This meta-analysis greatly increases the total number of cases available for the analysis of cutaneous metastases and provides a better overall view of this topic than was previously possible.
L eiomyosarcoma is a rare malignant neoplasm of smooth muscle cells. Although leiomyosarcoma has well-known metastatic potential, cutaneous metastases are a remarkably uncommon occurrence. A review of the English-language literature revealed 15 reported cases of leiomyosarcoma with metastases to the skin. Herein we report a case of leiomyosarcoma with scalp metastasis and review the literature.
Case ReportA 62-year-old African-American man presented with a painful and enlarging subcutaneous mass of the left ankle. Tissue biopsy revealed a high-grade malignant spindle cell neoplasm, and immunohistochemical staining was positive for smooth muscle actin, muscle-specific actin, and vimentin. Imaging studies disclosed multiple lung nodules and osteolytic lesions of the scapulae, ribs, and sternum. The diagnosis of leiomyosarcoma with pulmonary and bone metastases was made, and the patient underwent amputation of the left lower extremity below the knee. Surgical histopathology confirmed the diagnosis of high-grade leiomyosarcoma and demonstrated focal areas of tumor invasion into vascular structures. The tumor was classified as T2bN0M1 under the clinical staging guidelines of the American Joint Committee on Cancer (AJCC). 2 Three months later, the patient was seen in dermatology with a painless enlarging mass of the scalp.Physical examination revealed a 2-cm exophytic tumor on the occipital scalp. The mass was firm and pink to white in color (Figure 1). On further examination, the patient was noted to have a 3-mm erythematous papule and a 2-mm flesh-colored papule with scale, both on the frontal scalp. Biopsy of the largest lesion revealed a malignant spindle cell neoplasm ( Figure 2). The diagnosis of leiomyosarcoma was confirmed by immunohistochemistry, staining positively for smooth muscle actin, muscle-specific actin, and vimentin. Although primary cutaneous leiomyosarcoma was a diagnostic possibility, the presence of known primary, multiorgan metastases and multiple skin lesions led to the diagnosis of cutaneous metastases in this case.
Background: Lymphomatoid papulosis (LyP) is a clonal T cell proliferation with large cell histology, a chronic course, and an increased risk of lymphoma. Bexarotene (Targretin®) is an RXR-selective retinoid (rexinoid) approved for the cutaneous manifestations of cutaneous T cell lymphoma. Objective: To determine whether bexarotene is effective in treating LyP. Methods: Ten patients with chronic and symptomatic LyP were prospectively treated with oral (n = 3) or topical gel (n = 7) formulations of bexarotene. Results: A favorable response to bexarotene treatment with decreased numbers or duration of lesions was seen in all with objective responses in 8 patients. Conclusions: Bexarotene may be an effective palliative treatment for LyP, warranting further controlled studies.
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