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Cho YJ, Koh YK, Lim SC. Primary osseous leiomyosarcoma of humerus misinterpreted as aneurysmal bone cyst: A case report and literature review. Medicine (Baltimore) 2024; 103:e39762. [PMID: 39312383 PMCID: PMC11419512 DOI: 10.1097/md.0000000000039762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Accepted: 08/30/2024] [Indexed: 09/25/2024] Open
Abstract
RATIONALE Primary leiomyosarcoma of the bone (LMSB) is a rare aggressive sarcoma with limited treatment options. Histopathologic and immunohistochemical features are similar to their more common uterine and soft tissue counterparts. However, its broader spectrum of histopathologic features and rarity make diagnostic challenges. PATIENT CONCERNS We present a case of LMSB in a 20-year-old female who presented with left shoulder aching pain for 3 months. An osteolytic intramedullary lesion was found in the left proximal humeral epi-metaphysis. DIAGNOSES Initial open biopsy showed a giant cell tumor of bone with aneurysmal bone cyst (ABC)-like changes. However, an open biopsy followed by extended curettage showed LMSB with ABC-like changes. INTERVENTIONS Wide excision of the lesion and bipolar hemiarthroplasty followed by concomitant chemoradiation therapy was conducted. The mass was completely removed without significant problems. OUTCOMES Complete mass excision and symptomatic improvements were achieved, and no subsequent relapses were observed. LESSONS The authors encountered a rare case of LMSB. Most occurrences are in the lower extremity and trunk, respectively. ABC-like changes in bone tumors can lead to misdiagnosis. In this case, the ABC-like changes developed from the underlying LMSB as a secondary alteration. A careful examination of the underlying bone tumor is crucial to avoid misdiagnosing it as ABC or exhibiting ABC-like changes. Moreover, there has been no case report of LMSB with secondary ABC-like changes in bone.
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Affiliation(s)
- Yong Jin Cho
- Department of Orthopedic Surgery, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Young Kwon Koh
- Department of Pediatrics, College of Medicine, Chosun University, Gwangju, Republic of Korea
| | - Sung-Chul Lim
- Department of Pathology, College of Medicine, Chosun University, Gwangju, Republic of Korea
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2
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Niethard M, Knebel C, Leithner A, Tunn PU, Schoon J, Reichardt P, Pogkas A, Szkandera J, Pink D, Andreou D. What Is the Impact of Multimodal Treatment in Patients with Leiomyosarcoma of Bone? A Multicenter Study of 35 Patients with an Ultra-Rare Tumor Entity. Cancers (Basel) 2024; 16:1633. [PMID: 38730585 PMCID: PMC11083834 DOI: 10.3390/cancers16091633] [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: 03/29/2024] [Revised: 04/16/2024] [Accepted: 04/20/2024] [Indexed: 05/13/2024] Open
Abstract
Primary leiomyosarcoma of bone (LMSoB) is extremely rare, comprising only <0.7% of primary malignant bone tumors, and is therefore considered an ultra-rare tumor entity. There is currently no consensus as to whether therapeutic strategies should be based on the biological characteristics of soft tissue leiomyosarcoma or on primary tumor localization in the bone. The use of perioperative chemotherapy and its effectiveness in this rare tumor entity remains unclear. We aimed to evaluate the impact of different treatment approaches in a multicenter setting with a total of 35 patients included. The 5-year overall survival (OS) was 74%. Patients with localized disease undergoing surgery had a significantly higher 5-year OS compared to patients who did not undergo surgical treatment (82% vs. 0%, p = 0.0015). Axial tumor localization was associated with worse event-free survival (EFS) probability (p < 0.001) and OS (p = 0.0082). A high proportion of our patients developed secondary metastases. Furthermore, the perioperative chemotherapy protocols applied to our patients were not associated with an improved EFS or OS. Therefore, the benefit of perioperative chemotherapy in LMSoB needs to be further investigated, and the choice of agents still needs to be clarified.
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Affiliation(s)
- Maya Niethard
- Department of Orthopedic Oncology, Sarcoma Center, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany;
| | - Carolin Knebel
- Department of Orthopedics and Sports Orthopedics, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany;
| | - Andreas Leithner
- Department of Orthopedics and Trauma, Medical University of Graz, 8036 Graz, Austria; (A.L.); (D.A.)
| | - Per-Ulf Tunn
- Department of Orthopedic Oncology, Sarcoma Center, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Janosch Schoon
- Center for Orthopedics, Trauma Surgery and Rehabilitation Medicine, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, 17475 Greifswald, Germany;
| | - Peter Reichardt
- Department of Oncology, Sarcoma Center, Helios Klinikum Berlin-Buch, 13125 Berlin, Germany;
| | - Athanasios Pogkas
- Department of Hematology, Oncology and Palliative Medicine, Vivantes Klinikum Berlin Neukölln, Rudower Straße 48, 12351 Berlin, Germany;
| | - Joanna Szkandera
- Division of Clinical Oncology, Department of Internal Medicine, Medical University of Graz, 8036 Graz, Austria;
| | - Daniel Pink
- Department of Oncology, Sarcoma Center Berlin-Brandenburg, Helios Klinikum, 15526 Bad Saarow, Germany
| | - Dimosthenis Andreou
- Department of Orthopedics and Trauma, Medical University of Graz, 8036 Graz, Austria; (A.L.); (D.A.)
- Department of General Orthopedics and Tumor Orthopedics, Münster University Hospital, 48149 Münster, Germany
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3
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Shetty KJ, Kishan Prasad HL, Kotian S, Joshi D, Mathias L, Bhat S. Leiomyosarcoma of the bone: Unveiling the mystery of a spindly ossein. J Cancer Res Ther 2024; 20:1100-1102. [PMID: 39023626 DOI: 10.4103/jcrt.jcrt_265_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 11/22/2022] [Indexed: 07/20/2024]
Abstract
ABSTRACT Leiomyosarcoma (LMS) represents one of the most common soft tissue sarcomas, involving various anatomical sites like the retroperitoneum, genitourinary tract, and extremities. LMS of the bone is extremely rare, with a 0.7% incidence of all primary malignant bone tumors. They are histologically identical to the leiomyosarcomas of other sites but pose a diagnostic dilemma due to their rarity and varied presentation when it manifests as a bony lesion.
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Affiliation(s)
- K Jayaprakash Shetty
- Department of Pathology, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
| | - H L Kishan Prasad
- Department of Pathology, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
| | - Shravya Kotian
- Department of Pathology, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
| | - Divya Joshi
- Department of Pathology, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
| | - Lawrence Mathias
- Department of Orthopaedics, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
| | - Shubha Bhat
- Department of Pathology, K S Hegde Medical Academy of Nitte (Deemed to be University, Mangaluru, Karnataka, India
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4
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Zhang C, Wang J, Wu Z, Xu X. A novel conservative treatment approach for primary femoral leiomyosarcoma. Asian J Surg 2024; 47:622-623. [PMID: 37806875 DOI: 10.1016/j.asjsur.2023.09.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 09/22/2023] [Indexed: 10/10/2023] Open
Affiliation(s)
- Chun Zhang
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Jingkun Wang
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Zhonghan Wu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China
| | - Xinzhong Xu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, 230601, China.
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5
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Abu-Dayeh A, Alhyassat S. Primary leiomyosarcoma of the bone: a case report. J Pathol Transl Med 2024; 58:35-39. [PMID: 38229433 DOI: 10.4132/jptm.2023.11.14] [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: 06/17/2023] [Accepted: 11/14/2023] [Indexed: 01/18/2024] Open
Abstract
Primary leiomyosarcoma of the bone is rare. Histologically, it resembles leiomyosarcoma of soft tissue. Given the rarity of this entity, its diagnosis should be made only after clinical studies and workup have excluded metastasis from other sites. Herein, we describe an additional case of primary bone leiomyosarcoma. We report a 32-year-old female patient, who presented with right knee pain and was found to have a right distal femur mass by imaging studies. Biopsy showed a neoplasm composed of fascicles of spindle cells, arranged in different patterns, with significant pleomorphism. The tumor cells were positive for smooth muscle actin, focally positive for desmin and H-caldesmon. No other masses in the body were detected by imaging studies. The diagnosis of leiomyosarcoma of the bone was rendered. Given the broad diagnostic differential of primary bone leiomyosarcoma, it is important to be aware of this rare bone tumor phenotype and of its histomorphologic and immunohistochemical features for an accurate diagnosis.
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Affiliation(s)
- Ala Abu-Dayeh
- Anatomic Pathology Division, Hamad Medical Corporation, Doha, Qatar
| | - Samir Alhyassat
- Anatomic Pathology Division, Hamad Medical Corporation, Doha, Qatar
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Wu Z, Cheng L, Cao Q, Ye S, Yu S, Sun M, Jing J. Case report and literature review: Primary leiomyosarcoma of the bone in the trochanteric region of the femur. Front Surg 2023; 9:1045307. [PMID: 36704525 PMCID: PMC9872517 DOI: 10.3389/fsurg.2022.1045307] [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: 09/15/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023] Open
Abstract
Background Primary leiomyosarcoma of the bone (LMSB) is an extremely rare, invasive, and highly destructive primary osteosarcoma with limited treatment options and poor prognosis. Only a few case reports of LMSB have been described because of its rarity. Therefore, clinicians have a limited understanding of its diagnosis, treatment, and prognosis, and the final diagnosis depends on histopathological findings. In this report, we describe a rare case of primary LMSB in the trochanteric region of the femur. Reporting this case may increase the dissemination and understanding of information regarding LMSB and provide a reference for the diagnosis and treatment of similar cases. Case presentation A 63-year-old woman presented with pain and limited movement of the left hip, which had lasted for 3 months, with no history of trauma or illness. Plain radiography and computed tomography revealed a solitary osteolytic lesion in the trochanteric area of the left femur with focal cortical destruction. Magnetic resonance imaging findings suggested invasion of the lesion into the bone cortex, forming a soft tissue mass, although no distant positive findings were observed on a whole-body bone scan. A bone tumor puncture biopsy was performed to obtain a final diagnosis, and histopathological evaluation revealed left femoral intertrochanteric leiomyosarcoma, classified as G1T2M0 and staged as IB (extracompartmental low-grade malignant) according to the Enneking staging system. Thus, we performed extensive debridement and left hip arthroplasty. Postoperative chemotherapy was administered, and the patient was followed up for 4 years. Four years later, the patient's left hip pain had resolved, joint activity was good, and no signs of recurrence or distant metastasis of the bone tumor were noted. Conclusion For proximal femoral Enneking stage IB LMSB, extensive tumor resection combined with tumor prosthesis replacement may be an effective treatment method to prolong the patient's lifespan and to restore joint function.
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Affiliation(s)
- Zhonghan Wu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Li Cheng
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Qiliang Cao
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuming Ye
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Shuisheng Yu
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Min Sun
- Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China
| | - Juehua Jing
- Department of Orthopaedics, The Second Hospital of Anhui Medical University, Hefei, China,Institute of Orthopaedics, Research Center for Translational Medicine, The Second Hospital of Anhui Medical University, Hefei, China,Correspondence: Juehua Jing
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7
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Zhang J, Chen Y, Xing X, Wang Q, Liu K, Zhang E, Lang N. Primary leiomyosarcoma of the spine: an analysis of imaging manifestations and clinicopathological findings. Insights Imaging 2022; 13:195. [PMID: 36520263 PMCID: PMC9755377 DOI: 10.1186/s13244-022-01336-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Accepted: 11/22/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Primary leiomyosarcoma of the spine is extremely rare and lacks specific clinical symptoms. This study investigated the imaging manifestations and clinicopathological findings of primary leiomyosarcoma of the spine, aiming to improve the radiologists' understanding of the disease and reduce misdiagnoses. METHODS The clinical, imaging, and pathological manifestations in eleven patients with pathologically confirmed primary leiomyosarcoma of the spine were retrospectively analyzed. The imaging features analyzed included lesion location, shape, border, size, and density/intensity, and adjacent bone destruction status, residual bone trabeculae, vertebral compression, and contrast enhancement. RESULTS The patients' primary clinical symptom was usually focal pain. Primary leiomyosarcoma of the spine was mostly a solitary lesion and tended to occur in the posterior elements. The tumors had a lobulated shape with osteolytic bone destruction, ill-defined borders, and could involve multiple segments. Computed tomography (CT) examination showed isodense masses. Six patients showed residual bone trabeculae. Two patients had miscellany T2-weighted imaging (T2WI) signals, while the tumor and spinal cord of the remaining patients were isointense on T1-weighted imaging (T1WI) and T2WI. Among the seven patients who underwent contrast-enhanced scanning, six displayed homogeneous enhancement. Eight patients underwent gross-total tumor resection with no recurrence. CONCLUSIONS Primary leiomyosarcoma of the spine tends to be a solitary lesion in the posterior elements and appears as a lobulated mass with osteolytic bone destruction and an ill-defined border. The tumor and spinal cord can be isointense on T1WI and T2WI. Contrast-enhanced scanning displays homogeneous enhancement. The lesion tends not to recur after surgical gross-total tumor resection.
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Affiliation(s)
- Jiahui Zhang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Yongye Chen
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Xiaoying Xing
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Qizheng Wang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Ke Liu
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
| | - Enlong Zhang
- grid.449412.eDepartment of Radiology, Peking University International Hospital, Beijing, People’s Republic of China
| | - Ning Lang
- grid.411642.40000 0004 0605 3760Department of Radiology, Peking University Third Hospital, 49 North Garden Road, Haidian District, Beijing, 100191 People’s Republic of China
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8
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Mitra S, Bachchal V, Sinha A, Negi D, Chatterjee D. Primary Osseous Leiomyosarcoma with Vertebral and Nodal Metastasis in a Young Woman: A Rare Case Report. Int J Surg Pathol 2022:10668969221113476. [PMID: 35899293 DOI: 10.1177/10668969221113476] [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: 11/15/2022]
Abstract
Introduction. Primary leiomyosarcoma of bone is rarely described in the literature. In young patients, the clinical and radiological features may mimic relatively common tumours like osteosarcoma. Vertebral and nodal metastasis from osseous leiomyosarcoma is extremely uncommon. Case presentation. A 25-year-old female presented with progressively increasing pain and swelling of the right knee. Clinical and radiological features were suggestive of osteosarcoma. Pre-operative biopsy showed a malignant spindle cell tumour. The surgical resection specimen showed features of leiomyosarcoma of the right proximal tibia. On further evaluation, the patient was found to have an L3-L4 vertebral lesion and histopathological evaluation showed a similar tumour. After 11 months of initial presentation, the patient had axillary lymph node metastasis. Conclusion. Primary osseous leiomyosarcoma should be considered as a differential diagnosis even in young patients presenting with meta-diaphyseal expansile malignant bony lesions. Histology and ancillary studies can confirm the diagnosis.
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Affiliation(s)
- Saikat Mitra
- Department of Histopathology, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Vikas Bachchal
- Department of Orthopedics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anindita Sinha
- Department of Radiodiagnosis, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Deepak Negi
- Department of Orthopedics, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Debajyoti Chatterjee
- Department of Histopathology, 29751Postgraduate Institute of Medical Education and Research, Chandigarh, India
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9
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Boudou-Rouquette P, Martin E, Kempf E, Penel N, Toulmonde M, Bompas E, Duffaud F, Firmin N, Bertucci F, Kurtz JE, Chaigneau L, Isambert N, Saada-Bouzid E, Dubray-Longeras P, Larousserie F, Anract P, Chevreau C, Blay JY, Piperno-Neumann S. Rare bone sarcomas: A retrospective analysis of 145 adult patients from the French Sarcoma Group. Int J Cancer 2021; 150:825-836. [PMID: 34611903 DOI: 10.1002/ijc.33837] [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: 03/01/2021] [Revised: 08/28/2021] [Accepted: 09/13/2021] [Indexed: 11/10/2022]
Abstract
The benefit of chemotherapy (CT) in rare bone sarcomas is not documented in prospective studies. Our retrospective study from the French sarcoma network for bone tumors ResOs was performed in adult patients (pts) from 1976 to 2014, with histologically verified diagnosis of leiomyosarcomas (LMS), undifferentiated pleomorphic sarcoma (UPS) or radiation-associated sarcomas of bone. The median follow-up was 4.7 years (95% CI: 3.7-6.5). Clinical features, treatment modalities and outcomes were recorded and analyzed from 145 pts (median age 53 years [range 20-87]). Site of disease was extremities (66%) or axial skeleton (34%), 111 (77%) presented with localized and potentially resectable disease. The most common histological subtypes were UPS (58%) and LMS (33%); 58% were high-grade tumors. Surgery was performed in 127 pts. In the 111 localized pts, 28 pts (25%) underwent upfront surgery or exclusive radiotherapy (RT; >50 Gy) without CT, whereas 83 pts (75%) received either neoadjuvant (n = 26) or adjuvant CT (n = 13) or both (n = 44). Neoadjuvant and adjuvant CT was mostly doxorubicin-based (95%/86%) and cisplatin-based (67%/63%). R0 resection was achieved in 59 pts, and a good histological response in 15 patients (25%). Adjuvant RT was performed in 24 (22%) pts. For the whole cohort (n = 145), the 5-year overall survival (OS) rate was 53% [42; 62]. In univariate analysis, age ≤ 60 was associated with a longer disease-free survival (DFS) (P = .0436). Neoadjuvant and adjuvant CT tended to be associated with better DFS (P = .056) with no significant impact on OS in this retrospective series.
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Affiliation(s)
- Pascaline Boudou-Rouquette
- Department of Medical Oncology, Cochin Hospital, Paris, France.,AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France
| | - Elodie Martin
- Department of Biostatistics, Institut Claudius Regaud, Toulouse, France.,Department of Biostatistics, IUCT Oncopole, Toulouse, France
| | - Emmanuelle Kempf
- Department of Medical Oncology, Gustave-Roussy Institute, Villejuif, France
| | - Nicolas Penel
- Clinical Research and Innovation Department, Head of the General Oncology Department, Oscar Lambret Cancer Center, Lille, France
| | - Maud Toulmonde
- Department of Medical Oncology, Institut Bergonié, Bordeaux, France
| | - Emmanuelle Bompas
- Department of Medical Oncology, Centre René Gauducheau, Nantes, France
| | - Florence Duffaud
- Department of Medical Oncology, La Timone University Hospital, Marseille, France.,Department of Medical Oncology, Aix-Marseille Université (AMU), Marseille, France
| | - Nelly Firmin
- Department of Medical Oncology, Institut du Cancer de Montpellier, Montpellier, France
| | - François Bertucci
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Jean-Emmanuel Kurtz
- Department of Medical Oncology, Centre Hospitalo-Universitaire, Strasbourg, France
| | - Loïc Chaigneau
- Department of Medical Oncology, Institut Regional du Cancer en Franche-Comté-University Hospital, Besançon, France
| | - Nicolas Isambert
- Department of Medical Oncology, Centre Georges François Leclerc, Dijon, France
| | - Esma Saada-Bouzid
- Department of Medical Oncology, Centre Antoine-Lacassagne, Nice, France
| | - Pascale Dubray-Longeras
- Department of Medical Oncology, Cellular Therapy and Clinic Hematology Unit for Adults, Clermont-Ferrand, France
| | - Frédérique Larousserie
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Pathology, Cochin Hospital, Paris, France.,Department of Pathology, Paris University, Paris, France
| | - Philippe Anract
- AP-HP, Institut du Cancer Paris CARPEM (Cancer Research for PErsonalized Medicine), Paris, France.,Department of Orthopedic Surgery, Cochin Hospital, Paris, France.,Department of Orthopedic Surgery, Paris University, Paris, France
| | - Christine Chevreau
- Department of Medical Oncology, UCT-Oncopôle Institut Claudius Regaud, Toulouse, France
| | - Jean-Yves Blay
- Department of Medical Oncology, Centre Léon Bérard, LYRICAN, Universite de Lyon, Lyon, France
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Nagano A, Tsugita M, Nishimoto Y, Akiyama H, Kawai A. The 'other' bone sarcomas in Japan: a retrospective study of primary bone sarcomas other than osteosarcoma, Ewing sarcoma and chondrosarcoma, using data from the Bone Tumuor Registry in Japan. Jpn J Clin Oncol 2021; 51:1430-1436. [PMID: 34105731 DOI: 10.1093/jjco/hyab090] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 05/26/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND To date, no standard treatments for primary bone sarcomas other than those for osteosarcoma, Ewing sarcoma and chondrosarcoma have been developed. METHODS The clinical characteristics and prognostic factors of 330 patients with primary bone sarcomas other than osteosarcoma, Ewing sarcoma and chondrosarcoma, listed in a nationwide tumour registry (Bone and Soft Tissue Tumor Registry in Japan) were investigated. The effects of adjuvant chemotherapy were determined by comparing the outcomes of patients with non-metastatic bone tumours who received surgery plus chemotherapy with those of patients who underwent surgery alone. RESULTS The most common diagnosis was undifferentiated high-grade pleomorphic sarcoma. Axial site tumours (47.8%) and distant metastases at presentation (24.5%) were frequent. The 5-year overall and progression-free survival rates were 44.9 and 39.9%, respectively. Prognostic factor analysis identified surgery as an independent predictor of overall survival, and distant metastases at presentation was significant and independent predictor of both overall and progression-free survival. No significant difference in outcome was observed between patients treated with surgery alone and those treated with surgery plus chemotherapy (P = 0.71). CONCLUSIONS Patients with bone sarcomas other than osteosarcoma, Ewing sarcoma and chondrosarcoma without metastasis at presentation have a relatively good prognosis with definitive surgery; however, the benefit of adjuvant chemotherapy is unclear.
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Affiliation(s)
- Akihito Nagano
- The Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Masanori Tsugita
- The Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Yutaka Nishimoto
- The Department of Nursing Course, Gifu University School of Medicine, Gifu, Japan
| | - Haruhiko Akiyama
- The Department of Orthopaedic Surgery, Gifu University School of Medicine, Gifu, Japan
| | - Akira Kawai
- The Department of Rare Cancer Center, National Cancer Center Hospital, Chuo-ku, Tokyo, Japan
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11
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Gusho CA, Blank AT, Gitelis S. Comparison of clinicopathological features and outcomes in patients with primary leiomyosarcoma of bone and soft tissue. J Surg Oncol 2021; 123:1274-1283. [PMID: 33524203 DOI: 10.1002/jso.26404] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/06/2021] [Accepted: 01/18/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUNDS AND OBJECTIVES This investigation sought to describe the outcomes of primary leiomyosarcoma of bone (PLB) compared to soft tissue leiomyosarcoma (SLMS). METHODS This was a review of the Surveillance, Epidemiology, and End Results database from 1975 to 2016. Kaplan-Meier methods were used to estimate disease-specific survival (DSS), and a Cox regression model was used to identify prognostic factors. RESULTS Of the 7502 identifiable cases, 1% (n = 74) were PLB and 99% (n = 7428) were SLMS. Survival was the same between PLB and SLMS (p = .209). On multivariable analysis for high-grade SLMS, radiation (neoadjuvant: hazard ratio [HR], 0.56; 95% confidence interval [CI], 0.4-0.8; p = .003; adjuvant: HR, 0.75; 95% CI, 0.6-0.9; p = .008) and surgery (procedure specific) improved DSS. For PLB, wide resection/limb salvage (HR, 0.40; 95% CI, 0.3-0.5; p = .018) and amputation (HR, 0.69; 95% CI, 0.5-0.9; p < .001) were positive prognostic factors. Neither radiation nor chemotherapy were prognostic factors for survival in PLB. CONCLUSIONS For SLMS, radiation portends a survival advantage. For PLB, however, neither chemotherapy nor radiation were significant prognostic factors, which suggests the optimal treatment for PLB, similar to other primary soft tissue sarcomas originating in bone, remains an unmet medical need.
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Affiliation(s)
- Charles A Gusho
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Alan T Blank
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
| | - Steven Gitelis
- Department of Orthopedic Surgery, Section of Orthopedic Oncology, Rush University Medical Center, Chicago, Illinois, USA
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12
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Oyama R, Takahashi M, Kito F, Sakumoto M, Shiozawa K, Qiao Z, Yoshida A, Endo M, Kawai A, Kondo T. Establishment and characterization of patient-derived xenograft and its cell line of primary leiomyosarcoma of bone. In Vitro Cell Dev Biol Anim 2018; 54:458-467. [PMID: 29845452 DOI: 10.1007/s11626-018-0258-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 04/12/2018] [Indexed: 01/09/2023]
Abstract
Primary leiomyosarcoma (LMS) of bone is a rare and aggressive mesenchymal malignancy that differentiates toward smooth muscle. Complete resection is the only curable treatment, and novel therapeutic approaches for primary LMS of bone have long been desired. Patient-derived xenografts (PDXs) and cell lines are invaluable tools for preclinical studies. Here, we established PDXs from a patient with primary LMS of bone and a cell line from an established PDX. Bone primary LMS tissue was subcutaneously implanted into highly immune-deficient mice. After two passages, a piece of the tumor was subjected to tissue culturing, and a morphological evaluation and proteomic analysis were performed on the PDX and the established cell line. Moreover, the responses of the established cell line to anti-cancer drugs were examined. Microscopic observations revealed that the PDX tumors retained their original histology. The cell line was established from the third-generation PDX and named NCC-LMS1-X3-C1. The cells were maintained for over 18 mo and 40 passages. The cells exhibited a spindle shape and aggressive growth. Mass spectrometric protein identification revealed that the original tumor tissue, PDX tumor tissue, and NCC-LMS1-X3-C1 cells had similar but distinct protein expression profiles. We previously established the cell line, NCC-LMS1-C1, from the tumor tissue of same patient. We found that the response to drug treatments was different between NCC-LMS1-X3-C1 and NCC-LMS1-C1, suggesting the heterogeneous traits of tumor cells in the identical tumor tissue. This set of PDXs and stable cell line will be a useful resource for bone LMS research.
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Affiliation(s)
- Rieko Oyama
- Department of Innovative Seeds Evaluation, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Mami Takahashi
- Central Animal Division, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Fusako Kito
- Department of Innovative Seeds Evaluation, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Marimu Sakumoto
- Department of Innovative Seeds Evaluation, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Kumiko Shiozawa
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Zhiwei Qiao
- Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akihiko Yoshida
- Department of Pathology and Clinical Laboratories, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Makoto Endo
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Akira Kawai
- Division of Musculoskeletal Oncology, National Cancer Center Hospital, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan
| | - Tadashi Kondo
- Department of Innovative Seeds Evaluation, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan. .,Division of Rare Cancer Research, National Cancer Center Research Institute, 5-1-1 Tsukiji, Chuo-ku, Tokyo, 104-0045, Japan.
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13
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Sasaki T, Kawashima H, Ariizumi T, Yamagishi T, Oike N, Umezu H, Inagawa S, Hotta T, Endo N, Ogose A. Denosumab as a potential therapeutic option for leiomyosarcoma with osteoclast-like giant cells: A case report. Mol Clin Oncol 2018; 8:30-33. [PMID: 29387393 PMCID: PMC5769267 DOI: 10.3892/mco.2017.1489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2017] [Accepted: 10/26/2017] [Indexed: 11/06/2022] Open
Abstract
Bone leiomyosarcoma is a rare primary osseous malignant tumor with a high metastatic potential. Similar to other bone sarcomas, high histological grade and tumor stage are predictive of a poor outcome. We herein present our experience with treating a 64-year-old woman with bone leiomyosarcoma accompanied by multiple bone metastases. A biopsy revealed occasional osteoclast-like giant cells. In addition to radiation therapy, the osteoclastogenesis inhibitor denosumab was administered but the patient did not undergo adjuvant chemotherapy or surgery. Good clinical and short-term radiological responses to denosumab have been observed for 2 years. Therefore, denosumab may represent a viable treatment option without the need for adjuvant chemotherapy.
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Affiliation(s)
- Taro Sasaki
- Department of Orthopedic Surgery, Niigata Cancer Center Hospital, Niigata, Niigata 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Takashi Ariizumi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Tetsuro Yamagishi
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Naoki Oike
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Hajime Umezu
- Division of Pathology, Niigata University Medical and Dental Hospital, Niigata, Niigata 951-8510, Japan
| | - Shyoichi Inagawa
- Division of Radiology, Niigata University Medical and Dental Hospital, Niigata, Niigata 951-8510, Japan
| | - Tetsuo Hotta
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Naoto Endo
- Division of Orthopedic Surgery, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Niigata 951-8510, Japan
| | - Akira Ogose
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Niigata, Niigata 951-8510, Japan
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14
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Hanafy M, Schwonzen M, Kuhnen C, Schley B, Wilke A. Primary leiomyosarcoma of the distal fibula: A case report and review of the literature. Orthop Rev (Pavia) 2017; 9:7236. [PMID: 29564073 PMCID: PMC5850055 DOI: 10.4081/or.2017.7236] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Revised: 08/23/2017] [Accepted: 09/01/2017] [Indexed: 11/22/2022] Open
Abstract
We describe a primary leiomyosarcoma of bone located in the distal fibula in a 67- year-old man. Plain radiographs and computer tomography scan revealed a lytic destructive lesion in the distal metaepiphyseal region of the left fibula with little involvement of the surrounding soft tissues. The lesion was composed of proliferating spindle-shaped cells with very slim cytoplasm and narrow oval cigar shaped nuclei. Immunohistochemistry studies demonstrated a strong positivity for actin and desmin, and weak positivity for caldesmon.
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Affiliation(s)
- Marwan Hanafy
- Department of Orthopedic Surgery, Elisabeth Clinic, Olsberg
| | - Martin Schwonzen
- Department of Oncology and Hematology, St. Walburga Hospital, Meschede
| | | | - Bernhard Schley
- Department of Rheumatologic Orthopedics, Elisabeth Clinic, Olsberg, Germany
| | - Axel Wilke
- Department of Orthopedic Surgery, Elisabeth Clinic, Olsberg
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15
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Recine F, Bongiovanni A, Casadei R, Pieri F, Riva N, De Vita A, Mercatali L, Liverani C, Spadazzi C, Miserocchi G, Fausti V, Amadori D, Ibrahim T. Primary leiomyosarcoma of the bone: a case report and a review of the literature. Medicine (Baltimore) 2017; 96:e8545. [PMID: 29137065 PMCID: PMC5690758 DOI: 10.1097/md.0000000000008545] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Leiomyosarcoma (LMS) is a malignant sarcoma that can occur in different anatomic sites, including the bone, showing similar histological characteristics but heterogeneous clinical behavior and prognosis. Primary bone LMS was first described in 1965. It is a very rare sarcoma, accounting for <0.7% of all primary malignant bone tumors. PATIENT CONCERNS We report the case of a 52-year-old male with primary bone LMS who presented with a solitary osteolytic lesion with focal cortical destruction in the left clavicle, seen on an x-ray and subsequent computed tomography (CT) scan. DIAGNOSIS The multidisciplinary Osteoncology team of our institute planned a biopsy that revealed the presence of spindle and pleomorphic cells with a positive reaction for smooth muscle actin and desmin at immunohistochemical analysis, without the presence of cartilage or bone matrix. These results were consistent with a high-grade malignant LMS arising from the bone. INTERVENTIONS Complete surgical resection of the tumor was performed and a decision was made with the patient not to proceed with adjuvant chemotherapy or radiotherapy. OUTCOMES After more than 1 year of surgery, the patient is well, with no evidence of recurrent or metastatic disease. Follow-up is ongoing. LESSONS Little is known about the biology and clinical behavior of bone LMS due to its extreme rarity. A multidisciplinary team in a specialized center is needed for the optimal management of the disease. Surgery with a curative intent is the cornerstone of treatment of localized disease. No data are available about chemotherapy in neoadjuvant, adjuvant, or advanced settings. Further research is needed to identify more effective therapies.
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Affiliation(s)
- Federica Recine
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Alberto Bongiovanni
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Roberto Casadei
- Department of Orthopedics, Istituto Ortopedico Rizzoli, University of Bologna, Bologna
| | - Federica Pieri
- Pathology Unit, Morgagni-Pierantoni Hospital, Forlì, Italy
| | - Nada Riva
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Alessandro De Vita
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Laura Mercatali
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Chiara Liverani
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Chiara Spadazzi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Giacomo Miserocchi
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Valentina Fausti
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Dino Amadori
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
| | - Toni Ibrahim
- Osteoncology and Rare Tumors Center, Istituto Scientifico Romagnolo per lo Studio e la Cura dei Tumori (IRST) IRCCS, Meldola
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16
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Abstract
Primary bone sarcomas represent extremely rare entities. The use of now abolished labels, such as malignant fibrous histiocytoma and hemangiopericytoma, has significantly hampered the chance of identifying specific entities. It is now accepted that a broad variety of mesenchymal malignancies most often arising on the soft tissue may actually present as primary bone lesions. A more accurate morphologic partition is justified based on availability of distinct therapeutic options. An integrated diagnostic approach represents the only way to achieve a correct classification. In consideration of the significant complexity, primary bone sarcomas should ideally be handled in the context of expert centers.
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17
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Kropp L, Siegal GP, Frampton GM, Rodriguez MG, McKee S, Conry RM. Primary Intraosseous Smooth Muscle Tumor of Uncertain Malignant Potential: Original Report and Molecular Characterization. Rare Tumors 2016; 8:6507. [PMID: 27994831 PMCID: PMC5136771 DOI: 10.4081/rt.2016.6507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 07/22/2016] [Accepted: 07/26/2016] [Indexed: 11/29/2022] Open
Abstract
We report the first case of primary intraosseous smooth muscle tumor of uncertain malignant potential (STUMP) which is analogous to borderline malignant uterine smooth muscle tumors so designated. The tumor presented in the femur of an otherwise healthy 30-year-old woman. Over a 3-year period, the patient underwent 11 biopsies or resections and 2 cytologic procedures. Multiple pathologists reviewed the histologic material including musculoskeletal pathologists but could not reach a definitive diagnosis. However, metastases eventually developed and were rapidly progressive and responsive to gemcitabine and docetaxel. Molecular characterization and ultrastructural analysis was consistent with smooth muscle origin, and amplification of unmutated chromosome 12p and 12q segments appears to be the major genomic driver of this tumor. Primary intraosseous STUMP is thought to be genetically related to leiomyosarcoma of bone, but likely representing an earlier stage of carcinogenesis. Wide excision and aggressive follow-up is warranted for this potentially life-threatening neoplasm.
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Affiliation(s)
- Lauren Kropp
- Department of Radiation Oncology and Anatomic Pathology, University of Alabama at Birmingham , AL
| | - Gene P Siegal
- Department of Anatomic Pathology, University of Alabama at Birmingham , AL
| | | | - Michael G Rodriguez
- Department of Radiology and Hematology Oncology, University of Alabama at Birmingham , AL, USA
| | - Svetlana McKee
- Division of Hematology Oncology, University of Alabama at Birmingham , AL, USA
| | - Robert M Conry
- Division of Hematology Oncology, University of Alabama at Birmingham , AL, USA
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18
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Mori T, Nakayama R, Endo M, Hiraga H, Tomita M, Fukase N, Kobayashi E, Kawai A, Ueda T, Morioka H. Forty-eight cases of leiomyosarcoma of bone in Japan: A multicenter study from the Japanese musculoskeletal oncology group. J Surg Oncol 2016; 114:495-500. [DOI: 10.1002/jso.24322] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2015] [Accepted: 05/20/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Tomoaki Mori
- Department of Orthopaedic Surgery; School of Medicine, Keio University; Tokyo Japan
- Division of Musculoskeletal Oncology; National Cancer Center Hospital; Tokyo Japan
| | - Robert Nakayama
- Department of Orthopaedic Surgery; School of Medicine, Keio University; Tokyo Japan
| | - Makoto Endo
- Department of Orthopaedic Surgery; Kyushu University; Fukuoka Japan
| | - Hiroaki Hiraga
- Department of Orthopaedic Surgery; Hokkaido Cancer Center; Hokkaido Japan
| | - Masato Tomita
- Department of Orthopaedic Surgery; Nagasaki University; Nagasaki Japan
| | - Naomasa Fukase
- Department of Orthopaedic Surgery; Hyogo Cancer Center; Akashi Japan
| | - Eisuke Kobayashi
- Division of Musculoskeletal Oncology; National Cancer Center Hospital; Tokyo Japan
| | - Akira Kawai
- Division of Musculoskeletal Oncology; National Cancer Center Hospital; Tokyo Japan
| | - Takafumi Ueda
- Department of Orthopaedic Surgery; National Hospital Organization Osaka National Hospital; Osaka Japan
| | - Hideo Morioka
- Department of Orthopaedic Surgery; School of Medicine, Keio University; Tokyo Japan
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19
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Chow LTC. Metatarsal leiomyosarcoma masquerading as acute osteomyelitis - A diagnostic trap unveiled by vigilant clinical, radiologic and pathologic analysis. Foot (Edinb) 2016; 27:10-5. [PMID: 26802815 DOI: 10.1016/j.foot.2015.09.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2015] [Revised: 08/31/2015] [Accepted: 09/04/2015] [Indexed: 02/04/2023]
Abstract
Due to overlapping clinical and radiological features, the differentiation between osteomyelitis and bone tumor can be challenging. A 48-year-old lady presented with intermittent left foot pain for a few months. Plain radiographs showed an osteolytic lesion affecting the proximal diaphysis of the left fourth metatarsal bone, with thinning and irregularities of the cortex and focal periosteal reaction. Ultrasonography revealed diffuse subcutaneous edema in the dorsum of the left foot, cortical irregularities along the mid-shaft of the left fourth metatarsal bone, and surrounding periosteal collection. Computed tomography showed medullary expansion along the shaft and base of the left fourth metatarsal bone with cortical irregularities and defects suggestive of cloaca, and focal mild periosteal new bone formation. The clinico-radiologic diagnosis was acute osteomyelitis with periosteal collection. During open biopsy, the finding of intramedullary fleshy tissue in the absence of significant inflammatory edema and purulent discharge, and subsequent negative culture result prompted a review of the histologic slides which was initially reported as benign fibroblastic tissue proliferation. Careful analysis of the histomorphology disclosed a spindle cell sarcoma for which ray amputation of the fourth and fifth metatarsal was performed. The final diagnosis was grade 1 leiomyosarcoma and the patient remained well 33 months after the operation.
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20
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Bhatnagar N, Lingaiah P, Tiwari A, Mahajan N, Arora S, Dhal A. Primary leiomyosarcoma of femur. J Clin Orthop Trauma 2016; 7:125-129. [PMID: 28018091 PMCID: PMC5167449 DOI: 10.1016/j.jcot.2016.02.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 02/11/2016] [Indexed: 10/22/2022] Open
Abstract
Primary leiomyosarcoma of the bone is exceedingly rare. In this case, we describe a middle-aged female with a primary leiomyosarcoma of the distal femur. The patient was treated by hip disarticulation. The patient continues to be disease-free at one-year follow-up.
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Affiliation(s)
- Nishit Bhatnagar
- Senior Resident, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India,Corresponding author. Tel.: +91 9910465639.
| | - Purushotham Lingaiah
- Senior Resident, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India
| | - Anurag Tiwari
- Senior Resident, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India
| | - Nidhi Mahajan
- Assistant Professor, Department of Pathology, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India
| | - Sumit Arora
- Assistant Professor, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India
| | - Anil Dhal
- Director, Professor & Head, Department of Orthopaedic Surgery, Maulana Azad Medical College & Associated Lok Nayak Hospital, New Delhi 110002, India
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21
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Matsuyama A, Sakamomo A, Aoki T, Hisaoka M. Intraosseous leiomyosarcoma arising in the epiphysis of the distal femur. Pathol Res Pract 2013; 209:530-3. [PMID: 23856273 DOI: 10.1016/j.prp.2013.05.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2013] [Revised: 05/01/2013] [Accepted: 05/08/2013] [Indexed: 11/15/2022]
Abstract
Herein, we present a rare case of intraosseous leiomyosarcoma arising in the epiphysis of the distal femur and showing unusual radiographic features. A 44-year-old man presented with a pain in the left knee joint. Computed tomography revealed an intraosseous lesion with slightly increased attenuation and a thin marginal sclerotic rim in the femoral medial condyle. The signal of the lesion was hypointense on T1-weighted magnetic resonance (MR) images and hyperintense on fat-suppressed T2-weighted MR images. After gadolinium administration, the signal of the lesion was moderately and diffusely enhanced. The histological diagnosis of leiomyosarcoma was made based on a preoperative core biopsy specimen. Microscopic examination of the resected specimen revealed an ill-defined intraosseous tumor composed of proliferated atypical and mildly pleomorphic smooth muscle cells permeating among the bone trabeculae with only focal destruction of the bone trabeculae and low mitotic activity, indicating low grade leiomyosarcoma. The bone trabeculae at the periphery of the tumor were mildly thickened and anastomosed with a rim of an increased number of osteoblasts. Systemic examination showed no tumorous lesions in other anatomical sites. Leiomyosarcomas rarely present in the bone as a diffuse intertrabecular growth, even in low grade tumors.
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Affiliation(s)
- Atsuji Matsuyama
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Japan
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22
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Primary leiomyosarcoma of bone: analysis of prognosis. Sarcoma 2012; 2012:636849. [PMID: 22550421 PMCID: PMC3329678 DOI: 10.1155/2012/636849] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2011] [Revised: 12/31/2011] [Accepted: 01/02/2012] [Indexed: 11/24/2022] Open
Abstract
Leiomyosarcoma of bone is just one of the variants of spindle cell sarcoma of bone characterised by the expression of desmin and other markers indicating a significant element of smooth muscle in the tumour, without osteoid production we have investigated the management and outcome of this rare type of primary malignant bone tumour. Method. Retrospective review of data stored on a prospective database. Results. In a database of 3364 patients with primary malignant bone sarcomas, 31 patients were identified with a primary leiomyosarcoma of bone. There were 12 males and 19 females with a mean age of 46 and tumour size of 8 cm. The most common site was the distal femur followed by the proximal tibia. Treatment was with chemotherapy and surgical resection. Seven of the patients had metastases at diagnosis. Surgery was carried out in 28 patients, 8 having amputation and 20 limb salvage. Three patients developed local recurrence, but half developed metastases. All patient disease-specific survival was 57% at five years and 44% at 10 yrs but for those without metastases was 82% and 60%, respectively. The only prognostic factors were metastases at diagnosis. Conclusion. Leiomyosarcoma of bone is a very rare primary malignant bone tumour affecting a predominantly older population. Despite the high incidence of metastases, survival is better than for other bone sarcomas for those without metastases at diagnosis.
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Abstract
Accurate diagnosis of bone-forming tumors, including correct subclassification of osteogenic sarcoma is critical for determination of appropriate clinical management and prediction of patient outcome. The morphologic spectrum of osteogenic sarcoma is extensive, however, and its histologic mimics are numerous. This review focuses on the major differential diagnoses of the specific subtypes of osteosarcoma, presents summaries of various diagnoses, and provides tips to overcoming pitfalls in diagnosis.
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Affiliation(s)
- Adriana L Gonzalez
- Department of Pathology, Microbiology and Immunology, Vanderbilt University School of Medicine, 3rd Floor, Medical Center North, C-3321, Nashville, TN 37232-2561, USA
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24
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Rekhi B, Kaur A, Puri A, Desai S, Jambhekar NA. Primary leiomyosarcoma of bone--a clinicopathologic study of 8 uncommon cases with immunohistochemical analysis and clinical outcomes. Ann Diagn Pathol 2011; 15:147-56. [PMID: 21393038 DOI: 10.1016/j.anndiagpath.2010.11.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 10/24/2010] [Accepted: 11/11/2010] [Indexed: 01/15/2023]
Abstract
Primary leiomyosarcoma of bone is a rare and a diagnostically challenging tumor entity. Over a 7-year period, we identified 8 such cases that fulfilled the diagnostic criteria in 6 men and 2 women, with age ranging from 25 to 59 years (mean, 42.7 years). All cases were noted in the lower limbs, including femur and tibia as the commonly involved bones in 4 and 3 cases, respectively. On radiography, the most consistent feature was a solitary osteolytic lesion with cortical destruction, unassociated with matrix formation. On histopathology, all cases showed spindly sarcomatous cells, mostly arranged in fascicles and whorls. Of 8 cases, 6 (75%) were of high grade. Prominent vasculature was noted in 5 cases. Two cases displayed focal mineralization, including calcification and heterotropic woven bone formation in 1 case each, but lacked malignant osteoid or chondroid matrix. One case showed osteoclast-like giant cells. On immunohistochemistry, smooth muscle actin was diffusely positive in all cases (100%), desmin was positive in 6 (75%) of 8 cases, and h-caldesmon was positive in 5 (83.3%) of 6 cases. Five cases underwent surgery, including 3 amputations and 2 wide excisions. One case underwent chemotherapy. On follow-up, 5 cases developed metastasis, including 1 case with another, who died within 17 and 5 months. Leiomyosarcoma of bone is uncommon and diagnostically challenging. An index of suspicion is necessary for this diagnosis, especially in cases of lytic, destructive bone lesions, unassociated with matrix production, that show spindly sarcomatous cells on histopathology. Immunohistochemical analysis, including an optimum panel formed by smooth muscle actin (diffuse positivity), desmin, and h-caldesmon, is necessary for substantiating this diagnosis. Surgery forms the treatment mainstay. The prognosis appears to be dismal.
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Affiliation(s)
- Bharat Rekhi
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai 400012, India.
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25
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Engel EE, Brassesco MS, Valera ET, Tone LG, Nogueira-Barbosa MH, Becker AP. Primary skeletal leiomyosarcoma arising in the humerus. Arch Pathol Lab Med 2010; 134:1583-4. [PMID: 21043809 DOI: 10.5858/2010-0113-ler2.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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