Subcutaneus leiomyosarcoma of the neck: a case report

Do Posterior Neck Lumps Need Ultrasound Evaluation: A Case Series of 623 Neck Ultrasound Studies at a Single Institution

INTRODUCTION/OBJECTIVES

Neck lumps are a common presentation to primary care services. The aetiology of posterior neck lumps is poorly explored in the literature, and therefore remain a concern to patients and clinicians. This often results in an urgent referral for ultrasound assessment. The authors of this study sought to evaluate the aetiology of posterior neck lumps from a radiological perspective, to assess whether ultrasound can be used as a useful adjunct, rather than a first-line urgent investigation.

METHODS

A retrospective case series was carried out, examining all primary care referred ultrasound studies for assessment of posterior neck lumps, performed at a single institution in Essex, United Kingdom, over a period of over 10 years dating between 2nd February 2012 to 8th November 2022. Data was collected on: patient age at the time of study, patient sex, whether the lump was single or multiple as palpated and documented by the primary care physician, size of the lump to the nearest 0.5 cm as documented on ultrasound using the longest dimension, sonographic diagnosis and any follow up imaging (not limited to ultrasound).

RESULTS

A total of 623 neck ultrasounds were performed on 615 adults. Of the overall radiological diagnoses made from the 623 scans, 555 (89.09%) scans were benign, 63 (10.11%) scans had no lump found on sonography, and 3 (0.48%) scans showed malignancy. In the remaining 2 (0.32%) scans, the lump was deemed indeterminate. The most common aetiologies for benign lumps were due to: normal lymph nodes (n = 263; 42.21%), lipomas (n = 152; 24.39%), and benign dermal cysts (n = 105; 16.85%). All 3 malignant cases had co-existing anterior and posterior neck lumps.

CONCLUSIONS

Given that the overwhelming majority of posterior neck lumps in our study had benign findings, we propose that patients with solitary or even multiple posterior neck lumps alone, regardless of size can either be investigated routinely or can be reassured depending on other clinical examination characteristics. Patients who have the presence of co-existing anterior and posterior neck palpable neck lumps justifies urgent or 2-week wait radiological investigation.

Lingual Leiomyosarcoma: A Histopathological Case Report

Leiomyosarcomas are rare malignant mesenchymal neoplasms originating from smooth muscle cells. Although leiomyosarcoma is commonly located in the female reproductive system, gastrointestinal tract, and subcutaneous tissues, it is a rare entry in the head and neck area, probably due to the scarcity of smooth muscle tissue in this topographical region. Herein we present a histopathological case report of a 60-year-old male with a slow-growing painless mass on the middle third of the right lateral lingual margin, with focal ulceration measuring 1x1.5cm. After gross excision, histopathology revealed pleomorphic spindle cells, some with bizarre nuclei and abundant pathological mitotic activity with a tendency to grow in a fascicular pattern. As the patient had the demographic characteristic and risk factors for oral cavity squamous cell carcinoma, a spindle-shaped variety (sarcomatoid) variety was suspected, and immunohistochemistry with a broad set of antibodies was used to prove the histogenetic group of the tumor. As the tumor was pan-cytokeratin and desmin negative, focally positive for caldesmon, and positive for smooth muscle actin, the diagnosis of pleomorphic leiomyosarcoma of the tongue was established.

Scalp Leiomyosarcoma: Diagnosis and Treatment During a Global Pandemic With COVID-19

Leiomyosarcoma is an aggressive, uncommon sarcoma effecting smooth muscle tissue. Prompt tissue diagnosis and staging workup are keys to preventing distant metastasis. Identification of this rare sarcoma has become increasingly difficult with decreased ability to seek out non-coronavirus disease 2019 (COVID-19) medical care. The pandemic has caused a widespread healthcare demand with providers reaching their full capacity causing care and resources to be shifted to the pandemic. We have experienced an 83-year-old male who significantly delayed to seek any medical attention for his scalp lesion for several months due to a combination of fear and decreased available appointments. Since the patient presented with a delayed scalp leiomyosarcoma, he required an extensive excision and flap reconstruction for the lesion. This case sheds light on the importance of weighing the risks and benefits associated with cancer management during the pandemic for both patients and healthcare providers. The healthcare system's response to the pandemic also played a role in this case as well, with shorter appointment times and decreased frequency of follow-up. As a result, the pandemic has had a catastrophic impact on the diagnostic pathway for cancer. This case report discusses the difficulties in diagnosing and treating a rare cancer such as scalp leiomyosarcoma amidst the global pandemic and the importance of telemedicine in improving future outcomes.

Multimodality imaging and treatment strategy for malignant scalp neoplasms in adults

Malignant scalp masses deserve much attention as they have the potential to destroy local structures, recur and metastasize to distant organs. Moreover, malignant scalp lesions are known to be more aggressive in behavior than their counterparts elsewhere in the body. Multimodality imaging is essential in narrowing the differential diagnoses of scalp masses, as well as in differentiating benign from malignant masses. Furthermore, imaging is important in (1) evaluating the extent of tumor invasion in the scalp, (2) staging the disease, (3) guiding surgical biopsy and/or resection of the tumor, (4) preoperative planning and post-treatment surveillance of scalp tumors. An interdisciplinary treatment approach is crucial for the management of scalp malignancies given their complex and aggressive nature. This review seeks to describe the unique clinical and imaging characteristics of various types of malignant scalp masses, as well as to review their current treatment strategies.

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.

Primary Leiomyosarcoma of the Mandibular Alveolar Mucosa of a 12-Year-Old Child from Ethiopia: A Case Report

Leiomyosarcomas (LMSs) are rare malignant mesenchymal tumors which show smooth-muscle differentiation. Most LMSs involving the oral tissues primarily affect the maxillary sinus, the maxillary or mandibular bone. We present a case of LMS of the mandibular alveolar mucosa, arising in a 12-year-old male child from Ethiopia. A malignant spindle cell-like neoplasm was diagnosed on clinical and radiographic findings as well as on incisional biopsy. The tumor was resected with wide margins. The following histopathologic examination with additional immunohistochemical studies secured the diagnosis LMS. Microscopically, the spindle-shaped tumor cells were arranged in an interlacing fascicular pattern and contained oval to elongated, blunt-ended (cigar-shaped) nuclei. The immunohistochemical examination showed immunoreactive tumor cells for vimentin, actin, desmin, and H-caldesmon, which is pathognomonic for LMS. Immunohistochemical studies are mandatory to differentiate the LMS from other similar spindle cell neoplastic lesions. Radical resection with safety margins and a lifelong periodic follow-up has to be recommended.

[Leiomyosarcoma of the tongue: about a case]

Le léiomyosarcome primitif de la langue est une tumeur rare qui se développe aux dépens des fibres musculaires lisses. Le diagnostic est souvent difficile, fondé sur des caractéristiques immuno-histologiques particulières. L'objectif de ce travail est de décrire le profil épidémiologique, clinique, thérapeutique et évolutif du léiomyosarcome à travers un cas et une revue de la littérature. Nous rapportons le cas d'un homme âgé de 26 ans, sans antécédents pathologique particuliers, consultant pour une tuméfaction de la langue mobile évoluant depuis 2 ans. Une biopsie de la masse a été réalisée. L’étude anatomopathologique et immunohistochimique a confirmé le diagnostic d'un léiomyosarcome de la langue. L'IRM de la langue a objectivé un processus lesionnel intéressant la portion mobile et antérieur de la langue. Une exérèse de la masse a été réalisée. L'examen histologique a montré la présence d'un large néoplasme de 6 cm compatible à un léiomyosarcome peu différencié de la langue, de garde II selon la Fédération Nationale des Centres de Lutte Contre le Cancer (FNCLCC). Une radiothérapie externe sur la cavité buccale avec une dose de 65 Gy a été réalisée. Le patient a présenté 2 mois après la fin du traitement une adénopathie latéro-cervicale haute gauche (territoire II), il a bénéficié d'un curage ganglionnaire fonctionnel intéressant les territoires I, II et III puis réadressé en radiothérapie. Le léiomyosarcome de la langue est très rare surtout chez le sujet jeune. La chirurgie et la radiothérapie sont les armes thérapeutiques majeures. Le pronostic est très mauvais, Les facteurs les plus importants sont les marges d'exérèse et le grade.

Leiomyosarcoma of the base of the tongue and free edge of the epiglottis: a case report

Introduction

We present the case of a man with a leiomyosarcoma of the base of the tongue. We feel this case is important as this kind of pathology, though rare, can occur at a site where carcinomas are more frequent.

Case presentation

A 77-year-old Caucasian man had been reporting difficulty in swallowing and hoarseness for a month before admission to our department. After several preliminary tests, including a biopsy which was positive for a malignant epithelial neoplasm which required further immunohistochemical study, we decided to operate, removing the base of our patient’s tongue and performing a total laryngectomy. Histological examination of the specimen revealed a high-grade leiomyosarcoma of the base of the tongue and of the free edge of the epiglottis.

Conclusions

We wish to stress the rarity of this clinical case, related to the site of implantation of the tumor, as confirmed by the difficulties in finding reference to this topic in the international literature. In fact, several cases of leiomyosarcoma have been described, but in different locations from that seen in our patient’s case.