Leiomyosarcoma metastases to the spine

Abstract

<jats:p>✓Leiomyosarcoma is a rare malignant smooth-muscle tumor that rarely metastasizes to bone. It is extremely uncommon for osseous metastasis to be the initial presentation of leiomyosarcoma or to be the initial manifestation of recurrence in patients with a history of leiomyosarcoma. The authors have treated four cases of metastatic leiomyosarcoma with the lesion initially presenting in the spine, and a fifth case of disseminated leiomyosarcoma that involved the spine. In their report, they highlight the cases of two of these patients and provide tabular data for the remaining three.</jats:p> <jats:p>The authors performed a comprehensive review of the literature on spinal leiomyosarcomas and retrospective chart reviews of five surgically treated patients in whom a spinal metastatic leiomyosarcoma was diagnosed.</jats:p> <jats:p>Their series consists of five women who ranged in age from 36 to 47 years (mean age 43.2 years). Four patients had known, or presumed, uterine primary lesions, whereas one harbored a retroperitoneal primary tumor. These lesions generally appear as lytic foci on imaging studies, but variable imaging characteristics were observed. All cases were managed aggressively: four patients underwent posterior/posterolateral decompression and fusion, and one underwent anterior–posterior en bloc resection and fusion. In all cases preoperative symptoms resolved. Two patients died 9 and 13 years after initial presentation. The remaining patients are alive and neurologically intact.</jats:p> <jats:p>Metastatic spinal leiomyosarcomas tend to symptomatically involve only one spinal level at the time of diagnosis and are known to recur locally. These lesions commonly affect women in early middle age, and long-term survival, even in those with systemic metastatic lesions, is better than that seen in individuals with more aggressive spinal metastases. Attempted gross-total resection with fusion, as opposed to minimal palliative decompression, is recommended.</jats:p>

Leiomyosarcoma metastatic to the cervical spine causing a C6 compression fracture: A case report

“…However, distinguishing leiomyosarcomas from other aggressive spindle cell malignancies, particularly fibrosarcoma, malignant fibrous histiocytoma, malignant peripheral nerve sheath tumor and metastatic spindle cell carcinoma, is not always easy (2–4). Immunohistochemical studies are often useful in establishing the diagnosis by demonstrating the smooth muscle cell origin (3,8).…”

“…According to a previous study, patient survival times range from weeks to 13 years when leiomyosarcoma metastasizes to the spine (4). Despite numerous surgeons emphasizing that total resection of the tumor should be performed to achieve an improved prognosis (4,8,9), this was considered to be impossible in the patient in the present study. Therefore, decompressive surgery was selected as the therapeutic strategy.…”

“…The most commonly reported sites of metastasis from leiomyosarcoma are the lungs, liver, kidney, brain and skin. Spinal metastases of leiomyosarcoma have rarely been reported, and all cases have been located in the thoracic and lumbar spinal regions (4). The surgical treatment for spinal metastases of leiomyosarcoma may be a considered in situations involving mechanical instability and neural compression, and is regarded as palliative, with the aim of improving the patient’s quality of life.…”

Unusual Osteoblastic Secondary Lesion as Predominant Metastatic Disease Spread in Two Cases of Uterine Leiomyosarcoma

“…Reviewing the literature, we were able to find few cases of leiomyosarcoma recurrence occurring in bone. Elhammady et al [4] recently reported a case of spinal osteoblastic bone metastasis as the presenting symptom of leiomyosarcoma recurrence and reviewed six cases of leiomyosarcoma initially presented as spinal metastases. Shapiro et al [5] described a case of uterine smooth muscle tumor of uncertain malignant potential that recurred as a high-grade leiomyosarcoma in the humerus, 5 years after its successful removal by hysterectomy.…”

Uterine lipoleiomyosarcoma: Complete medullary compression as presentation of a solitary metastasis

“…Leiomyosarcoma is a rare malignant neoplasm of smooth muscle cells representing 7% of all soft-tissue sarcomas (Elhammady et al, 2007). Distant metastases arrive late in the disease and the predilection sites are lungs, liver, kidneys and skin through hematogenous dissemination.…”