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Kalantri SH, Joseph LD, Priyathersini N, Elangovan B. Epithelioid leiomyosarcoma: An unusual presentation. J Cancer Res Ther 2023; 19:490-492. [PMID: 37313923 DOI: 10.4103/jcrt.jcrt_1178_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Uterine mesenchymal tumors are a heterogeneous group of neoplasms that can be diagnostically challenging. Thorough investigations and histopathological findings are highly significant to arrive at the correct diagnosis, thus ensuring appropriate and prompt treatment to the patient. Leiomyosarcoma (LMS) is an uncommon uterine malignancy, which arises from the smooth muscle of the uterine wall. They usually present in postmenopausal women with abnormal uterine bleeding. It follows an aggressive clinical course with an extremely poor prognosis. Surgical management followed by adjuvant chemotherapy is usually the treatment for such cases. Here, we report the case of a 57-year-old menopausal female who presented with a large abdominal swelling that was seen infiltrating the adjacent structures. On resection and histopathological evaluation, a diagnosis of epithelioid LMS was made, which was confirmed by immunohistochemistry.
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Affiliation(s)
- Suman H Kalantri
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Leena Dennis Joseph
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - N Priyathersini
- Department of Pathology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Babu Elangovan
- Department of Surgical Gastroenterology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
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Adewole AA, Onile TG, Ugiagbe AO, Fadahunsi OO, Awelimobor DI, Akinro O. Cervical leiomyosarcoma in a teenage girl: A rare form of uterine leiomyosarcoma. J Taibah Univ Med Sci 2021; 17:523-528. [PMID: 35722227 PMCID: PMC9170738 DOI: 10.1016/j.jtumed.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 10/01/2021] [Accepted: 10/10/2021] [Indexed: 11/29/2022] Open
Abstract
Sarcomas arising from the cervix are rare, and the reported prevalence is 0.20–0.55%. A 15-year-old Para 0+0 secondary school student presented to the emergency department in shock with a 1-year history of painless vaginal protrusion, vaginal bleeding, foul-smelling vaginal discharge, occasional passage of blood clots, fatigue, fainting episodes, and weight loss. She was resuscitated with intravenous fluids and blood transfusions. General examination revealed a young girl with a 16-week sized abdominal mass. Vaginal examination revealed a large mobile fleshy mass 14 cm by 10 cm with an offensive discharge and odour. It was externally friable, bled actively on contact, had areas of tissue necrosis, and was oedematous. It was difficult to determine the adnexa structures because of tenderness. Examination under anaesthesia showed that the mass was continuous with the cervix and was not attached to the vagina or vulva. The histology report of the biopsied specimens showed features consistent with cervical leiomyosarcoma (LMS). Cervical LMS was confirmed by immunohistochemistry and a total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed as definitive treatment. Postoperative hormone replacement therapy was initiated. The patient's postoperative condition was stable and there was no tumour recurrence for >2 years on follow-up. Making a diagnosis and instituting surgical and adjuvant treatments for LMS in a low-resource setting are challenging. This is due to lack of access to universal healthcare coverage. A multidisciplinary approach with early diagnosis and complete surgical resection of the tumour provides the most favourable possibility of an improved survival and quality of life.
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Affiliation(s)
- Adebayo A. Adewole
- Department of Obstetrics and Gynecology, Federal Medical Center, Lokoja, Nigeria
- Corresponding address: Fertility and Minimal Access Surgery Unit, Department of Obstetrics and Gynecology, Federal Medical Centre, No. 1, Saliu Ibrahim Way, PMB 1001, Lokoja, Kogi State, Nigeria.
| | - Temitope G. Onile
- Department of Obstetrics and Gynecology, Federal Medical Center, Lokoja, Nigeria
| | - Austin O. Ugiagbe
- Department of Obstetrics and Gynecology, Federal Medical Center, Lokoja, Nigeria
| | - Oluwaseyi O. Fadahunsi
- Department of Histopathology and Morbid Anatomy, Federal Medical Center, Lokoja, Nigeria
| | - Daniel I. Awelimobor
- Department of Histopathology and Morbid Anatomy, Federal Medical Center, Lokoja, Nigeria
| | - Omotayo Akinro
- Department of Obstetrics and Gynecology, Federal Medical Center, Lokoja, Nigeria
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Characterization and Preoperative Risk Analysis of Leiomyosarcomas at a High-Volume Tertiary Care Center. Int J Gynecol Cancer 2018; 27:1183-1190. [PMID: 28463949 DOI: 10.1097/igc.0000000000000940] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Uterine morcellation in minimally invasive surgery has recently come under scrutiny because of inadvertent dissemination of malignant tissue, including leiomyosarcomas commonly mistaken for fibroids. Identification of preoperative risk factors is crucial to ensure that oncologic care is delivered when suspicion for malignancy is high, while offering minimally invasive hysterectomies to the remaining patients. OBJECTIVES The aim of this study was to characterize risk factors for uterine leiomyosarcomas by reviewing preoperative, intraoperative, and postoperative data with an emphasis on the presence of concurrent fibroids. METHODS A retrospective case-control study of women undergoing hysterectomy with pathologic diagnosis of uterine leiomyosarcoma at a tertiary care center between January 2005 and April 2014. RESULTS Thirty-one women were identified with leiomyosarcoma and matched to 124 controls. Cases with leiomyosarcoma were more likely to have undergone menopause and to present with larger uteri (19- vs 9-week sized), with the most common presenting complaint being a pelvic mass (35.5% vs 8.9%). Controls were ten times more likely to have undergone a tubal ligation (30.6% vs 3.2%). Endometrial sampling detected malignancy preoperatively in only 50% of cases. Leiomyosarcomas were more commonly present when pelvic masses were identified in addition to fibroids on preoperative imaging. Most leiomyosarcoma cases (77.4%) were performed by oncologists via an abdominal approach (83.9%), with only 2 of 31 leiomyosarcomas being morcellated. Comparative analysis of preoperative imaging and postoperative pathology showed that in patients with leiomyosarcoma, fibroids were misdiagnosed 58.1% of the time, and leiomyosarcomas arose directly from fibroids in only 6.5% of cases. CONCLUSIONS Leiomyosarcoma risk factors include older age/postmenopausal status, enlarged uteri of greater than 10 weeks, and lack of previous tubal ligation. Preoperative testing failed to definitively identify leiomyosarcomas, although the presence of synchronous pelvic masses in fibroid uteri should raise clinical suspicion. Given the difficulty of preoperative identification, future efforts should focus on the development of safer minimally invasive techniques for uterine morcellation.
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Clinicopathological correlations in leiomyosarcoma of the uterine corpus – a short series of cases and literature review. GINECOLOGIA.RO 2018. [DOI: 10.26416/gine.21.3.2018.1949] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
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Hope I, Morton K, Newlands C, Butler-Manuel S, Madhuri TK. Lockjaw from a metastatic uterine leiomyosarcoma- case report and review of the literature. BMC WOMENS HEALTH 2017; 17:119. [PMID: 29179757 PMCID: PMC5704575 DOI: 10.1186/s12905-017-0472-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 11/13/2017] [Indexed: 11/24/2022]
Abstract
Background Leiomyosarcoma (LMS) is a malignant tumour formed of cells with distinct smooth muscle features. Leiomyosarcomas rarely metastasise to the oral cavity and this literature review details all reported cases of metastasis to the mandible found in the literature. This offers a unique perspective by specifying mandible as the site of metastasis of leiomyosarcoma. Case presentation A 53-year-old female presented to her General Practitioner (GP) with heavy menstrual bleeding and was diagnosed with multiple fibroids. Folowing a hysterectomy and removal of both tubes and ovaries for these symptomatic uterine fibroids, an incidental diagnosis of low grade leiomyosarcoma was made. A CT scan found no evidence of residual or metastatic disease and no further treatment was deemed necessary. 6 months later she presented to A & E with a numb lower lip but it took another 6 months for the diagnosis of metastatic LMS to the mandible to be made. Discussion Leiomyosarcomas are aggressive tumours which are liable to metastasise and therefore have a poor prognosis. An extensive literature review was undertaken to explore the frequency of metastasis in the maxillo-facial region. Conclusions Although metastasis to the oral region is very rare as suggested from the literature review, when patients present with unusual symptoms after a diagnosis of LMS, physicians should be aware of the possibility of LMS metastases.
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Affiliation(s)
- Isabel Hope
- Faculty of Health & Medical Sciences, University of Southampton, Southampton, UK
| | - Karen Morton
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Carrie Newlands
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | | | - Thumuluru Kavitha Madhuri
- Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK. .,Department of Clinical & Experimental Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.
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Sarcoma Risk in Uterine Surgery in a Tertiary University Hospital in Germany. Int J Gynecol Cancer 2017; 27:961-966. [DOI: 10.1097/igc.0000000000000988] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Leiomyosarcoma of the Vagina: An Exceedingly Rare Diagnosis. Case Rep Obstet Gynecol 2015; 2015:363895. [PMID: 26783476 PMCID: PMC4689886 DOI: 10.1155/2015/363895] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2015] [Revised: 11/25/2015] [Accepted: 11/29/2015] [Indexed: 11/24/2022] Open
Abstract
Background. Primary leiomyosarcoma of the vagina is an exceedingly rare diagnosis. Current estimates are that this tumor could at most represent a mere 0.062% of malignant neoplasms in the female genital tract, although in actuality it is likely far less common. Case Presentation. A 70-year-old female gravida 3 para 2 with new onset palpable vaginal mass and pink vaginal discharge is diagnosed with primary leiomyosarcoma of the vagina. Chemotherapy is complicated by acute Lyme disease, and the patient requires a robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and partial vaginectomy. The patient remains without recurrence 18 months after surgery. Conclusion. Vaginal leiomyosarcoma is exceedingly rare with an aggressive course, high recurrence, and undetermined ideal treatment regimen. Its diagnosis can be delayed and its presentation varied. Information on this rare tumor type is predominantly through rare case reports with collective consensus on management lacking. The gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy.
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Matsuzono T, Chan CYH, Chan MYM. Gonadal vein leiomyosarcoma: A case report with radiological findings. Intractable Rare Dis Res 2015; 4:152-4. [PMID: 26361567 PMCID: PMC4561245 DOI: 10.5582/irdr.2015.01016] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2015] [Revised: 05/27/2015] [Accepted: 05/28/2015] [Indexed: 11/05/2022] Open
Abstract
A 56 year old postmenopausal lady presented with a rapidly enlarging pelvis mass. Clinical and ultrasonographic features were compatible with a rapidly enlarging fibroid with possible sarcomatous changes, and hence, computated tomography (CT) scan was performed to further delineate the nature and extent of the disease. However, CT scan revealed a huge tumour arising from the retroperitoneal space along the course of the left gonadal vein with typical radiological features of a gonadal vein leiomyosarcoma which were described in previous literatures. With joint collaboration with the surgeons, radical surgery with optimal debulking was subsequently performed for the patient and the diagnosis was confirmed intra-operatively and histologically.
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Affiliation(s)
- Tomoko Matsuzono
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, China
- Address correspondence to: Dr. Tomoko Matsuzono, Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, 30 Gascoigne Road, Hong Kong, China. E-mail:
| | | | - May Yuk-May Chan
- Department of Obstetrics and Gynaecology, Queen Elizabeth Hospital, Hong Kong, China
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Chen I, Hopkins L, Firth B, Boucher J, Singh SS. Incidence of Tissue Morcellation During Surgery for Uterine Sarcoma at a Canadian Academic Centre. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2015; 37:421-425. [DOI: 10.1016/s1701-2163(15)30256-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Qiu LL, Yu RS, Chen Y, Zhang Q. Sarcomas of abdominal organs: computed tomography and magnetic resonance imaging findings. Semin Ultrasound CT MR 2012; 32:405-21. [PMID: 21963162 DOI: 10.1053/j.sult.2011.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sarcomas originating from abdominal organs are extremely rare, and literature in which investigators focus on their imaging features is scarce. This article aims to review the computed tomography and magnetic resonance imaging features of these rare tumors and to help in clinical diagnosis. Various sarcomas (eg, angiosarcoma, undifferentiated embryonal sarcoma, leiomyosarcoma, carcinosarcoma, rhabdomyosarcoma) originating, respectively, from different abdominal visceral organs (liver, pancreas, spleen, kidney, adrenal gland, uterus, and prostate gland) are reviewed along with cases we encountered.
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Affiliation(s)
- Ling-Ling Qiu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Kao YH, Saad U, Tan AEH, Magsombol BM, Padhy AK. Fluorine-18-fluorodeoxyglucose PET/CT for the evaluation of suspected recurrent uterine leiomyosarcomas. Acta Radiol 2011; 52:463-6. [PMID: 21498277 DOI: 10.1258/ar.2011.100509] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
BACKGROUND Uterine leiomyosarcomas are rare and aggressive malignancies of the uterine corpus with high recurrence rates and poor prognoses. The current recommendation for detection of recurrent uterine leiomyosarcoma involves periodic physical examination and conventional imaging such as CT or MRI. The role of fluorine-18-fluorodeoxyglucose positron emission tomography with integrated computed tomography (FDG-PET/CT) in the detection of recurrent uterine leiomyosarcomas is not yet established. PURPOSE To evaluate the use of FDG-PET/CT as a single integrated modality for the evaluation of suspected recurrent uterine leiomyosarcomas. MATERIAL AND METHODS A retrospective study was performed on patients who underwent FDG-PET/CT scans for suspected recurrent uterine leiomyosarcoma. Only patients with follow-up data were included in the study. FDG-PET/CT was evaluated as a single integrated imaging modality. A positive lesion on FDG-PET/CT was defined as a focal abnormality detected on either the PET or CT components, or both. RESULTS Sixteen consecutive patients over 5 years underwent FDG-PET/CT for suspected recurrent uterine leiomyosarcoma. Five patients were excluded due to incomplete follow-up data. The remaining 11 patients were aged 36-58 years (mean age 48). FDG-PET/CT had a sensitivity of 100% (95% CI 63-100) and specificity of 100% (95% CI 20-100) for the detection of recurrent uterine leiomyosarcomas. Sites of metastases include lungs, peritoneum, liver, pancreas and breast, of which lungs and peritoneum were the most common. Two (18%) patients had discordant findings: FDG-PET negative metastatic nodules in the breast and lung detected on the CT component. The maximum standardized uptake value (SUVmax) of metastatic lesions ranged from 2.0 to 16.0 (mean 7.6). CONCLUSION FDG-PET/CT as a single integrated modality may be a useful for the evaluation of suspected recurrent uterine leiomyosarcomas. FDG-PET negative discordant nodules detected on the CT component may represent metastases and should be followed up closely.
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Affiliation(s)
- Yung Hsiang Kao
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - U Saad
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Andrew EH Tan
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Butch M Magsombol
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
| | - Ajit Kumar Padhy
- Department of Nuclear Medicine and PET, Singapore General Hospital, Singapore
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