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Affiliation(s)
- Abdurrahman F. Kharbat
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
| | - Kishore Balasubramanian
- Division of Neurosurgery, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (K.B.); (K.S.)
| | - Kiran Sankarappan
- Division of Neurosurgery, Texas A&M University College of Medicine, Bryan, TX 77807, USA; (K.B.); (K.S.)
| | - Ryan D. Morgan
- Division of Neurosurgery, Texas Tech University Health Sciences Center, Lubbock, TX 79430, USA;
| | - Khawaja M. Hassan
- Department of Neurosurgery, King Edward Medical University, Lahore 54000, Pakistan;
| | - Paolo Palmisciano
- Department of Neurosurgery, University of California Davis, Davis, CA 95616, USA;
| | - Panayiotis E. Pelargos
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
| | - Michael Chukwu
- Department of Surgery, New York Presbyterian Hospital/Weill Cornell, New York, NY 10065, USA;
| | - Othman Bin Alamer
- Department of Neurosurgery, University of Pittsburg Medical Center, Pittsburg, PA 15219, USA;
| | - Ali S. Haider
- Department of Neurosurgery, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA;
| | | | - John F. Burke
- Department of Neurosurgery, University of Oklahoma Health Sciences Center, Oklahoma City, OK 73104, USA; (P.E.P.); (J.F.B.)
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Townsend DC, Purohit N, Giannoulis K, Shtaya A. Presentation, management and outcome of primary leiomyosarcoma of the spine: A systematic review. World Neurosurg 2022; 163:25-35. [PMID: 35390494 DOI: 10.1016/j.wneu.2022.03.138] [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: 02/06/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 11/18/2022]
Abstract
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.
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Affiliation(s)
- Dominic Charles Townsend
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Wessex Neurological Centre, Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
| | - Neeraj Purohit
- Department of Clinical Radiology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Kyriakos Giannoulis
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Anan Shtaya
- Wessex Spinal Unit, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom; Wessex Neurological Centre, Department of Neurosurgery, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
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