Recurrent subcutaneous trunk leiomyosarcoma: Management and review of the literature
A 68-year-old Caucasian male presented to our department with a two-month history of a small palpable nodule at the inferior angle of the right scapula. His medical history was remarkable for arterial hypertension.\nPhysical examination revealed a well-defined, non-tender and relatively mobile nodule at the inferior angle of the right scapula. There were no signs of infection and the overlying skin was normal. The remainder of the clinical examination was unremarkable. Ultrasonography demonstrated a well-circumscribed hypoechoic mass measuring 1.8 × 1.5 cm. Full blood count, biochemical tests and tumor markers were within the normal range.\nA surgical resection with wide margins of at least 2 cm was performed. Histological examination revealed a tumor measuring 1.8 × 1.5 × 0.7 cm consisting of elongated malignant cells characterized by nuclear polymorphic figures combined with mitoses. The surgical margins were free of disease. On detailed immunohistochemical analysis the tumor cells stained positive for smooth muscle actin (SMA), a1-antitrypsin, and vimentin [] and negative for desmin, S-100 protein, myocin and a1-antichymotrypsin. Based on immunohistochemical findings, the diagnosis of a subcutaneous leiomyosarcoma was established. Staging investigations including computed tomography scans of the chest and abdomen were all negative. Although a complete resection with wide surgical margins had been performed, adjuvant postoperative radiation therapy was administered due to the high mitotic rate of the tumor.\nTwo years after surgery, the patient was readmitted with a palpable small, non-tender nodule very close to the scar of the previous operation within the irradiated field. A tumor recurrence was suspected and a new surgical resection with wide margins was performed. Complete blood count and tumor markers were within the normal range.\nHistological examination and immunohistochemical analysis revealed a recurrent leiomyosarcoma measuring 1 cm in diameter. Staging investigations were negative. Adjuvant radiation therapy was not considered at this point by the multidisciplinary oncology team because the patient had received the maximum dose after the primary tumor resection. The patient is being followed up and is well without signs of disease six years after the resection of the recurrent tumor [].