Primary Leiomyosarcoma of the Colon: A Report of Two Cases, Review of the Literature, and Association with Immunosuppression for IBD and Rheumatoid Arthritis

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.

Two cases of primary leiomyosarcoma of sigmoid colon treated with laparoscopic surgery: A case report and a review of literature

“…Yamamoto et al, concluded that the only negative predictive factor for survival is tumor size of more than 5 cm [16] . However, based on previous case studies local and distal recurrence occurred even with favorable tumor features [14] . Compared with adults, infantile LMS has a better prognosis even with poor histologic features [17] .…”

“…True LMS of the colon is such a rare disorder that there isn't enough description of its nature. The classical colon LMS presents with a vast majority of non-specific symptoms including mild abdominal pain, fresh/obscure rectal bleeding, intra-abdominal hemorrhage, weight loss, changes in bowel habits, bowel obstruction, and tenesmus [14] . Diagnosis is based on colonoscopy and histologic evaluation and IHC profiling.…”

Two cases of primary leiomyosarcoma of sigmoid colon treated with laparoscopic surgery: a case report and a review of literature

“…Yamamoto et al, concluded that the only negative predictive factor for survival is tumor size of more than 5 centimeters [15]. However, based on previous case studies local and distal recurrence occurred even with favorable tumor features [13].…”

“…The classical colon LMS presents with a vast majority of non-speci c symptoms including mild abdominal pain, fresh/obscure rectal bleeding, intraabdominal hemorrhage, weight loss, changes in bowel habits, bowel obstruction, and tenesmus. [13] Diagnosis is based on colonoscopy and histologic evaluation and IHC pro ling.…”

Laparoscopic Right Hemicolectomy to Curatively Treat Primary Leiomyosarcoma at the Ileocecal Valve

“… 1 , 2 These colonic leiomyosarcomas have been reported primarily in Japan. 1 , 2 Only a few articles have come out about PLC in the United States. 1 , 4 PLC are aggressive tumors with a 5-year survival of 45.6%.…”