Primary leiomyosarcoma of the scalp: a case report and review of the literature

Abstract

Background and importance: Leiomyosarcoma is a rare and aggressive malignant tumor with a high potential for relapse and metastasis. Correct and timely diagnosis is critical for effective treatment, yet it is often challenging due to the diverse clinical presentations. This case report highlights the significance of early identification and the consequences of delayed diagnosis in scalp leiomyosarcoma.

Clinical presentation: We present the case of a 39-year-old woman with a scalp neoplasm. Initially, the diagnosis was missed, leading to a delay in surgical intervention. The tumor demonstrated a locally aggressive course, infiltrating the skull and dura mater. Upon admission, the scalp tumor was promptly excised. This case provides valuable insights into the varied symptoms and presentations of scalp leiomyosarcoma, which can aid in the recognition of this condition.

Conclusion: This report underscores the importance of considering leiomyosarcoma in the differential diagnosis of scalp masses, particularly when the etiology is unclear. Early recognition and intervention are essential to prevent locally invasive growth and potential metastasis, emphasizing the need for a high index of suspicion among healthcare professionals.

Keywords: case report; leiomyosarcoma; sarcoma; scalp; surgery.

Figure 1

(A) Local cutis verticis gyrata and a 12cm hard, painless mass in the occipital and vertex region. The lesion was burgeoning. The tumor was exposed during the operation (B).

Figure 2

The computed tomography (CT) scan (A, B) showed that the tumor located on the right side of the occipital and vertex region, 3D reconstruction (C) revealed the skull was severely destroyed. (D) Magnetic resonance imaging (MRI) revealed the tumor signal was mixed and that neighboring brain tissue was compressed, poorly circumscribed lesion with infiltrative border.

Figure 3

(A) CT angiography (CTA) with 3D reconstruction revealed tumor was hypervascula, leading to an angiomatous lesion with skull invasion. (B) CTA presented the lesion’s vascularization. (C) the lesion’s main vascularization were occipital artery (bottom arrow) and arteriae auricularis posterior (upper arrow). (D, E) the patient accepted embolization therapy of occipital. (F, G) most parts of the tumor were removed.

Figure 4

H&E staining showing interlacing fascicles of elongated spindle cells with cytological atypia and abundant eosinophilic cytoplasm [(A) X100]. High-power microscopic examination showing moderate mitosis. The arrows are annotated as mitosis. [(B) X200], marked nuclear atypia and tumoral necrosis [(C) X40]. Immunohistochemical staining of, SMA [(D) X400], and vimentin [(E) X400], H-caldesmon [(F) X400] were positive.