Primary intracranial leiomyosarcoma presenting with frontal bone mass: a case report

Abstract

Primary intracranial mesenchymal neoplasms are rare tumors. These tumors are usually metastatic disease from other primary sites. We presented a 31-year-old man with a 6-month history of gradually enlarging frontal mass and positional headache. There was no other symptom demonstrating other organs' involvement. The patient underwent an uncomplicated craniotomy with clear surgical margins. The pathology review and the immunohistochemistry staining confirmed leiomyosarcoma grade II. We prescribed radiation therapy with tumor dose of 60 Gy in 30 fractions with conformal treatment planning to the tumor bed. As this disease has a high potency for metastasis, we advised four courses of single agent doxorubicin chemotherapy 75 mg/m2 every 4 weeks starting one month after the end of radiotherapy. In the last follow-up visit 34 months later, the patient was disease free in physical exam and imaging findings.

Keywords: Brain neoplasms; Intracranial; Leiomyosarcoma.

Fig. 1.

An axial view of brain magnetic resonance imaging.

Fig. 2.

Immunohistochemistry staining showing h-caldesmon positivity (microscopic image at ×40).

Fig. 3.

Interlacing bundles of spindle to oval cells with moderate dysplasia and noticeable mitotic figures (microscopic image at ×40).

Fig. 4.

Immunohistochemistry staining showing vimentin positivity (microscopic image at ×40).

Fig. 5.

Target volumes (GTV in red and PTV in blue) and isodoses around target volume (isodose 95% in green and 90% in yellow with maximum hot dose of 105% in the GTV). GTV, gross tumor volume; PTV, planning target volume.