The Extremity Leiomyosarcoma of Vascular Origin-A Case Report

Abstract

Leiomyosarcoma (LMS) is a rare tumor that mutates from smooth muscle. It has occupied around 5-10 % of adult soft tissue sarcoma. Sometimes, we can find LMSs occurring from vascular origins clinically and they are usually found in large size vessels, such as the pulmonary trunk. It could seldom happen in peripheral small vessels. We present one case of LMS over the upper limb with a vascular origin and further discuss the best strategy in treating such a disease. A 64-year-old male, who has suffered from a growing palpable mass along the dorsal vein in R't dorsal forearm for 6 months, visited our clinic. In clinic division, completed image surveys revealed an intravascular lesion that favored hemangioma. Surgical excision was performed for him after serial examinations. Intraoperatively, the frozen sections of the lesion margins were checked for times and the reports showed malignancy. Afterwards, we made repeated checks both proximal and distal ends of the cut vessel and found they were free of tumor. Post-operatively, because the tumor within the vascular wall might contribute to early hematogenous spreading, we prescribed adjuvant radiotherapy for him. The patient has been followed post-operatively for 48 months, no local recurrence or distant metastasis is found, and his general condition is remaining robust. In the previous literatures, some authors reported the diseases occurred from vascular origins, mostly from large vessels of the pulmonary trunk. Besides, LMSs were diseases dominant in retroperitoneum and rare in peripheral vessels. However, now we present one case of the upper limb LMS with a vascular origin, which clinically might mimic a hemangioma or ganglion cyst. We successfully treat it with adequate resection combined with post-operative radiotherapy. Therefore, we believe that detailed pre-operative surveys, adequate resection of tumor, en block removal of adjacent tissue, careful checks of intraoperative frozen sections, and post-operative adjuvant radiotherapy are all key points to excellent diseasefree results and greatly reduce the possibilities of local recurrence.