Uterine Leiomyosarcoma Presenting With Bilateral Orbital and Left Neck Metastases

Abstract

Uterine leiomyosarcoma is a rare neoplasm of mesodermic origin with a predilection for hematologic dissemination, but bilateral orbital metastases have never been reported. A 63-year-old lady presented with an 18-month history of a left neck and left breast mass, and a short history of left eye pain and intermittent diplopia. Ultrasoundguided core biopsy of the left neck node showed evidence of leiomyosarcoma, and computed tomography of the orbits demonstrated bilateral infraorbital masses arising from the medial recti. The patient was diagnosed with uterine leiomyosarcoma with orbital metastases. She was treated with bilateral orbital radiotherapy but had further disease progression, and has since started doxorubicin. Surgery is usually advocated in the management of metastatic leiomyosarcoma, but given the extensive metastases in this case, radiotherapy was the preferred option. This is the first reported case of bilateral orbital and neck metastases from a uterine leimyosarcoma.

Neck subcutaneous nodule as first metastasis from broad ligament leiomyosarcoma: a case report and review of literature

“…Gynecological leiomyosarcoma has poor prognosis because of local invasiveness and a tendency for distant metastasis usually to the liver, lung, and bone [6]. Metastasis to the head and neck region is rare, with only 24 cases reported in the literature [2,[7][8][9][10][11][12]. The rarity of metastasis to the head and neck increases the likelihood of misdiagnosis or delayed diagnosis [1,13], particularly when concurrent liver or lung metastases are absent.…”