1
|
Øines MN, Smith HG, Preisler L, Penninga L. Leiomyosarcoma of the abdomen and retroperitoneum; a systematic review. Front Surg 2024; 11:1375483. [PMID: 39086921 PMCID: PMC11288885 DOI: 10.3389/fsurg.2024.1375483] [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: 01/23/2024] [Accepted: 06/24/2024] [Indexed: 08/02/2024] Open
Abstract
Background Intraabdominal and retroperitoneal leiomyosarcomas are rare cancers, which cause significant morbidity and mortality. Symptoms, treatment and follow up differs from other cancers, and proper diagnosis and treatment of intraabdominal and retroperitoneal leiomyosarcomas is of utmost importance. We performed a systematic review to collect and summarize available evidence for diagnosis and treatment for these tumours. Methods We performed a systematic literature search of Pubmed from the earliest entry possible, until January 2021. Our search phrase was (((((colon) OR (rectum)) OR (intestine)) OR (abdomen)) OR (retroperitoneum)) AND (leiomyosarcoma). All hits were evaluated by two of the authors. Results Our predefined search identified 1983 hits, we selected 218 hits and retrieved full-text copies of these. 144 studies were included in the review. Discussion This review summarizes the current knowledge and evidence on non-uterine abdominal and retroperitoneal leiomyosarcomas. The review has revealed a lack of high-quality evidence, and randomized clinical trials. There is a great need for more substantial and high-quality research in the area of leiomyosarcomas of the abdomen and retroperitoneum. Systematic Review Registration PROSPERO, identifier, CRD42023480527.
Collapse
Affiliation(s)
- Mari Nanna Øines
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | - Louise Preisler
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Luit Penninga
- Department of Surgery and Transplantation, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
2
|
Fickenscher M, Gvozdenovic N, Ponsel O. Diagnostic and therapy of an early-stage primary leiomyosarcoma of the sigmoid colon: A case report. Clin Case Rep 2024; 12:e9178. [PMID: 39005578 PMCID: PMC11245400 DOI: 10.1002/ccr3.9178] [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: 06/01/2024] [Revised: 07/11/2024] [Accepted: 07/06/2024] [Indexed: 07/16/2024] Open
Abstract
Key Clinical Message Primary leiomyosarcoma of the colon is a very rare tumor entity. Because of unspecific findings, diagnostic can be challenging. Most cases are diagnosed in advanced stages with poor overall survival. Unclear histological findings of smooth muscle cell tissue in colon biopsies together with a tumor of the colon wall in computed tomography (CT) imaging should lead to the differential diagnosis of primary colonic leiomyosarcoma and further diagnostic procedures. Abstract Primary colonic leiomyosarcoma is an extremely rare tumor entity arising from smooth muscle cells in the colon wall. Only 0.1% of all colorectal malignancies are leiomyosarcomas. Most patients are diagnosed in advanced disease stages. The overall survival rates are low, and recurrence rates are high. Only few data regarding the outcome in localized early disease stages are available. We report the case of an early-stage primary leiomyosarcoma of the sigmoid colon treated with surgical resection. We present the case of a 53-year-old male patient who underwent a colonoscopy due to intermittent rectal bleeding. Colonoscopy revealed an intraluminal polypoid growing tumor in the sigmoid colon. A biopsy was performed with inconclusive histological results. A CT scan revealed a process in the sigmoid colon with wall thickening; there was no evidence of metastatic lesions. After laparoscopic oncological resection of the sigmoid colon, histological examination surprisingly revealed a localized high-grade leiomyosarcoma. Primary leiomyosarcoma of the colon is a rare tumor entity and diagnostic can be challenging. Only a few patients with colonic leiomyosarcoma diagnosed in localized early disease stages and treated with complete surgical resection have been reported in the literature. These patients seem to have a better prognosis with longer overall survival. Because of unspecific diagnostic findings and the lack of symptoms in early disease stages, interdisciplinary collaborations between gastroenterologists, radiologists, pathologists, and surgeons are crucial for early diagnosis and treatment.
Collapse
Affiliation(s)
- M Fickenscher
- Department of General and Visceral Surgery Klinikum Bayreuth Bayreuth Germany
| | - N Gvozdenovic
- Department of General and Visceral Surgery Klinikum Bayreuth Bayreuth Germany
| | - O Ponsel
- Department of General and Visceral Surgery Klinikum Bayreuth Bayreuth Germany
| |
Collapse
|
3
|
Lee SH, Bae SH, Lee SC, Ahn TS, Kim Z, Jung HI. Curative resection of leiomyosarcoma of the descending colon with metachronous liver metastasis: A case report. World J Gastrointest Surg 2023; 15:992-999. [PMID: 37342841 PMCID: PMC10277942 DOI: 10.4240/wjgs.v15.i5.992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 01/23/2023] [Accepted: 04/07/2023] [Indexed: 05/26/2023] Open
Abstract
BACKGROUND Leiomyosarcoma (LMS) has a poor prognosis and rarely originates from the colon. If resection is possible, surgery is the first treatment most commonly considered. Unfortunately, no standard treatment exists for hepatic metastasis of LMS; although, several treatments, such as chemotherapy, radiotherapy, and surgery, have been used. Subsequently, the management of liver metastases remains controversial.
CASE SUMMARY We present a rare case of metachronous liver metastasis in a patient with LMS originating from the descending colon. A 38-year-old man initially reported abdominal pain and diarrhea over the previous two months. Colonoscopy revealed a 4-cm diameter mass in the descending colon, 40 cm from the anal verge. Computed tomography revealed intussusception of the descending colon due to the 4-cm mass. The patient underwent a left hemicolectomy. Immunohistochemical analysis of the tumor revealed that it was positive for smooth muscle actin and desmin, and negative for cluster of differentiation 34 (CD34), CD117, and discovered on gastrointestinal stromal tumor (GIST)-1, which are characteristic of gastrointestinal LMS. A single liver metastasis developed 11 mo post-operatively; the patient subsequently underwent curative resection thereof. The patient remained disease-free after six cycles of adjuvant chemotherapy (doxorubicin and ifosfamide), and 40 and 52 mo after liver resection and primary surgery, respectively. Similar cases were obtained from a search of Embase, PubMed, MEDLINE, and Google Scholar.
CONCLUSION Early diagnosis and surgical resection may be the only potential curative options for liver metastasis of gastrointestinal LMS.
Collapse
Affiliation(s)
- Soo-Hyeon Lee
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Sang-Ho Bae
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Sang-Cheol Lee
- Department of Internal Medicine, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Tae-Sung Ahn
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| | - Zisun Kim
- Department of Surgery, Soonchunhyang University Bucheon Hospital, Bucheon 14584, Gyeonggi, South Korea
| | - Hae-Il Jung
- Department of Surgery, Soonchunhyang University Cheonan Hospital, Cheonan 31151, Chungnam, South Korea
| |
Collapse
|
4
|
Metastasectomy in Leiomyosarcoma: A Systematic Review and Pooled Survival Analysis. Cancers (Basel) 2022; 14:cancers14133055. [PMID: 35804827 PMCID: PMC9264936 DOI: 10.3390/cancers14133055] [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: 05/28/2022] [Revised: 06/20/2022] [Accepted: 06/20/2022] [Indexed: 12/10/2022] Open
Abstract
Simple Summary Leiomyosarcoma (LMS) is an aggressive soft tissue sarcoma with a poor prognosis. Approximately 40% of patients will develop metastatic disease. The optimal treatment for patients with metastatic LMS is not well established, and there are no randomized controlled trials regarding metastasectomy. This systematic review and pooled survival analysis aims to assess the survival in patients undergoing a metastasectomy for LMS and compare the outcomes based on the site of metastasectomy. We identified that patients with LMS metastases in the lungs, liver, spine, and brain can undergo metastasectomy with acceptable survival. Two studies have compared survival outcomes between patients treated and not treated with metastasectomy; despite their low quality, these studies support a survival benefit associated with metastasectomy. Abstract This study assesses the survival in patients undergoing metastasectomy for leiomyosarcoma (LMS) and compares the outcomes by the site of metastasectomy. We conducted a systematic review and pooled survival analysis of patients undergoing metastasectomy for LMS. Survival was compared between sites of metastasectomy. We identified 23 studies including 573 patients undergoing metastasectomy for LMS. The pooled median survival was 59.6 months (95% CI 33.3 to 66.0). The pooled median survival was longest for lung metastasectomy (72.8 months 95% CI 63.0 to 82.5), followed by liver (34.8 months 95% CI 22.3 to 47.2), spine (14.1 months 95% CI 8.6 to 19.7), and brain (14 months 95% CI 6.7 to 21.3). Two studies compared the survival outcomes between patients who did, versus who did not undergo metastasectomy; both demonstrated a significantly improved survival with metastasectomy. We conclude that surgery is currently being utilized for LMS metastases to the lung, liver, spine, and brain with acceptable survival. Although low quality, comparative studies support a survival benefit with metastasectomy. In the absence of randomized studies, it is impossible to determine whether the survival benefit associated with metastasectomy is due to careful patient selection rather than a surgical advantage; limited data were included about patient selection.
Collapse
|
5
|
Hong L, Wang YN, Zhang X, Zhou X, Fan S, Xu M, Zhang S, Jiang D. Colorectal leiomyosarcoma with BRCA2 mutation benefit from treatment with olaparib: a case report. J Gastrointest Oncol 2022; 13:1499-1504. [PMID: 35837171 DOI: 10.21037/jgo-22-419] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 06/01/2022] [Indexed: 12/27/2022] Open
Abstract
Background Colorectal leiomyosarcoma (LMS) is a rare colorectal malignancy accounting for approximately 1% of all colorectal malignancies with a poor prognosis and limited treatment options. Targeted therapies have been applied for breast cancer 2 (BRCA2) alterations, but their role remains to be explored in colorectal LMS. This case could provide clinical proof for the application of olaparib for LMS patients. Case Description Here, we present a case of colorectal LMS with BRCA2 alterations who was treated with olaparib and achieved progression-free survival (PFS) for 1 year. In August 2016, a 46-year-old female patient was admitted to hospital due to a mass in the left lower abdomen and was diagnosed with LMS of the sigmoid colon. After surgical resection, chemotherapy with ifosfamide or ifosfamide combined with pirarubicin was given and achieved stable disease (SD) until the disease progressed 1.5 years later. Afterwards, a multi-target tyrosine kinase inhibitor, anlotinib, was taken. Before the observation of lung and liver metastasis, the patient's disease was stable for 1 year. BRCA2 mutation and rearrangement was revealed by next-generation sequencing (NGS), and the targeted therapy, olaparib, was given. Efficacy evaluation showed SD for 1 year, and no obvious toxic and side effects were observed. Conclusions Our case suggested that NGS should be considered for further treatment of patients with colorectal LMS, and poly (ADP-ribose) polymerase (PARP) inhibitors could be a feasible therapy for LMS patients with BRCA2 alterations.
Collapse
Affiliation(s)
- Lei Hong
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Ya-Nan Wang
- Pathology Department, Affiliated Hospital of Hebei University, Baoding, China
| | - Xue Zhang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Xinliang Zhou
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shaoshuang Fan
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mian Xu
- Shanghai OrigiMed Co., Ltd., Shanghai, China
| | | | - Da Jiang
- Department of Medical Oncology, The Fourth Hospital of Hebei Medical University, Shijiazhuang, China
| |
Collapse
|
6
|
Lorenzo Pagliai, Annicchiarico A, Morini A, Montali F, Virgilio E, Costi R. The double challenge (preoperative diagnosis and surgical approach) of primary leiomyosarcoma of the sigmoid colon. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022124. [PMID: 35421072 PMCID: PMC10510961 DOI: 10.23750/abm.v93is1.11652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 06/27/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND AIM Primary colonic leiomyosarcoma (cLMS) is a rare malignancy of muscularis mucosae or muscularis propria showing highly aggressive behaviour and poor prognosis. To date, making a preoperative diagnosis and performing the most appropriate treatment represent laborious tasks for the clinicians. On the one hand, in fact, cLMS diagnosis is often difficult to achieve preoperatively because of the low specificity of clinical, radiological and bioptical features: for these motives, the diagnosis is usually obtained at postoperative histology/immune-histochemistry. On the other hand, although surgery represents the mainstay of multi-modal treatment, in the current era of minimally invasive surgery the optimal approach to cLMS is debated: in the absence of a standardized and unanimous algorithm, in fact, laparoscopy is usually proposed for small tumors, whereas laparotomy for masses exceeding 4 cm in diameter. Our aim was to elucidate such two aspects by reporting our experience. METHODS We present the case of a 51-year-old man affected with a 6-cm LMS of the sigmoid colon. RESULTS Preoperative diagnosis was achieved through a preoperative echo-endoscopic biopsy. The lesion was successfully and safely managed by laparoscopic surgery. CONCLUSIONS Our case suggests that a preoperative diagnosis of cLMS is possible in an appropriate setting. Moreover, laparoscopy seems to be a safe and successful approach to resect cancers even larger than the common 4 centimetres proposed by the current literature.
Collapse
Affiliation(s)
| | | | - Andrea Morini
- Department of Medicine and Surgery, University of Parma, Parma (PR), Italy..
| | - Filippo Montali
- Department of General Surgery, di Vaio Hospital, Fidenza (PR), Italy.
| | - Edoardo Virgilio
- Department of General Surgery, di Vaio Hospital, Fidenza (PR), Italy.
| | - Renato Costi
- Department of Medicine and Surgery, University of Parma, Parma (PR), Italy..
| |
Collapse
|
7
|
Massaras D, Kontis E, Stamatis K, Zampeli E, Myoteri D, Primetis E, Pantiora E, Fragulidis G. Primary leiomyosarcoma of the colon with synchronous liver metastasis. Rare Tumors 2022; 14:20363613221080549. [PMID: 35360880 PMCID: PMC8961372 DOI: 10.1177/20363613221080549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 01/27/2022] [Indexed: 12/02/2022] Open
Affiliation(s)
- Dimitrios Massaras
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Elissaios Kontis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Konstantinos Stamatis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Evanthia Zampeli
- Department of Gastroenterology Alexandra General Hospital, Athens Greece
| | - Despoina Myoteri
- Department of Pathology, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | | | - Eirini Pantiora
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| | - Georgios Fragulidis
- 2ndDepartment of Surgery, National and Kapodistrian University of Athens, Aretaieio Hospital, Athens, Greece
| |
Collapse
|
8
|
Tsuzaka S, Asahi Y, Kamiyama T, Kakisaka T, Orimo T, Nagatsu A, Aiyama T, Uebayashi T, Kamachi H, Matsuoka M, Wakabayashi K, Otsuka T, Matsuno Y, Taketomi A. Laparoscopic liver resection for liver metastasis of leiomyosarcoma of the thigh: a case report. Surg Case Rep 2022; 8:47. [PMID: 35307790 PMCID: PMC8934789 DOI: 10.1186/s40792-022-01400-1] [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: 02/10/2022] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background Although there is no established treatment strategy for liver metastasis of leiomyosarcoma, liver resection has been reported to be effective in some cases. However, almost all liver resections performed for liver metastasis of primary leiomyosarcoma are reported to be open resections, and there are few reports of liver resection performed by laparoscopy. Here, we report a case of laparoscopic liver resection for liver metastasis of a leiomyosarcoma in the right thigh.
Case presentation An 80-year-old man was diagnosed with leiomyosarcoma of the right thigh with liver metastasis. The primary tumor was first resected, and he was discharged on the 25th postoperative day. Four months after primary tumor resection, a laparoscopic right posterior sectionectomy was performed. There were no postoperative complications, and the patient was discharged on the 11th postoperative day with a histopathological diagnosis of liver metastasis of leiomyosarcoma and negative resection margins. Currently, 9 months have passed since the resection of the primary tumor, and 5 months have passed since the laparoscopic liver resection; there is no recurrence. Conclusions The liver metastasis of leiomyosarcoma was successfully removed, with good short-term outcomes after the laparoscopic liver resection. Laparoscopic liver resection seems to be effective for liver metastasis of leiomyosarcoma, which is characterized by a high recurrence rate after surgery. However, more case studies may be necessary to examine the effectiveness and long-term results of laparoscopic liver resection for the treatment of liver metastasis of leiomyosarcoma.
Collapse
Affiliation(s)
- Shoichi Tsuzaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoh Asahi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan.
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuhiko Kakisaka
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Tatsuya Orimo
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akihisa Nagatsu
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeshi Aiyama
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takeyuki Uebayashi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Hirofumi Kamachi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Masatake Matsuoka
- Department of Orthopaedic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Kento Wakabayashi
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Takuya Otsuka
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Yoshihiro Matsuno
- Department of Surgical Pathology, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Hospital, Kita-ku, Kita 15, Nishi 7, Sapporo, Hokkaido, 060-8638, Japan
| |
Collapse
|
9
|
Seely KD, Morgan AD, Hagenstein LD, Florey GM, Small JM. Bacterial Involvement in Progression and Metastasis of Colorectal Neoplasia. Cancers (Basel) 2022; 14:1019. [PMID: 35205767 PMCID: PMC8870662 DOI: 10.3390/cancers14041019] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 02/06/2023] Open
Abstract
While the gut microbiome is composed of numerous bacteria, specific bacteria within the gut may play a significant role in carcinogenesis, progression, and metastasis of colorectal carcinoma (CRC). Certain microbial species are known to be associated with specific cancers; however, the interrelationship between bacteria and metastasis is still enigmatic. Mounting evidence suggests that bacteria participate in cancer organotropism during solid tumor metastasis. A critical review of the literature was conducted to better characterize what is known about bacteria populating a distant site and whether a tumor depends upon the same microenvironment during or after metastasis. The processes of carcinogenesis, tumor growth and metastatic spread in the setting of bacterial infection were examined in detail. The literature was scrutinized to discover the role of the lymphatic and venous systems in tumor metastasis and how microbes affect these processes. Some bacteria have a potent ability to enhance epithelial-mesenchymal transition, a critical step in the metastatic cascade. Bacteria also can modify the microenvironment and the local immune profile at a metastatic site. Early targeted antibiotic therapy should be further investigated as a measure to prevent metastatic spread in the setting of bacterial infection.
Collapse
Affiliation(s)
- Kevin D. Seely
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Amanda D. Morgan
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Lauren D. Hagenstein
- College of Osteopathic Medicine, Rocky Vista University, Ivins, UT 84738, USA; (A.D.M.); (L.D.H.)
| | - Garrett M. Florey
- College of Osteopathic Medicine, Rocky Vista University, Parker, CO 80134, USA;
| | - James M. Small
- Department of Biomedical Sciences, Rocky Vista University, Parker, CO 80134, USA;
| |
Collapse
|
10
|
Al Laham O, Albrijawy R, Atia F, Shaheen J, AlTabbakh H. Spindle Cell Sarcoma (SCS); a case of primary leiomyosarcoma (LMS) of the sigmoid colon presented as intestinal obstruction. J Surg Case Rep 2021; 2021:rjab515. [PMID: 34876975 PMCID: PMC8643466 DOI: 10.1093/jscr/rjab515] [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: 09/25/2021] [Accepted: 10/25/2021] [Indexed: 11/12/2022] Open
Abstract
Leiomyosarcoma (LMS) is a common form of soft tissue sarcoma. Primary colonic LMS is an extremely rare entity, comprising 1-2% of gastrointestinal malignancies. Primary mesenchymal sarcomas of the gastrointestinal system are rare and constitute just 0.1-3% of all gastrointestinal tumours. LMS is the most common variant of such tumours and represents just 0.12% of colorectal malignancies. We present a case of a 65-year-old female, who presented to the emergency department with 3 days history of obstipation and generalized abdominal pain. Radiology (X-ray and ultrasound) indicated a large pelvic mass compressing the sigmoid colon and its surrounding structures. Histopathological analysis indicated a primary LMS of the sigmoid colon. Diagnosis is established mostly postoperatively after histopathological evaluation. Prognosis and treatment modalities for this aggressive malignancy remain insufficient. LMS is relatively impervious to chemotherapy/radiotherapy. Our patient was treated by surgical excision of the tumour and referred postoperatively for adjuvant chemotherapy.
Collapse
Affiliation(s)
- Omar Al Laham
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria
| | - Reham Albrijawy
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria
| | - Fareed Atia
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria
| | - Jack Shaheen
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria
| | - Hani AlTabbakh
- Department of Surgery, Al-Mouwasat University Hospital, Mazzah, Damascus, Syria
| |
Collapse
|
11
|
Mesenteric Lymph Node Recurrence of a Primary Colorectal Leiomyosarcoma. Case Rep Surg 2020; 2020:6935834. [PMID: 32257499 PMCID: PMC7125469 DOI: 10.1155/2020/6935834] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 03/16/2020] [Indexed: 12/14/2022] Open
Abstract
Primary colorectal leiomyosarcoma is an excessively rare entity. It is associated with an aggressive behavior and typically favor hematogenous spread. The current standard of care is surgical resection. A 49-year-old patient presented with a 2-month history of fever. A PET-scan revealed a hypermetabolic mass in the transverse colon, and colonoscopy confirmed a tumor. A right hemicolectomy was performed. Histopathological diagnosis was of a leiomyosarcoma. Fourteen months after the surgery, a follow-up abdominal scan revealed a 2 cm mesenteric lymph node that was hypermetabolic on PET-scan. The mesenteric lymph node was resected and histopathology confirmed a leiomyosarcoma metastasis. This case opens the controversy on the management of rare lymph node recurrences in colorectal leiomyosarcoma.
Collapse
|
12
|
Nassif MO, Habib RA, Almarzouki LZ, Trabulsi NH. Systematic review of anorectal leiomyosarcoma: Current challenges and recent advances. World J Gastrointest Surg 2019; 11:334-341. [PMID: 31523383 PMCID: PMC6715585 DOI: 10.4240/wjgs.v11.i8.334] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 08/10/2019] [Accepted: 08/13/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The anorectal leiomyosarcoma (LMS) is an aggressive malignant neoplasm. Owing to the rarity of LMSs, an optimal treatment modality has yet to be determined.
AIM To collect all published data on anorectal LMS characteristics, explore current treatment options, and review recent cases of postradiation LMS.
METHODS A literature search of the PubMed electronic database was conducted using the MeSH terms “rectal neoplasms”, “anus neoplasms” and “gastrointestinal neoplasms” combined with “leiomyosarcoma”. The search was limited to English language and human studies. All available case reports and case series of anal or rectal LMSs that were published from the beginning of January 1996 to May 2017 were included if the diagnosis of LMS had been confirmed by histopathologic examination. Data were analyzed using simple statistics (mean, median, and standard deviation). Independent sample t-test was used to compare means for continuous variables.
RESULTS A total of 27 articles reporting on 51 cases of anorectal LMS were identified. Among these cases, 11.7% had undergone previous pelvic radiotherapy (developing LMS at 13-35 years afterwards). Anorectal LMS affected the rectum in 92.2% of the cases, and no sex-based predominance was observed. Surgical resection with negative margins remains the mainstay of treatment, which can be accomplished with wide local excision or radical resection. The local recurrence rate was higher among cases who received wide local excision (30%), as compared to radical resection (20%); however, the overall rate of metastasis was 51.61% regardless of the treatment approach. The use of neoadjuvant radiation lowers the risk of local recurrence compared to adjuvant radiotherapy, and facilitates R0 resection of the tumor. Cases treated with adjuvant chemotherapy showed better rates of distant recurrence and overall survival. Nonetheless, multidisciplinary team discussion is necessary to determine the optimal management plan whilst considering patient- and disease-related factors.
CONCLUSION A multidisciplinary team approach, considering the underlying patient- and disease- related factors, is necessary for optimal management of these complex tumors.
Collapse
Affiliation(s)
- Mohammed O Nassif
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Razan A Habib
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Luai Z Almarzouki
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| | - Nora H Trabulsi
- Department of Surgery, King Abdulaziz University, Jeddah 21589, Saudi Arabia
| |
Collapse
|
13
|
Abstract
OPINION STATEMENT Soft tissue sarcomas are rare cancers with an expected incidence of about 14,000 new cases in 2018, and account for less than 1% of all cancers. It includes in excess of 75 heterogeneous subtypes with varying biology, molecular aberrations, and variable response to treatment. Because of the rarity of these tumors and the many different subtypes, there is no large-scale data to guide treatment, and hence the need for a multidisciplinary individualized approach to treatment, preferably at a high-volume tertiary referral center. For localized disease, surgery with or without radiation is the preferred treatment. In metastatic disease, the longest track record is with use of anthracyclines, either alone or in combination with ifosfamide, but the median overall survival even with combination was just over a year. There have been recent advances in understanding the heterogeneity of these tumors and the need for an individualized approach. With that new knowledge, recent approvals of trabectedin, eribulin, and pazopanib have been limited to some select histologic subtypes with improved outcomes. More recently, immunotherapy has been tested in select histotypes of sarcoma with encouraging activity and has led to further evaluation in combination with immunotherapeutic agents, as well as with chemotherapy and radiation treatments. Here, in this article, we summarize the data of the currently approved therapies in metastatic soft tissue sarcoma, with the principal focus on first-line therapies. We also review the recent encouraging data with PDGFR-targeted antibody (olaratumab) with doxorubicin which showed an impressive improvement in overall survival in phase II study. Molecular characterization of sarcoma subtypes will likely improve understanding of these very diverse tumors and improve target characterization. The ongoing efforts in better understanding these rare tumors hold the key to make a difference in the outcome of these patients.
Collapse
Affiliation(s)
- Megan Meyer
- Internal Medicine, Mayo Clinic, 5777 E Mayo Blvd., Phoenix, AZ, 85054, USA
| | - Mahesh Seetharam
- Hematology and Oncology, Mayo Clinic, 5881 E Mayo Blvd., Phoenix, AZ, 85054, USA.
| |
Collapse
|
14
|
Fukui K, Takase N, Miyake T, Hisano K, Maeda E, Nishimura T, Abe K, Kozuki A, Tanaka T, Harada N, Takamatsu M, Kaneda K. Review of the literature laparoscopic surgery for metastatic hepatic leiomyosarcoma associated with smooth muscle tumor of uncertain malignant potential: Case report. World J Hepatol 2018; 10:402-408. [PMID: 29713398 PMCID: PMC5924371 DOI: 10.4254/wjh.v10.i4.402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 03/10/2018] [Accepted: 04/03/2018] [Indexed: 02/06/2023] Open
Abstract
Metastatic hepatic leiomyosarcoma is a rare malignant smooth muscle tumor. We report a case of metastatic hepatic leiomyosarcoma associated with smooth muscle tumor of uncertain malignant potential (STUMP). A 68-year-old female presented with a liver mass (60 mm × 40 mm, Segment 4). She underwent left salpingo-oophorectomy for an ovary tumor with STUMP in a broad ligament 6 years ago. Though FDG-PET showed obvious metabolically active foci, abnormal metabolically active foci other than the lesion were not detected. A malignant liver tumor was strongly suspected and laparoscopic partial liver resection was performed with vessel-sealing devices using the crush clamping method and Pringle maneuver. Immunohistochemical findings revealed metastatic liver leiomyosarcoma associated with STUMP in a broad ligament. This case is an extremely rare case of malignant transformation from primary STUMP to metastatic hepatic leiomyosarcoma. It provides important evidence regarding the treatment for metastatic hepatic leiomyosarcoma associated with STUMP.
Collapse
Affiliation(s)
- Keisuke Fukui
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Nobuhisa Takase
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Taiichiro Miyake
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Koji Hisano
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Eri Maeda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Tohru Nishimura
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Koichiro Abe
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Akihito Kozuki
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Tomohiro Tanaka
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Naoki Harada
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Manabu Takamatsu
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| | - Kunihiko Kaneda
- Department of Surgery, Kakogawa Central City Hospital, Kakogawa 675-8611, Japan
| |
Collapse
|
15
|
Primary Leiomyosarcoma of the Colon: A Report of Two Cases, Review of the Literature, and Association with Immunosuppression for IBD and Rheumatoid Arthritis. Case Rep Surg 2018; 2018:6824643. [PMID: 29780656 PMCID: PMC5892970 DOI: 10.1155/2018/6824643] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2017] [Accepted: 01/10/2018] [Indexed: 01/17/2023] Open
Abstract
Primary leiomyosarcomas (LMS) of the colon are rare and aggressive neoplasms and have been infrequently reported in the literature. These tumors are more aggressive and have poorer prognoses than adenocarcinoma of the colon and are often mistaken as such on initial evaluation. While the former has a clear association with inflammatory bowel disease (IBD), this correlation is not known to exist with LMS and IBD. Nor is there a known link between LMS and the immunosuppression for IBD, despite the known association between malignancy and immunosuppression for other diseases. Due to the low prevalence of this disease entity, there is limited knowledge and literature on the approach to diagnosing and treating these neoplasms, especially in the setting of the aforementioned comorbidities. Here, we describe two cases of this rare entity, presenting in two different circumstances: one in the setting of immunosuppression for IBD and arthritis, with a synchronous urothelial carcinoma, and the second appearing as the source of an acute abdomen. Both diagnoses were established following pathologic analysis.
Collapse
|