Leiomyosarcoma metastases to the spine: Case series and review of the literature

Mohamed Samy A. Elhammady, Glen R. Manzano, Nathan Lebwohl, Allan D. Levi

Research output: Contribution to journalArticle

22 Scopus citations

Abstract

Leiomyosarcoma is a rare malignant smooth-muscle tumor that rarely metastasizes to bone. It is extremely uncommon for osseous metastasis to be the initial presentation of leiomyosarcoma or to be the initial manifestation of recurrence in patients with a history of leiomyosarcoma. The authors have treated four cases of metastatic leiomyosarcoma with the lesion initially presenting in the spine, and a fifth case of disseminated leiomyosarcoma that involved the spine. In their report, they highlight the cases of two of these patients and provide tabular data for the remaining three. The authors performed a comprehensive review of the literature on spinal leiomyosarcomas and retrospective chart reviews of five surgically treated patients in whom a spinal metastatic leiomyosarcoma was diagnosed. Their series consists of five women who ranged in age from 36 to 47 years (mean age 43.2 years). Four patients had known, or presumed, uterine primary lesions, whereas one harbored a retroperitoneal primary tumor. These lesions generally appear as lytic foci on imaging studies, but variable imaging characteristics were observed. All cases were managed aggressively: four patients underwent posterior/posterolateral decompression and fusion, and one underwent anterior-posterior en bloc resection and fusion. In all cases preoperative symptoms resolved. Two patients died 9 and 13 years after initial presentation. The remaining patients are alive and neurologically intact. Metastatic spinal leiomyosarcomas tend to symptomatically involve only one spinal level at the time of diagnosis and are known to recur locally. These lesions commonly affect women in early middle age, and long-term survival, even in those with systemic metastatic lesions, is better than that seen in individuals with more aggressive spinal metastases. Attempted gross-total resection with fusion, as opposed to minimal palliative decompression, is recommended.

Original languageEnglish (US)
Pages (from-to)178-183
Number of pages6
JournalJournal of Neurosurgery: Spine
Volume6
Issue number2
DOIs
StatePublished - Feb 1 2007

    Fingerprint

Keywords

  • Initial presentation
  • Metastatic leiomyosarcoma
  • Spinal leiomyosarcoma
  • Spinal metastasis

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery
  • Neurology

Cite this