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Case Reports
. 2019 Jun 24:12:1179547619857680.
doi: 10.1177/1179547619857680. eCollection 2019.

Secondary Leiomyosarcoma of the Lower Limb Following Uterine Smooth Muscle Tumor of Uncertain Malignant Potential

Jose María García-Sánchez  1 , Mónica Bauza  2 , Alberto Pérez-García  1 , Empar Mayordomo Aranda  2 , Alejandro Ruiz Valls  1
Affiliations
Case Reports

Secondary Leiomyosarcoma of the Lower Limb Following Uterine Smooth Muscle Tumor of Uncertain Malignant Potential

Jose María García-Sánchez et al. Clin Med Insights Case Rep. .

Abstract

Introduction: This report presents uterine smooth muscle tumors of uncertain malignant potential course with an unpredictable clinical behavior and late metastases. Metastases have been described to the humerus, lung, and peritoneum.

Case presentation: Hereby we present the case of a 71-year-old woman with a past surgical history of hysterectomy and bilateral adnexectomy due to a smooth muscle tumor of unknown malignant potential, who was evaluated 6 years later after the appearance of a mass in the proximal third of the right lower limb. The mass was diagnosed as a G1 epithelioid leiomyosarcoma and was surgically removed with immediate reconstruction with a tendinous transfer to the tibialis posterior muscle to maintain foot dorsiflexion.

Conclusion: Patients diagnosed with smooth uterine muscle tumors of uncertain malignant potential should be closely followed up given the possibility of recurrence and late metastases, bearing in mind uncommon locations as well, such as the lower limb.

Keywords: leiomyosarcoma; lower extremity; metastases; smooth muscle tumors of unknown malignant potential.

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Conflict of interest statement

Declaration of conflicting interests:The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
STIR FSE coronal MRI showing a soft tissue tumor in the proximal third of the right leg with fusiform morphology. FSE indicates fast spin echo; STIR, Short-TI Inversion Recovery; MRI, magnetic resonance imaging.
Figure 2.
Figure 2.
Foot dorsiflexion motion after resection and tendinous transfer surgery.
Figure 3.
Figure 3.
Macroscopic image corresponding to the bloc, free-border resection of the tumor located in the lower limb. Tumor size 13 × 5 × 5 cm3. Pearl-colored lesion, with focal yellowish areas, that represents necrosis areas and minor read-colored areas that correspond with hemorrhage foci.
Figure 4.
Figure 4.
Hematoxylin-eosin (10×): atypical cellular proliferation of mesenchymal cells of epithelioid and fusiform morphology, disposed in a fascicular and storiform pattern.
Figure 5.
Figure 5.
Immunohistochemistry: caldesmon, actin, calponin, and desmin diffuse positive, which confirms smooth muscle origin and the diagnosis of leiomyosarcoma. Nuclear positivity to estrogen receptor suggests a metastatic gynecological origin; in this case, a STUMP. STUMP indicates smooth uterine muscle tumors of uncertain malignant potential.
See this image and copyright information in PMC

References

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