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Koruga N, Rončević A, Koruga AS, Rajc J, Flam J, Rotim T, Turk T, Škiljić S, Cesarik M, Paun T. A rare presentation of leiomyosarcoma metastasis to the cervical spine: A case report and a brief review. Surg Neurol Int 2024; 15:128. [PMID: 38741997 PMCID: PMC11090574 DOI: 10.25259/sni_66_2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Accepted: 03/24/2024] [Indexed: 05/16/2024] Open
Abstract
Background Leiomyosarcoma (LMS) is a rare malignancy that originates from smooth muscle. The most common sites of metastases include the lungs, liver, kidney, and skin. Notably, metastases of LMS to the central nervous system/or spine are extremely rare. When a cervical spinal LMS lesion was encountered, the patient successfully underwent gross total tumor resection with negative margins. Case Description A 63-year-old female had undergone an anterior cervical C5-C7 diskectomy and fusion 18 years ago and resection of a retroperitoneal LMS 3 years ago. She newly presented with right-sided numbness and pain of 2 months duration that correlated with a focal right-sided C5-level hemiparesis (i.e., 4/5 motor strength). When the cervical magnetic resonance demonstrated a right-sided C5 intralaminar mass with extension into the C5-C6 foramen, she underwent posterior tumor resection; pathologically, this proved to be an LMS metastasis. Respectively, 1- and six months postoperatively, follow-up magnetic resonance imaging scans showed no tumor recurrence; she tolerated adjuvant oncological treatment accompanied by physical therapy. However, in one postoperative year, the lesion recurred, and she is presently under consideration for additional surgical management. Conclusion Gross total surgical resection is the first line of treatment for patients with metastatic LMS. Here, a patient with a C5 laminar/C5-C6 foraminal bony LMS metastasis underwent posterior tumor resection accompanied by adjuvant oncological treatment but exhibited disease recurrence within one postoperative year.
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Affiliation(s)
- Nenad Koruga
- Department of Neurosurgery, University Hospital Center Osijek, Osijek, Croatia
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Alen Rončević
- Department of Neurosurgery, University Hospital Center Osijek, Osijek, Croatia
| | - Anamarija Soldo Koruga
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Neurology, University Hospital Center Osijek, Osijek, Croatia
| | - Jasmina Rajc
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Pathology and Forensic Medicine, University Hospital Center Osijek, Osijek, Croatia
| | - Josipa Flam
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Oncology, University Hospital Center Osijek, Osijek, Croatia
| | - Tatjana Rotim
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, Osijek, Croatia
| | - Tajana Turk
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Diagnostic and Interventional Radiology, University Hospital Center Osijek, Osijek, Croatia
| | - Sonja Škiljić
- Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
- Department of Anesthesiology and Critical Care, University Hospital Center Osijek, Osijek, Croatia
| | - Marijan Cesarik
- Department of Neurology, Požega County Hospital, Požega, Požeško-Slavonska, Croatia
| | - Tomislav Paun
- Department of Neurology, Požega County Hospital, Požega, Požeško-Slavonska, Croatia
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Contartese D, Bandiera S, Giavaresi G, Borsari V, Griffoni C, Gasbarrini A, Fini M, Salamanna F. Postoperative Survival and Clinical Outcomes for Uterine Leiomyosarcoma Spinal Bone Metastasis: A Case Series and Systematic Literature Review. Diagnostics (Basel) 2022; 13:diagnostics13010015. [PMID: 36611309 PMCID: PMC9818380 DOI: 10.3390/diagnostics13010015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 12/24/2022] Open
Abstract
Spinal bone metastases from uterine leiomyosarcoma (LMS) are relatively uncommon and few data are present in the literature. In this study, cases of nine consecutive patients who underwent spinal surgery for metastatic uterine LMS between 2012 and 2022 at a single institution were retrospectively reviewed. The recorded demographic, operative, and postoperative factors were reviewed, and the functional outcomes were determined by changes in Frankel grade classification during follow-up. A systematic review of the literature was also performed to evaluate operative and postoperative factors and outcomes for patients with the same gynecological metastases to the spine. For our cases, the mean time between primary tumors to bone metastases diagnosis was 5.2 years, and the thoracic vertebrae were the most affected segment. Overall, median survival after diagnosis of metastatic spine lesions was 46 months. For the systematic review, the mean time between primary tumors to bone metastases was 4.9 years, with the lumbar spine as the most involved site of metastasis. Overall, median survival after diagnosis was 102 months. Once a spinal bone lesion from LMS is identified, surgical treatment can be beneficial and successful in alleviating symptoms. Further efforts will be crucial to identify prognostic markers as well as therapeutic targets to improve survival in these patients.
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Affiliation(s)
- Deyanira Contartese
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
- Correspondence:
| | - Stefano Bandiera
- Spine Surgery, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Gianluca Giavaresi
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Veronica Borsari
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | | | | | - Milena Fini
- Scientific Direction, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
| | - Francesca Salamanna
- Complex Structure of Surgical Sciences and Technologies, IRCCS Istituto Ortopedico Rizzoli, 40136 Bologna, Italy
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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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4
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Clinical outcomes and survivals after total en bloc spondylectomy for metastatic leiomyosarcoma in the spine. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:3237-3244. [DOI: 10.1007/s00586-020-06461-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 05/02/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
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5
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He S, Xu Y, Li J, Zhang Y, Wei H, Xiao J. Leiomyogenic tumor of the spine: surgical treatments and long-term outcomes of 12 consecutive patients. J Neurosurg Spine 2019; 32:89-97. [PMID: 31585418 DOI: 10.3171/2019.7.spine19650] [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: 06/03/2019] [Accepted: 07/12/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Leiomyogenic tumor of the spine is rare with limited published information. Here, the authors report the clinical features and long-term surgical outcomes and investigate the prognostic factors affecting disease-free survival (DFS). METHODS Twelve patients presented to the authors' institution for surgical treatment from January 2005 to December 2018. The clinical characteristics and outcomes were retrospectively reviewed, and the DFS rate was estimated using the Kaplan-Meier method. The log-rank test was used to identify the potential prognostic factors, with p < 0.05 considered statistically significant. RESULTS The mean patient age was 49.7 ± 12.9 years (range 22-73 years). Four patients underwent marginal en bloc resection, and 8 patients underwent conventional piecemeal resection. Pathological diagnosis revealed leiomyosarcoma in 9 patients and leiomyoma in 3 patients. Three patients had tumor recurrence at a mean follow-up of 10.4 months (range 7.0-15.0 months), while 4 developed metastases at an average of 13.8 months (range 5.5-21.3 months) postoperatively. During the mean follow-up of 33.7 months (range 9.6-78.5 months), the estimated 1- and 5-year DFS rates were 66.7% and 38.2%, respectively. Albumin loss > 20 g/L after surgery, Ki-67 positivity > 10%, and piecemeal resection were correlated with worse DFS. CONCLUSIONS Surgical management of spinal leiomyogenic tumors is challenging due to the high rate of recurrence and metastases. En bloc resection should be performed in eligible patients. Albumin loss > 20 g/L and the Ki-67 index may be independent factors affecting prognosis.
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Lung metastases regression with increased CD8+ T lymphocyte infiltration following preoperative spinal embolization and total en bloc spondylectomy using tumor-bearing frozen autograft in a patient with spinal metastatic leiomyosarcoma. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2018; 28:41-50. [PMID: 30465309 DOI: 10.1007/s00586-018-5831-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2018] [Accepted: 11/12/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE To report systemic immunological enhancement following preoperative spinal embolization and total en bloc spondylectomy (TES) using tumor-bearing frozen autograft in a patient with spinal metastatic leiomyosarcoma. METHODS A 44-year-old woman with metastatic uterine leiomyosarcoma of the lung and L1 vertebra underwent TES following bilateral three-level preoperative segmental artery embolization. Resected tumor-bearing lamina was frozen using liquid nitrogen and used as tumor-bearing bone graft for spinal reconstruction. RESULTS Tumor necrosis and obstructing material used in preoperative embolization were detected in the resected specimen of L1. Five days after TES, chest computed tomography scan demonstrated decreased solitary lung mass size without adjuvant treatment. Lobectomy was performed for the lung metastasis 42 days after TES. Infiltration of CD8+ T lymphocyte into tumor tissue significantly increased in shrunk lung metastasis. On the other hand, slight infiltration in both the resected L1 and primary uterine lesion was observed. Six months after TES, activities of daily living were normal with no evidence of local recurrence or distant metastasis. One year after TES, however, lung CT revealed occurrence of another lung metastasis, and molecular-targeting therapy (pazopanib) was initiated. CONCLUSIONS There were no reports demonstrating metastasis regression with CD8+ T lymphocyte infiltration after TES. This case demonstrated that preoperative tumor embolization combined with TES using tumor-bearing autograft provided both a local radical cure and systemic antitumor immunological enhancement, although the long-term effect can be limited.
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7
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Kawabata Y, Aoki T, Yamamoto T, Yasui H, Sawai S, Fukuda S, Kawarazaki S, Tsukahara T. Pazopanib-mediated Long-term Disease Stabilization after Local Recurrence and Distant Metastasis of Primary Intracranial Leiomyosarcoma: A Case Report on the Efficacy of Pazopanib as a Salvage Therapy. NMC Case Rep J 2018; 5:1-7. [PMID: 29354331 PMCID: PMC5767479 DOI: 10.2176/nmccrj.cr.2017-0048] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 05/16/2017] [Indexed: 11/20/2022] Open
Abstract
Primary intracranial leiomyosarcoma (LMS) is an extremely rare tumor of the central nervous system. Only sporadic case reports have been published, and therefore data regarding long-term prognosis remain scarce. A 76-year-old woman presented with a right parietal mass, which had grown rapidly in the month prior to admission. Neuroimaging showed a resemblance to intraosseous meningioma. Gross total resection of the tumor was achieved, and histological diagnosis confirmed LMS. Because positron emission tomography (PET) with fluorodeoxyglucose (FDG) just after the resection showed no abnormal uptake, we diagnosed the tumor as primary intracranial LMS. Follow-up PET at 16 months after treatment showed two foci of FDG uptake in the bilateral lungs. Histological diagnosis by surgical resection identified the lesions as lung metastases of LMS. In addition, follow-up head magnetic resonance imaging (MRI) at 31 months showed local recurrence, and we conducted salvage therapy using CyberKnife system (Accuray incorporated) and pazopanib. To date, for 15 months after local recurrence, she is alive with intracranial recurrent disease remained inactive.
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Affiliation(s)
- Yasuhiro Kawabata
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tomokazu Aoki
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tetsurou Yamamoto
- Department of Pathology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Hisateru Yasui
- Department of Medical Oncology, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Satoru Sawai
- Department of Chest Surgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Shunichi Fukuda
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Satoru Kawarazaki
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
| | - Tetsuya Tsukahara
- Department of Neurosurgery, National Hospital Organization Kyoto Medical Center, Kyoto, Kyoto, Japan
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8
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A Rare Intramedullary Spinal Cord Metastasis from a Retroperitoneal Leiomyosarcoma Presenting as a Non-Traumatic Spinal Cord Injury. Am J Phys Med Rehabil 2017. [PMID: 28628542 DOI: 10.1097/phm.0000000000000651] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Leiomyosarcoma (LMS) is a rare but well-recognized malignant soft tissue sarcoma of smooth muscle origin. Metastases commonly occur in the lungs, liver, kidney, brain, and bone. Cases of metastatic osseous lesions or other extradural space-occupying masses secondary to LMS leading to neurologic compromise are relatively commonplace in the literature. Conversely, cases of intramedullary spinal cord metastasis (ISCM), an unusual entity as a sequela of any cancer, are exceedingly rare as a consequence of LMS. Only 2 cases of an ISCM from LMS are currently documented in the literature, and to the best of our knowledge, no case is described in the rehabilitation literature. This case report presents a patient with a history of longstanding metastatic LMS presenting with incomplete paraplegia, neurogenic bowel and bladder, and neuropathic pain. The patient was found to have an ISCM of the thoracic spinal cord. She made functional gains with concurrent inpatient rehabilitation and radiation but was unable to perform her own intermittent catheterization program, bowel program, or transfers and was unable to discharge home independently. Intramedullary spinal cord metastasis is a rare and potentially devastating consequence of LMS or any primary cancer, but can be amenable to common interventions in the acute inpatient rehabilitation setting.
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9
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Drapeau-Zgoralski V, Doyon J, Berthiaume MJ, Mottard S. Uterine lipoleiomyosarcoma: Complete medullary compression as presentation of a solitary metastasis. Gynecol Oncol Rep 2017; 21:7-9. [PMID: 28560297 PMCID: PMC5440249 DOI: 10.1016/j.gore.2017.04.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2017] [Revised: 04/10/2017] [Accepted: 04/24/2017] [Indexed: 11/30/2022] Open
Abstract
A rare case of lipoleiomyosarcoma. Patient presented at our center with paraplegia caused by a solitary vertebral metastasis of a uterine cancer. Lobectomy performed for a solitary lung metastasis.
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Affiliation(s)
| | - Josée Doyon
- Hôpital Maisonneuve-Rosemont, Montreal, QC, Canada
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10
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Agarwal N, Hansberry DR, Kavi A, Agarwal P, Baisre A, Goldstein IM. Prognostic Differences: Epstein-Barr Virus-Associated Primary Leiomyosarcoma of the Spine Versus Spinal Leiomyosarcoma Metastases. World Neurosurg 2016; 99:484-490. [PMID: 28011357 DOI: 10.1016/j.wneu.2016.12.035] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 12/09/2016] [Accepted: 12/10/2016] [Indexed: 12/25/2022]
Abstract
OBJECTIVE The authors studied 6 cases of osseous leiomyosarcoma of the spine. Two of these cases were of immunocompromised human immunodeficiency virus (HIV)-positive patients with Epstein-Barr virus (EBV)-associated primary vertebral leiomyosarcomas. The remaining 4 cases were of patients with leiomyosarcoma metastases to the spine. METHODS Each patient underwent surgical resection of their vertebral mass; however, the patients with the EBV-associated tumors had the best postoperative prognosis. RESULTS The HIV-positive patients have had no further local recurrence, while the other 4 patients had rapid local recurrences requiring multiple surgical interventions. Furthermore, the patients living with HIV have lived longer with fewer leiomyosarcoma-related health complications. CONCLUSIONS These findings suggest that EBV-associated vertebral leiomyosarcoma is of a less aggressive variety than metastatic leiomyosarcoma of the spine.
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Affiliation(s)
- Nitin Agarwal
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA; Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - David R Hansberry
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Ami Kavi
- Department of Medicine, Mount Sinai School of Medicine, New York, New York, USA
| | - Prateek Agarwal
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Ada Baisre
- Department of Pathology, Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Ira M Goldstein
- Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey, USA.
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Strong MJ, Rosenlof T, Padmanabha S, Weiner RS, Morgan LR, Ware ML. Treatment of recurrent metastatic uterine leiomyosarcoma of the spine: a multimodality approach using resection, radiosurgery, and chemotherapy. J Neurosurg Spine 2015; 23:607-612. [PMID: 26186448 PMCID: PMC4715988 DOI: 10.3171/2015.1.spine14640] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The authors describe the case of a patient who initially presented with uterine leiomyosarcoma (LMS) that later metastasized to the spine. The patient was treated at another institution for her primary uterine LMS, undergoing resection followed by adjuvant chemotherapy. After several years of disease remission, the patient presented in January 2011 to the authors' institution with recurrent uterine LMS metastatic to the spine, which has been treated with multiple therapeutic modalities in a combination of surgery, radiosurgery, and chemotherapy. As a result of this approach, the patient has been progression free for 35 months since her presentation (April 2011 to March 2014). We herein describe our experience treating this patient with recurrent uterine LMS of the spine and suggest that patients with recurrent uterine LMSs should be considered for treatment using a multimodality approach with emphasis on enrollment into clinical trials.
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Affiliation(s)
- Michael J. Strong
- Tulane University School of Medicine
- Department of Pathology, Tulane University
- Tulane Cancer Center, New Orleans
| | | | | | - Roy S. Weiner
- Tulane University School of Medicine
- Tulane Cancer Center, New Orleans
- Department of Medicine, Section of Hematology and Medical Oncology, Tulane University School of Medicine
| | | | - Marcus L. Ware
- Department of Neurosurgery, Ochsner Medical Center, New Orleans, Louisiana
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12
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Liu A, Sankey EW, Goodwin CR, Kosztowski TA, Elder BD, Bydon A, Witham TF, Wolinsky JP, Gokaslan ZL, Sciubba DM. Postoperative survival and functional outcomes for patients with metastatic gynecological cancer to the spine: case series and review of the literature. J Neurosurg Spine 2015; 24:131-44. [PMID: 26360144 DOI: 10.3171/2015.3.spine15145] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Spinal metastases from gynecological cancers are rare, with few cases reported in the literature. In this study, the authors examine a series of patients with spinal metastases from gynecological cancer and review the literature. METHODS The cases of 6 consecutive patients who underwent spine surgery for metastatic gynecological cancer between 2007 and 2012 at a single institution were retrospectively reviewed. The recorded demographic, operative, and postoperative factors were reviewed, and the functional outcomes were determined by change in Karnofsky Performance Scale and the American Spine Injury Association (ASIA) score during follow-up. A systematic review of the literature was also performed to evaluate outcomes for patients with similar gynecological metastases to the spine. RESULTS In this series, details regarding metastatic gynecological cancers to the spine are as follows: 2 patients with cervical cancer (both presented at age 46 years, mean postoperative survival of 32 months), 2 patients with endometrial cancer (mean age of 40 years, mean postoperative survival of 26 months), and 2 patients with leiomyosarcoma (mean age of 44 years, mean postoperative survival of 20 months). All patients presented with pain, and no complications were noted following surgery. All patients with known follow-up had stable or improved neurological outcomes, performance status, and improved pain, without local recurrence of tumor. Overall median survival after diagnosis of metastatic spine lesions for all cases in the literature as well as those treated by the authors was 15 months. When categorized by type, median survival of patients with cervical cancer (n = 2), endometrial cancer (n = 26), and leiomyosarcoma (n = 16) was 32, 10, and 22.5 months, respectively. CONCLUSIONS Gynecological cancers metastasizing to the spine are rare. In this series, overall survival following diagnosis of spinal metastasis and surgery was 27 months, with cervical cancer, endometrial cancer, and leiomyosarcoma survival being 32, 26, and 20 months, respectively. Combined with literature cases, survival differs depending on primary histology, with decreasing survival from cervical cancer (32 months) to leiomyosarcoma (22.5 months) to endometrial cancer (10 months). Integrating such information with other patient factors may more accurately guide decision making regarding management of such spinal lesions.
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Affiliation(s)
- Ann Liu
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Eric W Sankey
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - C Rory Goodwin
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Benjamin D Elder
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Ali Bydon
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Timothy F Witham
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Ziya L Gokaslan
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Hospital, Baltimore, Maryland
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13
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Pacheco-Nuñez JA, Sheppard JE, Mahoney AP. Distal ulna leiomyosarcoma treated with custom polymethylmethacrylate prosthesis with a 4-year follow-up. Hand (N Y) 2015; 10:541-6. [PMID: 26330792 PMCID: PMC4551620 DOI: 10.1007/s11552-014-9725-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND Intraosseous leiomyosarcoma is a rare neoplasm having an aggressive biologic behavior. The distal end of the ulna is a very uncommon site for this type of primary bone tumor frequently mistaken for benign lesions. En bloc resection of the distal ulna with reconstruction is a valid option as a limb salvage procedure for the treatment of this difficult problem, minimizing local recurrence while preserving hand function. CASE DESCRIPTION We present an unusual case of a 63-year-old woman with a primary leiomyosarcoma arising from the distal end of the ulna treated successfully with a wide excision and custom distal ulna, with 4-year follow-up and no recurrence. LITERATURE REVIEW Tumors to develop at the distal end of the ulna have been reported as part of large series such as Dahlin and few case reports. According to Cooney, Exner, and Mankin, reconstruction for distal ulnar neoplasms is not necessary to maintain function. However, Noble and Laurentin-Perez disagree because stabilization of the distal ulna following large resection, as in our case, can be a significant problem with associated pain and weakness due to a decreased interosseous space with ulnar stump impingement on the radial metaphysis and ulnar translation of the carpus. CLINICAL RELEVANCE Custom methacrylate in situ radioulnar joint prosthesis for reconstruction of a large segment of the distal ulna can be a valid option to reestablish the mechanical continuity of the forearm, reducing pain and improving strength and function.
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Affiliation(s)
| | - Joseph E. Sheppard
- Department of Orthopaedic Surgery, University of Arizona Medical Center, P.O. Box 245064, Tucson, AZ 85724-5064 USA
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14
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MR Imaging Findings of a Leiomyosarcoma of the Thoracic Spine: A Case Report. Clin Neuroradiol 2015; 26:229-33. [PMID: 26170221 DOI: 10.1007/s00062-015-0420-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2015] [Accepted: 06/05/2015] [Indexed: 10/23/2022]
Abstract
We report a case of leiomyosarcoma of the thoracic spine. Primary leiomyosarcoma is a malignant connective tissue tumor originating from smooth muscle cells. Leiomyosarcoma frequently occurs in the uterus, retroperitoneal space, gastrointestinal tract, and deep soft tissues; primary leiomyosarcoma of the bone is rare. The MR imaging including intravoxel incoherent motion (IVIM) imaging findings of the current case indicated a low diffusion coefficient and high blood flow, which were in concurrence with high cell density on histology and increased vascularity by angiography. Although some benign tumors such as osteoblastoma and giant cell tumor would show similar findings on IVIM imaging, these additional imaging features may narrow the differential diagnosis of spinal tumors.
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Sun Z, Wang H, Yang H, Jiang W. Leiomyosarcoma metastatic to the cervical spine causing a C6 compression fracture: A case report. Oncol Lett 2014; 8:263-265. [PMID: 24959258 PMCID: PMC4063593 DOI: 10.3892/ol.2014.2132] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 04/24/2014] [Indexed: 11/18/2022] Open
Abstract
Leiomyosarcoma is a rare malignant tumor derived from smooth muscle cells, which commonly metastasizes to the lungs, liver, kidney, brain and skin. The current study presents the case of a 42-year-old male who presented with progressive neck pain and numbness of the left arm. Spinal computed tomography and magnetic resonance imaging revealed osteolytic lesions of numerous vertebrae (C2, C3, C4, C5, C6, C7, T1 and T2). With regard to the C6 vertebra, total destruction of the vertebral body resulted in vertebral collapse and subsequent spinal cord compression. The patient underwent an anterior C6 corpectomy, reconstruction with a mesh cage filled with polymethyl methacrylate (PMMA) and open PMMA infusion to C5 and C7. The surgical procedure significantly alleviated the symptoms and obtained a reliable reconstruction. The clinical follow-up examination at 13 months was uneventful with the exception of mild numbness of the left hand since the surgery. To the best of our knowledge, this is the first case of leiomyosarcoma recurrence presenting in the cervical spine, and the present study provides insight into the use of a surgical technique that has rarely been used in the cervical spine.
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Affiliation(s)
- Zhenzhong Sun
- Department of Orthopedics, Wuxi No. 9 People's Hospital, Wuxi, Jiangsu 214062, P.R. China
| | - Heng Wang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Huilin Yang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
| | - Weimin Jiang
- Department of Orthopedics, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu 215006, P.R. China
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Fang C, Avis I, Salomon D, Cuttitta F. Novel Phenotypic Fluorescent Three-Dimensional Platforms for High-throughput Drug Screening and Personalized Chemotherapy. J Cancer 2013; 4:402-15. [PMID: 23833685 PMCID: PMC3701810 DOI: 10.7150/jca.6780] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2013] [Accepted: 06/13/2013] [Indexed: 12/20/2022] Open
Abstract
We have developed novel phenotypic fluorescent three-dimensional co-culture platforms that efficiently and economically screen anti-angiogenic/anti-metastatic drugs on a high-throughput scale. Individual cell populations can be identified and isolated for protein/gene expression profiling studies and cellular movement/interactions can be tracked by time-lapse cinematography. More importantly, these platforms closely parallel the in vivo angiogenic and metastatic outcomes of a given tumor xenograft in the nude mouse model but, unlike in vivo models, our co-culture platforms produce comparable results in five to nine days. Potentially, by incorporating cancer patient biopsies, the co-culture platforms should greatly improve the effectiveness and efficiency of personalized chemotherapy.
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Affiliation(s)
- Changge Fang
- 1. Advanced Personalized Diagnostics LLC, 6006 Bangor Drive, Alexandria, VA 22303, USA. ; 2. Angiogenesis Core Facility, Advanced Technology Center, Room 115, Center for Cancer Research, National Cancer Institute, 8717 Grovemont Circle, Bethesda, MD 20892-4605, USA
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17
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Tan LA, Kasliwal MK, Nag S, O'Toole JE. A rare intramedullary spinal cord metastasis from uterine leiomyosarcoma. J Clin Neurosci 2013; 20:1309-12. [PMID: 23591183 DOI: 10.1016/j.jocn.2012.09.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2012] [Accepted: 09/26/2012] [Indexed: 12/19/2022]
Abstract
Leiomyosarcoma is a rare smooth-muscle-derived malignancy with a significant malignant potential. Systemic metastases are a common late complication of leiomyosarcoma typically to lungs, liver, brain and bones. We report a 44-year-old woman with a prior history of uterine leiomyosarcoma who presented to us with a cervicothoracic intramedullary lesion and recent onset of neurological deficits. She underwent surgery with histological confirmation of a diagnosis of metastatic leiomyosarcoma, which was followed by adjuvant radiation and chemotherapy. To our knowledge there is no prior report of intramedullary spinal cord metastases (ISCM) from a leiomyosarcoma in the English literature. We report the present patient in view of the rarity of ISCM and its clinical significance. Even though ISCM are unusual, they should be suspected in any patient with primary malignancy irrespective of the histology. The overall prognosis remains grim irrespective of the treatment modality chosen and recognition of the same is important in preoperative counseling and overall treatment approach.
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Affiliation(s)
- Lee A Tan
- Department of Neurosurgery, 1725 West Harrison Street, Suite 855, RUSH University Medical Center, Chicago, IL 60612, USA
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18
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Helmchen C, Greggersen W, Geaid A, Nowak G, Bos I, Petersen D. Intramedullary spinal metastasis of a gastrointestinal leiomyosarcoma without vertebral bone lesions. Neurol Sci 2013; 34:2037-9. [PMID: 23479030 DOI: 10.1007/s10072-013-1341-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 02/19/2013] [Indexed: 11/29/2022]
Affiliation(s)
- C Helmchen
- Department of Neurology, University Hospitals Schleswig-Holstein, Luebeck, Germany,
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Ziewacz JE, Lau D, La Marca F, Park P. Outcomes after surgery for spinal metastatic leiomyosarcoma. J Neurosurg Spine 2012; 17:432-7. [PMID: 22938551 DOI: 10.3171/2012.8.spine12331] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Leiomyosarcoma is a smooth-muscle sarcoma that rarely metastasizes to the spine. Its clinical course is variable, although patients with metastatic leiomyosarcoma can experience prolonged survival as compared with patients with more aggressive metastatic tumors. The authors report their single-institution experience in the surgical treatment of patients with leiomyosarcoma metastatic to the spine. METHODS A retrospective review of the electronic medical records was performed to obtain details on clinical management and outcomes for patients who had undergone surgical intervention for metastatic leiomyosarcoma of the spine. The few articles available in the current literature on this topic were also analyzed. RESULTS Eight patients with metastatic leiomyosarcoma of the spine underwent surgical management between 2005 and 2011. Six patients (75%) had improvement in their Nurick grade. Patients who had presented with pain as a primary symptom experienced significant relief. Five patients (63%) had lesion recurrence, and 4 underwent repeat surgery at a mean of 10.2 months after their initial surgery. The mean duration of survival was 11.7 months (range 3.3-23.0 months). CONCLUSIONS Leiomyosarcoma rarely metastasizes to the spine. However, surgical intervention can relieve pain and improve neurological function. Given the potential for prolonged survival, aggressive management should be considered in well-selected patients.
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Affiliation(s)
- John E Ziewacz
- Department of Neurosurgery, University of Michigan Medical School, Ann Arbor, Michigan 48109-5338, USA
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Shirzadi A, Drazin D, Shirzadi N, Westhout F, Drazin N, Fan X, Acosta FL. Metastatic Leiomyosarcoma to the Spine Complicated With Thrombocytopenia. World J Oncol 2012; 3:182-186. [PMID: 29147302 PMCID: PMC5649841 DOI: 10.4021/wjon481w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2012] [Indexed: 11/03/2022] Open
Abstract
Uterine leiomyosarcomas do not frequently metastasize to the bone, and spinal column metastases are even less common. Surgery is the treatment of choice. Adjuvant radiation with or without chemotherapy depending on the extent of disease can be beneficial. We present the case of leiomyosarcoma metastasis to the spine with a previous history of known primary disease complicated by thrombocytopenia. Thrombocytopenia can present surgical challenges, but can also be present concurrently unrelated to the primary disease. A thorough evaluation is needed to rule out any underlying lymphoproliferative disorder or microangiopathic phenomenon.
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Affiliation(s)
- Ali Shirzadi
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Doniel Drazin
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Neda Shirzadi
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Franklin Westhout
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Noam Drazin
- Department of Internal Medicine, Division of Hematology/Oncology, Cedars Sinai Medical Center, Los Angeles, CA, USA
| | - Xuemo Fan
- Department of Pathology and Laboratory Medicine, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Frank L Acosta
- Department of Neurosurgery, Cedars Sinai Medical Center, Los Angeles, CA, USA
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Multifocal osteolytic lesions within lumbar spine in a middle-aged Chinese woman: a benign metastasizing leiomyoma? Spine (Phila Pa 1976) 2012; 37:E259-63. [PMID: 21857396 DOI: 10.1097/brs.0b013e31822e9578] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Case report. OBJECTIVE To describe a case presented as osteolytic lesions involving 2 inconsecutive lumbar, which was pathologically proved to be of smooth muscular origin. SUMMARY OF BACKGROUND DATA Smooth muscle tumor of uncertain malignant potential (STUMP) could be diagnosed when the neoplasm showed some malignant behavior, whereas its histologic image revealed very low malignance. A 47-year-old woman presented with low back pain and numbness of the left lower extremity attributable to osteolytic lesions in the second and fourth lumbar vertebral bodies, which was subsequently diagnosed as STUMP. A benign metastasizing leiomyoma was highly suspected. METHODS Clinical, pathologic, and radiologic characters of the patient with STUMP confined within the lumbar spine were retrospectively reviewed. A mini review was also conducted. RESULTS We describe the first spine-confined case of STUMP. CONCLUSION Significant new information in the growing literature of this rare and newly identified diagnosis has addressed the need for orthopedists to consider the STUMP diagnosis.
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Cytogenetic evidence of metastatic myxoid liposarcoma and therapy-related myelodysplastic syndrome in a bone marrow biopsy. Hum Pathol 2009; 40:1040-4. [DOI: 10.1016/j.humpath.2008.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2008] [Revised: 12/10/2008] [Accepted: 12/12/2008] [Indexed: 11/21/2022]
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Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA. Treatment of early uterine sarcomas: disentangling adjuvant modalities. World J Surg Oncol 2009; 7:38. [PMID: 19356236 PMCID: PMC2674046 DOI: 10.1186/1477-7819-7-38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/08/2009] [Indexed: 11/10/2022] Open
Abstract
Uterine sarcomas are a rare group of neoplasms with aggressive clinical course and poor prognosis. They are classified into four main histological subtypes in order of decreasing incidence: carcinosarcomas, leiomyosarcomas, endometrial stromal sarcomas and "other" sarcomas. The pathological subtype demands a tailored approach. Surgical resection is regarded as the mainstay of treatment. Total abdominal hysterectomy and bilateral salpingo-oophorectomy represents the standard treatment of uterine sarcomas. Pelvic and para-aortic lymph node dissection in carcinosarcomas is recommended, given their high incidence of lymph node metastases, and may have a role in endometrial stromal sarcomas. Adjuvant radiation therapy has historically been of little survival value, but it appears to improve local control and may delay recurrence. Regarding adjuvant chemotherapy, there is little evidence in the literature supporting its use except for carcinosarcomas. However, more trials are needed to address these issues, especially, their sequential application. Patients with uterine sarcomas should be referred to large academic centers for participation in clinical trials.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece.
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