Abstract
Our case demonstrates how metastases may be present and symptomatic long before they produce sufficient osseous changes to render the lesions radiologically detectable. A case of leiomyosarcoma arising in the uterus and initially presenting as a femoral lesions is presented. It required an intensive review of the case history and of the previous pathology in order to identify the primary site in the uterus. In the literature nine cases of metastatic leiomyosarcoma presenting initially in bone are reviewed. Ten additional cases from the literature showed bone metastases as the first site of recurrence. When this is assessed together with some 14 cases of primary leiomyosarcomas reported arising in bone, one is impressed that this is an uncommon tumour in bone either as a primary or secondary.
In all patients in whom a leiomyosarcoma is histologically proven in bone, all primary sites should be specifically and categorically excluded before the lesion is accepted as an osseous primary. This should include special stains for myofibrils and electron microscopy if at all possible, in order to differentiate such tumours from other sarcomas such as fibrosarcoma. This applies especially to patients with uterine lesions that have been previously treated, even if they have been regarded as benign initially. All previous pathology and in particular hysterectomy specimens should be care-fully reviewed. The need to specifically identify a leiomyosarcoma as a primary lies in the different modalities of treatment used: aggressive ablative surgery for primary lesions as opposed to radiation and chemotherapy for metastatic disease.
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References
Angervall L, Berlin O, Kindblom L, Stener B (1980) Primary leiomyosarcoma of bone: A study of five cases. Cancer 46:1270
Birla R, Bowden L (1975) Solitary bony metastasis as the first sign of malignant gastric tumour or of its recurrence. Ann Surg 182:45
Boutselis JG, Ullery JC (1962) Sarcoma of the uterus. Obstet Gynecol 20:23
Brooke WS, Thomason JR (1945) Leiomyosarcoma of the uterus with metastasis to the femur. Arch Surg 51:120
Christopherson WM, Williamson EO, Gray LA (1972) Leiomyosarcoma of the uterus. Cancer 29:1512
Decio C (1939) Humeral metastasis of uterine sarcoma: Case. Riv Ital Ginecol 22:640
Drake ET, Dobben GD (1959) Leiomyosarcoma of the uterus with unusual metastases. JAMA 170:1294
Evans DMD, Sanerkin NG (1976) Primary leiomyosarcoma of bone. J Pathol 90:348
Ferenczy A, Richart RM, Okagaki T (1971) A comparative ultrastructural study of leiomyosarcoma, cellular leiomyoma and leiomyoma of the uterus. Cancer 28:1004
Gallup DG, Cordray DR (1979) Leiomyosarcoma of the uterus: Case reports and a review. Obstet Gynecol Surv 34:300
Gardner LU (1917) A case of metastatic leiomyosarcoma primary in the uterus. J Med Res 36:19
Grynfeltt E (1927) Etude histologique de la métastase fémorale d'un myosarcome de l'utérus. Bull Cancer (Paris) 16:447
Gunn WG, Kramer S (1963) The value of radiation therapy in leiomyosarcoma of the uterus. Radiology 81:854
Jaffe HL (1958) Tumours and tumourous conditions of the bones and joints. Lea and Febiger, Philadelphia, p 512
Larmi TKL, Niinimaki T (1973) Leiomyosarcoma of the vein: Review of the literature and report of a case. Scand J Thorac Cardiovasc Surg 7:262
Lichtenstein L (1977) Bone tumours, 5th Edn. Mosby, Saint Louis, p 363
Meister P, Konrad E, Gokel JM, Remberger K (1978) Case report 59. Skeletal Radiol 2:265
Miles AEW, Waterhouse JP (1962) A leiomyosarcoma of the oral cavity with metastasis to lymph glands. J Pathol 83:551
Miller RH, Rogers H (1928) Sarcoma of the uterus. N Engl J Med 198:927
Mirra JM (1980) Bone tumours diagnosis and treatment. Lippincott, Philadelphia, p 275
Morrissey K, Cho ES, Gray GF, Thorbjarnarson B (1973) Muscular tumours of the stomach: Clinical and pathological study of 113 cases. Ann Surg 178:148
Overgaard, J, Frederiksen P, Helmig O, Myhre J, Jensen O (1977) Primary leiomyosarcoma of bone. Cancer 39:1664
Ranchod M, Kempson RK (1977) Smooth muscle tumours of the gastrointestinal tract and retroperitoneum: A pathological analysis of 100 cases. Cancer 39:255
Rao BK, Kapur MM, Roy S (1980) Leiomyosarcoma of the colon: A case report and review of the literature. Dis Colon Rectum 23:184
Robbins LL (1943) Roentgenologic demonstration of spinal metastases from leiomyosarcoma of the uterus. Arch Surg 47:463
Sanerkin NG (1979) Primary leiomyosarcoma of the bone and its comparison with fibrosarcoma. A cytological, histological and ultrastructural study. Cancer 44:1375
Schjott-Rivers E (1949) Sarcoma of the uterus. Acta Obstet Gynecol Scand 28:418
Spiro RH, Koss LG (1965) Myosarcoma of the uterus: A clinicopathological study. Cancer 18:571
Spjut HJ, Dorfman HD, Fechner RE, Ackerman LV (1970) Tumours of bone and cartilage. Atlas of tumour pathology, Washington, D.C., Second Series, Fascicle 5. AFIP, Washington
Stout AP, Hill WT (1958) Leiomyosarcoma of the superficial soft tissues. Cancer 11:844
Sylven B (1947) Myogenic sarcomas of the uterus with skeletal metastases: Report of cases. Acta Radiol [Diagn] (Stockh) 28:691
Willis RA (1973) The spread of tumours in the human body, 3rd edn. Butterworths, London, p 234
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Fornasier, V.L., Paley, D. Leiomyosarcoma in bone: Primary or secondary?. Skeletal Radiol 10, 147–153 (1983). https://doi.org/10.1007/BF00357768
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DOI: https://doi.org/10.1007/BF00357768