Leiomyosarcoma of the Nasal Cavity

[Radiation-induced parotid leiomyosarcoma]

INTRODUCTION

First case of radiation-induced parotid leiomyosarcoma.

ANATOMO-CLINICAL OBSERVATION

A 50-year-old woman with a history of cervical irradiation for Hodgkin's lymphoma presented with a right parotid tumefaction. Examination noted a deep adherent pretragal mass with peripheral facial palsy. A total parotidectomy with intra-operative examination and cervical curage was performed. Histopathological analysis concluded to a grade 3 parotid leiomyosarcoma according to the National Federation of Cancer Centers. Adjuvant radiotherapy was performed. After 24 months of follow-up, the patient presented bone and liver metastases without local recurrence.

DISCUSSION

This is the first case of radiation-induced leiomyosarcoma and the 12th case of parotid leiomyosarcoma described in the literature. The management associates surgery with adjuvant radiotherapy. Follow-up is by clinical examination, parotid MRI, and annual thoracoabdominal CT scan to search for metastases. Recurrences occur during the first year in 40 to 64% of cases, and distant metastases in 40 to 60% of cases. The 5-year survival rate is between 10 and 30%.

Endoscopic finding of leiomyosarcoma in a neurofibromatosis patient

A man with a history of neurofibromatosis presented to our hospital with a soft palate mass. Since the patient had neurofibromatosis, we diagnosed the mass as a neurofibroma and planned annual regular follow-up without any treatment. Five months later, the patient visited our emergency department because of uncontrolled epistaxis, and the mass was enlarged to the extent of the airway obstruction. Endoscopic resection was performed and the tumor was confirmed to be a leiomyosarcoma. The malignant potential of the new lesion in a neurofibromatosis patient should be actively evaluated and treated, if required.

Endoscopic Treatment of Sinonasal Leiomyosarcoma: A Case Report in Light of the Literature

A 49-year-old Japanese man presented with a rare case of sinonasal leiomyosarcoma with left nasal bleeding for 12 months. He had no history of irradiation or malignancies, including retinoblastoma. Preoperative histological examination suggested vascular leiomyoma. Complete resection with endoscopic surgery was performed. Histological examination during the operation suggested that the tumor was a leiomyoma. However, immunohistochemical staining for α smooth muscle actin and desmin were helpful in establishing a definitive diagnosis of sinonasal leiomyosarcoma. The resection margins were positive for tumor cells. Staging with CT of the neck and thorax, ultrasound of the abdomen, and MRI of the head ruled out metastases. Second endoscopic tumor resection surgery was performed for positive resection margins. The patient's condition was successfully managed with additional excision, and he remains well with no evidence of recurrence and metastasis 36 months after treatment. Endoscopic management should be considered in suitable cases.