Isolated cutaneous metastasis of uterine leiomyosarcoma: case report and review of literature

Abstract

A 54 year old lady presented for routine excision of a scalp lesion thought clinically to represent a sebaceous cyst of the right occiput. 4 years earlier she underwent total abdominal hysterectomy and right salpingo-oophorectomy for 3 large uterine fibroids. Histo-pathological examination of the hysterectomy specimen revealed an incidental low-grade leiomyosarcoma. Staging imaging was negative for metastatic disease. She made an uneventful recovery and was treated further by adjuvant pelvic radiotherapy.She noticed an uncomfortable and unsightly cystic swelling on her occiput four years after hysterectomy and was referred for routine excision of what was believed to be a benign lesion. The lesion was excised and sent for histopathological examination. Microscopic analysis including immuno-histochemistry demonstrated an ER and PR positive metastatic deposit of leiomyosarcoma. The margins of excision were histologically clear of disease.At Multi-Disciplinary Team (MDT) discussion a diagnosis of metastatic scalp deposit from previous uterine leiomyosarcoma was made. Re-staging CT brain, thorax, abdomen and pelvis and MRI brain were negative for local recurrence or distant metastases. She is currently undergoing radiotherapy to the scalp and surrounding tissues and will be followed up closely by the involved teams.To the best of our knowledge, this is the first case described in the worldwide literature of isolated cutaneous metastasis to the scalp of uterine leiomyosarcoma without evidence of disseminated disease at other sites.Virtual slidesThe virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/1311834987345566.

Evaluation of Metastatic Cutaneous Lesions on Fine Needle Aspiration Cytology: A Five Year Study

“…Skin lesions ,metastases of sarcoma occurs by hematogenous spread, so cutaneous metastases is an unusual finding. [15]3 cases of soft tissue sarcomas that had metastases to skin ans subcutaneous tissue were identified in 3 females .The histological types were epitheloid sarcoma, leiomyosarcoma and rhabdomyosarcoma .Metastases occured to interscapular area and abdominal wall .The diagnosis was established by FNAC.2 cases of metastaic neuroendocrine carcinoma were seen in our series .One patient had primary in salivary gland and the other presented with metastases in sacral area.Patient on follow up was found to have neuroendocrine carcinoma prostrate .Cutaneous metastases from neuroendocrine carcinoma of visceral organ has already been reported .When a neuroendocrine carcinoma is found in the skin ,it is importantto distinguish Merkel cell carcinoma from cutaneous metastases of visceral origin.Positive staining for CK20 is strongly diagnostic. [17]The diagnosis was confirmed by a complete IHC study of both primary and secondary lesions.…”

Uterine leiomyosarcoma metastasizing to multiple sites: a rare presentation

“…3 Metastases of uterine leiomyosarcoma to the breast and scalp are rare and only five cases of each have been reported in the medical literature. [3][4][5][6] The first case metastatic to the breast was reported way back in 2003 while that with scalp being the metastatic site was reported much earlier in 1917. 3,6 The cytomorphologic features described in leiomyosarcoma and well visualised in our case are cellular smears composed of tissue fragments, clusters and fascicles of cohesive tumor cells.…”

“…[3][4][5][6] The first case metastatic to the breast was reported way back in 2003 while that with scalp being the metastatic site was reported much earlier in 1917. 3,6 The cytomorphologic features described in leiomyosarcoma and well visualised in our case are cellular smears composed of tissue fragments, clusters and fascicles of cohesive tumor cells. [7][8][9][10] Elongated nuclei with blunt ends and a vague "C" shape containing small amount of wispy cytoplasm with bipolar cytoplasmic processes may be appreciated.…”

“…Metastases of uterine leiomyosarcoma to the breast and scalp are rare. [3][4][5][6] To the best of our knowledge, this is the first report of simultaneous metastasis to scalp, breast and soft tissue from leiomyosarcoma arising in the uterine broad ligament.…”

55-Year-Old Woman With Estrogen Receptor–Positive Scalp Lesion

“…The type of skin metastases has been shown to vary by age, sex, and primary tumor type. Skin metastases may occur from various primary tumor sites in both children and adults (including rhabdomyosarcomas, adenocarcinomas, various solid tumors of the lung, breast, ovaries, uterus, and other sarcomas) [1][2][3][4][5][6] and have often heralded more widely metastatic disease as well as a poorer outcome. 7 However, the appearance of a scalp carcinoma in metastasis the absence of an evident primary site is very rare.…”