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Metastatic cutaneous leiomyosarcoma from primary neoplasm of the mesentery
Author(s) -
Kim Kyoung Jin,
Lee Won Sin,
Chang Sung Eun,
Choi Jee Ho,
Sung Kyung Jeh,
Moon Kee Chan,
Koh Jai Kyoung
Publication year - 2001
Publication title -
international journal of dermatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.677
H-Index - 93
eISSN - 1365-4632
pISSN - 0011-9059
DOI - 10.1046/j.1365-4362.2001.01254-4.x
Subject(s) - medicine , leiomyosarcoma , abdomen , dermis , nodule (geology) , anatomy , subcutaneous tissue , physical examination , pathology , radiology , paleontology , biology
A 31‐year‐old South Korean woman was referred to the dermatology department from the oncology department for the evaluation of a subcutaneous nodular lesion on the back. Three years before, she noted a palpable, fingertip‐sized, nontender mass on her right lower abdomen. The mass had increased in size slowly. One year ago, she visited a local clinic and physical examination revealed a 7 × 8 × 7 cm, slightly tender, deep‐seated mass on the right lower quadrant of the abdomen. The mass on the ilial mesentery was resected by surgical exploration and tissue examination revealed leiomyosarcoma. She refused adjuvant chemotherapy. Approximately 3 months later, she re‐visited the clinic with a tender, subcutaneous nodule on the back. Cutaneous examination revealed a solitary, 2 × 2 cm, well‐defined, hard, movable, subcutaneous nodule on the upper back without skin color change ( Fig. 1). She complained of tenderness on touching the lesion. Histologic examination of a biopsy specimen showed irregularly arranged spindle cells scattered throughout the dermis. They were arranged in haphazardly oriented or interweaving fascicles. Most of the spindle cells possessed elongated nuclei with blunt ends and some cells had a polygonal outline with irregularly shaped nuclei ( Fig. 2). There were many mitoses: 3–4 per high‐power (× 400) field. Immunohistochemically, smooth muscle actin and desmin were positive in most of the tumor cells ( Fig. 3). S‐100 reactivity was not observed. A diagnosis of metastatic leiomyosarcoma was made. About 1 month later, computed tomography showed two, ill‐defined, heterogeneous, low attenuation masses in the right lobe of the liver, suggesting liver metastasis. The patient was treated with chemotherapy for 2 months and remains in good condition. 12 × 2 cm, solitary, well‐defined, hard, movable, subcutaneous nodule without any overlying skin change2(a) Characteristic findings of cutaneous leiomyosarcoma with markedly high cellularity and densely packed transverse and longitudinal fascicles of cells (hematoxylin and eosin, × 40). (b) High magnification of the neoplasm revealing spindle cells with blunt‐ended nuclei, pleomorphism, and mitotic figures (hematoxylin and eosin, × 200)3Dense cytoplasmic reactivity for smooth muscle actin is apparent (smooth muscle actin, × 200)