J Korean Assoc Oral Maxillofac Surg.  2020 Aug;46(4):275-281. 10.5125/jkaoms.2020.46.4.275.

Leiomyosarcoma of the jaw: case series

• Choi YS
• Almansoori AA
• Jung TY
• Lee JI
• Kim SM
• Lee JH

• KMID: 2505449
• DOI: http://doi.org/10.5125/jkaoms.2020.46.4.275

Abstract

Objectives
Leiomyosarcoma is a malignant neoplasm that affects smooth muscle tissue and it is very rare in the field of oral and maxillofcial surgery. The purpose of this study was to obtain information on diagnosis of and treatment methods for leiomyosarcoma by retrospectively reviewing of the cases.
Patients and Methods
The study included nine patients who were diagnosed with leiomyosarcoma in the Department of Oral and Maxillofacial Surgery at Seoul National University Dental Hospital. The subjects were analyzed with respect to sex, age, clinical features, primary site of disease, treatment method, recurrence, and metastasis.
Results
Particular clinical features included pain, edema, mouth-opening limitations, dysesthesia, and enlarged lymph nodes. All cases except one were surgically treated, and recurrence was found in two cases. Four of nine patients were followed up without recurrence and one patient underwent additional surgery due to recurrence.
Conclusion
In our case series, notable symptoms included pain, edema, mouth-opening limitations, and dysesthesia; however, it was difficult to label these as specific symptoms of leiomyosarcoma. Considering the aggressive characteristics of the disease and poor prognosis, surgical treatment is necessary with careful consideration of postoperative radiotherapy and chemotherapy.

Keyword

Leiomyosarcoma; Mouth neoplasm; Case series

Figure

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  Fig. 1 A 55-year-old female patient. A. Pericoronal gingival swelling, and tooth mobility was shown. B. Panorama showing radiopaque lesion on the #43 to #45 area. C. Enhanced computed tomographic image of #33 to #46; destruction of the alveolar bone was observed, and the continuity of some lingual cortical bone disappeared. Soft tissue bulging, which was thought to be granulation tissue, was observed as a continuity loss site. Permeable osteolysis at the border of the lesion. D. F-18 flurorodeoxyglucose positron emission tomography scan showing a hypermetabolic lesion in the lower-anterior gingival area. E, F. Partial mandibulectomy was performed.

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  Fig. 2 A 23-year-old female patient. A. Microscopic image shows fascicles of spindle-shaped cells with blunt-ended cigar-shaped nuclei. B. Smooth muscle actin(+) positive cytoplasm in spindle-shaped tumor cells. C. Microscopic image of recurrent tumor shows similar-spindle shaped cells similar to panel A of Fig. 2 with increased cellularity and mitosis; some areas of tumor show rounded cells with eosinophilic cytoplasm. H&E and immunohistochemical staining, A: ×100; B and C: ×200.

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  Fig. 3 A 48-year-old female patient. A. Preoperative panoramic image. Unclear radiography was observed at the left mandibular site; the border of the lesion was from #34 posterior to the left mandibular site. The alveolar crest was intact but cortical bone loss was observed at the lower mandible. B. Enhanced computerized tomographic image; a large, enhancing lesion was observed at #34 to #36, filling the marrow of the left mandible, partially perforating the cortical bone and swelling outwards, making buccal contact at the lower buccinator muscle and pushing the platysma muscle outwards. There is also lateral contact at the mylohyoid muscle and the anterior belly of the digastric muscle as well as anterior contact at the edge of sublingual gland. The mandibular canal was within the lesion, surrounded by the enhancing lesion. C. Postoperative panoramic image. Two years postoperatively, dental implants and prostheses are attached at the fibular region and there is no evidence of recurrence.

Reference

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