Leiomyosarcoma of prostate: A rare, aggressive tumor

Abstract

Leiomyosarcoma of prostate is a rare, aggressive tumor with bizarre presentation at advanced stage. Though definite treatment modalities are not recommended till now, innovative combined multimodality treatment strategies may help to improve the prognosis of patients with this tumor of poor survival rate. Here we report a case of leiomyosarcoma of the prostate which presented with chest metastasis.

A Review of the Literature on Primary Leiomyosarcoma of the Prostate Gland

“…Presentation . Patients with PLSOPs tend to present with the following (see [ 2 , 10 , 11 ] for some of the presentations): “Lower urinary tract symptoms” including urinary frequency, poor flow, hesitancy, urinary urgency, and inability to void. The presentation of lower urinary tract symptoms may mimic benign prostatic hypertrophy clinically in that rectal examination findings may indicate benign prostatic hypertrophy and the diagnosis is established after the patient has undergone transurethral resection of prostate and the histology result would indicate leiomyosarcoma of the prostate.…”

“…Enlargement of the prostate as well as the characteristic features of the prostate gland and its relationship to nearby structures can be illustrated by ultrasound scan. Transrectal ultrasound scan of prostate (TRUSP) and biopsies (see [ 10 , 15 ] in which transrectal ultrasound scan of prostate and biopsies were undertaken): transrectal ultrasound scan of prostate is a useful technique for the assessment of the characteristics of the prostate gland which may show enlargement of the whole or part of the prostate gland involved. It may show heterogeneous hypoechoic lesions in the prostate, invasion of the capsule or extension into the rectum, pelvic side wall, seminal vesicle, ejaculatory duct, or protrusion into the urinary bladder or infiltration of the wall of the urinary bladder.…”

“…A patient who had previously undergone radiotherapy by means of external beam method or brachytherapy or who has been having hormonal treatment for adenocarcinoma of prostate gland upon subsequent development of relapse and further enlargement of prostate may undergo a further ultrasound-guided biopsy of the prostate gland and its histological examination on the second occasion may reveal leiomyosarcoma of the prostate. Computed tomography (CT) scan (see [ 10 , 11 , 13 ] in which CT scan was used): CT scan of abdomen, pelvis, and thorax can be used to assess the features of the prostatic lesion, the relation of the lesion to nearby structures, and the extent of the disease locally. It can also show whether or not there is lymphadenopathy or metastases in the abdomen or within the thorax.…”

“…MRI scan can also be used in the follow-up assessment of the patient following treatment. Isotope bone scan (see [ 10 ] in which isotope bone scan was used): isotope bone scan can be used in the initial as well as follow-up assessment of the patient to ascertain whether or not there is bone metastasis. …”

Leiomyosarcoma of the prostate—an unexpected histopathological outcome

“…Low-grade leiomyosarcoma are rare. They show moderate atypia, scattered mitoses and a focally infiltrative growth pattern around benign prostate glands 4 8 11 12. Neoplastic cells commonly express vimentin, smooth muscle antigen, desmin and cytokeratin.…”