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Annals of Surgical Oncology
Erschienen in:

16.08.2024 | Sarcoma

Clinical Variables Influencing Outcomes in Patients with Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas): Single-Institution Study of 95 Surgical Patients

verfasst von: Alicia Gingrich, MD, MS, Sintawat Wangsiricharoen, MD, Madeline B. Torres, MD, Vinod Ravi, MD, Ravin Ratan, MD, Emily Z. Keung, MD, Christopher P. Scally, MD, Alexander J. Lazar, MD, PhD, Wei-Lien Wang, MD, Christina L. Roland, MD, MS, Kelly K. Hunt, MD, Wendong Yu, MD, PhD, Keila E. Torres, MD, PhD, MBA

Erschienen in: Annals of Surgical Oncology | Ausgabe 12/2024

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Abstract

Background

Atypical intradermal smooth muscle neoplasm, also commonly termed cutaneous leiomyosarcoma, is a soft tissue tumor with a low risk of aggressive behavior. These lesions arise in the dermis with possible superficial subcutaneous extension, demonstrate cytologic atypia, and often show mitotic activity.

Methods

A retrospective review of patient demographics, tumor characteristics, and treatment methods was conducted in a consecutive series of patients presenting to MD Anderson Cancer Center (MDACC) from 2002 to 2021 (n = 95). All pathology was reviewed by MDACC pathologists and determined to be atypical intradermal smooth muscle neoplasm.

Results

Median age at diagnosis was 58 years (range 22–86), and 74% were male. Ninety-five percent (n = 90) of patients identified as White, non-Hispanic. Most tumors were slow-growing, solitary, and painless nodules. Tumors were in the lower extremities (44.2%), followed by the upper extremity (28.4%), trunk (22.1%), and head and neck (5.2%). All patients (n = 44, 46.3%) who had a punch/incisional biopsy for diagnostic purposes had a subsequent tumor excision. Unplanned excision or excisional biopsy was performed on the remaining 46 (48%) patients. Of this subset, 41 of the 46 aforementioned patients (89%) had positive margins and underwent re-excision. Final pathology in 25/38 (66%) re-excision specimens was negative for residual tumor despite an initial positive margin. Two patients in the cohort had local recurrence 2 and 3 years after initial surgery. Both patients had positive margins, underwent excision of the recurrent tumor, and remain free of disease. After median follow-up of 6.9 years (range 1 day–18 years), 5-year recurrence-free survival was 96% and overall survival (OS) of the entire cohort was 78%.

Conclusion

In this study of consecutive patients presenting with atypical intradermal smooth muscle neoplasm, we found good OS and local control after definitive surgical excision with negative margins, including excisional biopsy with close margins. Atypical intradermal smooth muscle neoplasm is unlikely to metastasize and has an excellent prognosis. Guidelines to determine optimal surveillance strategies for these patients should be revisited.
Literatur
1.
Kraft S. CDM fletcher. Atypical intradermal smooth muscle neoplasms: clinicopathologic analysis of 84 cases and a reappraisal of cutaneous “Leiomyosarcoma.” Am J Surg Pathol. 2011;35(4):599–607.CrossRefPubMed
2.
Sandhu N, et al. Cutaneous leiomyosarcoma: a SEER database analysis. Dermatol Surg. 2020;46(2):159–64.CrossRefPubMed
3.
Massi D, et al. Primary cutaneous leiomyosarcoma: clinicopathological analysis of 36 cases. Histopathology. 2010;56(2):251–62.CrossRefPubMed
4.
Hall BJ, et al. Atypical intradermal smooth muscle neoplasms (formerly cutaneous leiomyosarcomas): case series, immunohistochemical profile and review of the literature. Appl Immunohistochem Mol Morphol. 2013;21(2):132–8.CrossRefPubMed
5.
Wollina U, et al. A 10-year analysis of cutaneous mesenchymal tumors (sarcomas and related entities) in a skin cancer center. Int J Dermatol. 2013;52(10):1189–97.CrossRefPubMed
6.
Zacher M, et al. Primary leiomyosarcoma of the skin: a comprehensive review on diagnosis and treatment. Med Oncol. 2018;35(10):135.CrossRefPubMed
7.
Kazlouskaya V, Lai YC, Khachemoune A. Leiomyosarcoma of the skin: review of the literature with an emphasis on prognosis and management. Int J Dermatol. 2020;59(2):165–72.CrossRefPubMed
8.
Planet C, et al. Clinicopathologic and molecular analyses of cutaneous leiomyosarcoma: A retrospective, multicenter study of 79 cases. J Am Acad Dermatol. 2023;88(1):215–6.CrossRefPubMed
9.
Vargas-Mora P, et al. Primary cutaneous leiomyosarcoma: a single institution study treated with modified Mohs surgery. Int J Dermatol. 2023;62(1):e10–3.CrossRefPubMed
10.
Wang WL, et al. Sarcoma metastases to the skin: a clinicopathologic study of 65 patients. Cancer. 2012;118(11):2900–4.CrossRefPubMed
11.
Oliver G, et al. Cutaneous and subcutaneous leiomyosarcoma: a clinicopathological review of 14 cases with reference to antidesmin staining and nuclear DNA patterns studied by flow cytometry. Br J Dermatol. 1991;124(3):252–7.CrossRefPubMed
12.
Aneiros-Fernandez J, et al. Primary cutaneous and subcutaneous leiomyosarcomas: evolution and prognostic factors. Eur J Dermatol. 2016;26(1):9–12.CrossRefPubMed
13.
Wong GN, et al. Cutaneous leiomyosarcoma: dermal and subcutaneous. Austral J Dermatol. 2020;61(3):243–9.CrossRef
14.
Ho J, Collie CJ, What's new in dermatopathology 2023: WHO 5th edition updates. J Pathol Transl Med. 2023;57(6):337-340.
15.
De Giorgi V, et al. Superficial cutaneous leiomyosarcoma: a rare, misleading tumor. Am J Clin Dermatol. 2008;9:185–7.CrossRefPubMed
16.
Fauth CT, et al. Superficial leiomyosarcoma: a clinicopathologic review and update. J Cutaneous Pathol. 2010;37(2):269–76.CrossRef
17.
Menko FH, et al. Hereditary leiomyomatosis and renal cell cancer (HLRCC): renal cancer risk, surveillance and treatment. Fam Cancer. 2014;13(4):637–44.CrossRefPubMedPubMedCentral
18.
Fields JP, Helwig EB. Leiomyosarcoma of the skin and subcutaneous tissue. Cancer. 1981;47(1):156–69.CrossRefPubMed
19.
Auroy S, et al. Primary cutaneous leiomyosarcoma: 32 cases [in French]. Annales de dermatologie et de venereologie. 1999;126(3):235–42.PubMed
20.
Farshid G, et al. Leiomyosarcoma of somatic soft tissues: a tumor of vascular origin with multivariate analysis of outcome in 42 cases. Am J Surg Pathol. 2002;26(1):14–24.CrossRefPubMed
21.
Berzal-Cantalejo F, et al. Desmoplastic cutaneous leiomyosarcoma: Case report and review of the literature. J Cutaneous Pathol. 2006;33:29–31.CrossRef
22.
Annest NM, et al. Cutaneous leiomyosarcoma: a tumor of the head and neck. Dermatol Surg. 2007;33(5):628–33.PubMed
23.
Deneve JL, et al. Cutaneous leiomyosarcoma: treatment and outcomes with a standardized margin of resection. Cancer Control. 2013;20(4):307–12.CrossRefPubMed
24.
Glazer ES. C Prieto-Granada, JS Zager, Current approaches to cutaneous sarcomas: dermatofibrosarcoma protuberans and cutaneous leiomyosarcoma. Curr Probl Cancer. 2015;39(4):248–57.CrossRefPubMed
25.
Humphreys TR, Finkelstein DH, Lee JB. Superficial leiomyosarcoma treated with Mohs micrographic surgery. Dermatol Surg. 2004;30(1):108–12.PubMed
26.
Starling J, Coldiron BM. Mohs micrographic surgery for the treatment of cutaneous leiomyosarcoma. J Am Acad Dermatol. 2011;64(6):1119–22.CrossRefPubMed
27.
Svarvar C, et al. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group. Cancer. 2007;109(2):282–91.CrossRefPubMed
Metadaten
Titel
Clinical Variables Influencing Outcomes in Patients with Atypical Intradermal Smooth Muscle Neoplasms (Formerly Cutaneous Leiomyosarcomas): Single-Institution Study of 95 Surgical Patients
verfasst von
Alicia Gingrich, MD, MS
Sintawat Wangsiricharoen, MD
Madeline B. Torres, MD
Vinod Ravi, MD
Ravin Ratan, MD
Emily Z. Keung, MD
Christopher P. Scally, MD
Alexander J. Lazar, MD, PhD
Wei-Lien Wang, MD
Christina L. Roland, MD, MS
Kelly K. Hunt, MD
Wendong Yu, MD, PhD
Keila E. Torres, MD, PhD, MBA
Publikationsdatum
16.08.2024
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 12/2024
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-024-15528-x

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