Journals on Medical Casereports - BJSTR Journal

Abstract

#Primary leiomyosarcoma (LMS) of the bone is a very rare tumor with #smooth muscle differentiation on #immunohistochemical studies. Radiologically, LMS appears as an osteolytic lesion with aggressive features but no #pathognomonic radiological findings that helps making the diagnosis. We report one case of primary LMS of the femur with fluid-fluid levels (FFLs) on the MRI, the first case to our knowledge. We consider we should include primary LMS of the bone in the differential diagnosis of "FFL” lesions. LMS is a malignant tumor comprising of spindle-shaped cells with distinctive smooth muscle cell features [1]. They are approximately 7% to 10% of all soft tissue sarcoma [2]. Most of these tumors occur frequently in uterus and soft-tissues and more rarely in bone [3-5]. The first description of a primary bone LMS in a long bone was given in 1965 [1]. Since then, to the best of our knowledge, around 130 cases of primary LMS of bone have been reported, mostly small case reports that have focused on its #histological diagnosis [4]. The clinical behavior of osseous LMS is generally aggressive. Most of the published studies of LMS of the bone have reported poor prognosis with a 35% overall survival rate [6]. LMS diagnosis is established by the presence of #morphologically typical spindle cells with smooth muscle differentiation and the positivity of a smooth muscle actin and other muscle markers on tumor cells, such as #desmin and h-caldesmon [7]. Furthermore, the specific characteristic of primary bone LMS is a solitary osteolytic lesion with indistinct margins and cortical destruction with the absence of either osteoid or chondroid matrix [8,9]. Since its recognition as a distinct entity, to our knowledge no sizeable series has examined its imaging features. Furthermore, only a few studies about primary LMS of the bone with emphasis on MRI findings have been published [10]. We present the clinical features, radiological findings and pathological description of a primary LMS originating from the distal femur in a middle-aged lady. Best to our knowledge, this is the first case report of "FFLs” on MRI of a primary LMS of the bone.

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"Fluid-Fluid" levels on a Primary Leiomyosarcoma of the Bone: First Case Report to the Best of Our Knowledge by Elsa López Soriano in BJSTR