Leiomyosarcoma of the extremity deep soft tissues: analysis of factors predictive of survival and imaging features

Main Article Content

Rana Kapukaya
Osman Ciloglu


Objective:  This study aimed to report the visual outcomes of deeply located Leiomyosarcoma (LMS) in the extremities and treatment results.

Methods: The histological diagnosis of each case was confirmed by the pathology council and only cases with LMS localized in the deep soft tissue of the limb were included in this study. Treatment-related factors such as all the visual features of the tumor, type of therapy, local and distant recurrence, follow-up time, and outcome were analyzed. Overall survival time was determined.

Results: Evaluation was made of 17 patients, comprising 11 females and 6 males with a mean age of 64.35 years (range, 52-75 years). The localization of the primary lesion was the lower extremity in 14 patients (82.34%), and the upper extremity in 3 (17.34%). The average size of the lesions was 8.23 cm (range, 3-22 cm). All lesions were staged according to the TNM Classification of soft tissue sarcomas, as 3 (17.64%) patients in stage IIA, 9 (52.94%) in stage IIB, and 5 (29.41%) in stage IV. In the radiological features of the lesions, only two patients had scattered calcification and osseous pathology in the tumor tissue. The signal properties obtained in other soft tissue sarcomas on magnetic resonance images (MRI) were also present in these lesions. Neoadjuvant chemotherapy was applied to 5 of 17 patients, and surgical and adjuvant radiotherapy was applied to the remaining 12 patients. These patients were followed up for an average of 66 (23-111) months. Local recurrence occurred in 3 patients. The five-year disease-free survival rate was 58.8%, and the disease-survival rate was 64.7%.

Conclusion: The most important result of this study was that the only effective factor on overall survival is tumor size (p <0.001). Neoadjuvant chemotherapy was not seen to have any significant effect on this disease.


Download data is not yet available.

Article Details

How to Cite
Kapukaya, R., & Ciloglu, O. (2020). Leiomyosarcoma of the extremity deep soft tissues: analysis of factors predictive of survival and imaging features . Medical Science and Discovery, 7(9), 647-651. https://doi.org/10.36472/msd.v7i9.420
Research Article


1. Farshid G, Pradhan M, Goldblum J et al (2002) Leiomyosarcoma of somatic soft tissues: a tumor of vascular origin with multivariate analysis of outcome in 42 cases. Am J Surg Pathol 26:14–

2. Miettinen M, Fetsch JF. Evaluation of biological potential of smooth muscle tumours. Histopathology 2006; 48:97–105

3. Pijpe J, Broers GH, Plaat BE et al.The relation between histological, tumor-biological and clinical parameters in deep and superficial leiomyosarcoma and leiomyoma. Sarcoma 2002; 6:105–110

4. Hung GY, Yen CC, Horng JL et al (2015) Incidences of primary soft tissue sarcoma diagnosed on extremities and trunk wall: a population-based study in Taiwan. Medicine (Baltimore) 2015; 94:1696

5. Gustafson P (1994) Soft tissue sarcoma: epidemiology and prognosis in 508 patients. Acta Orthop Scand Suppl 199; 259:1–31

6. Mastrangelo G, Coindre JM, Ducimetiere F. et al. Incidence of soft tissue sarcoma and beyond: a population-based prospective study in 3 European regions. Cancer. 2012; 118:5339–5348

7. Kaynaklar Bharat Rekhi, Amrit Kaur, Saral Desai Primary leiomyosarcoma of bone—a clinicopathologic study of 8 uncommon cases with immunohistochemical analysis and clinical outcomes. Annals of Diagnostic Pathology 15 (2011) 147–156

8. Sundaram M, Akduman I, White LM, McDonald DJ, Kandel R, Janney C. Primary leiomyosarcoma of bone. AJR 1999; 172:771–776

9. Berlin Ö, Angervall L, Kindblom LG, Berlin IC, Stener B. Primary leiomyosarcoma of bone: a clinical, radiographic, pathologic-anatomic, and prognostic study of 16 cases. Skeletal Radiol 1987; 16:364–376

10. Charles H. Bush, John D. Reith, Suzanne S. Spanier Mineralization in Musculoskeletal Leiomyosarcoma: Radiologic– Pathologic Correlation. AJR 2003; 180:109–113

11. Scurr M: Histology-driven chemotherapy in soft tissue sarcoma. Curr Treat Options Oncol 2011; 12:32–45.

12. Clark MA, Fisher C, Judson I, et al.: Soft-tissue sarcoma in adults. N Engl J Med 2005; 353:701–711.

13. Gage MJ, Patel AV, Koenig KL, et al.: Non-vena cava venous leiomyosarcomas: A review of the literature. Ann Surg Oncol 2012; 19:3368–3374.

14. Monk BJ, Blessing JA, Street DG, et al. A phase II evaluation of trabectedin in the treatment of advanced, persistent, or recurrent uterine leiomyosarcoma: A gynecologic oncology group study. Gynecol Oncol 2012; 124:48–52.

15. Pautier P, Floquet A, Chevreau C, et al.: Trabectedin in combination with doxorubicin for first-line treatment of advanced uterine or soft-tissue leiomyosarcoma (LMS-02): A non-randomised, multicentre, phase 2 trial. Lancet 2015; 16:457–464.

16. Scheoffski P, Ray-Coquard IL, Cioffi A, et al. Activity of eribulin mesylate in patients with soft-tissue sarcoma: A phase 2 study in four independent histological subtypes. Lancet Oncol 2011; 12:1045–1052

17. Svarvar C, Bohling T, Berlin O et al. Clinical course of nonvisceral soft tissue leiomyosarcoma in 225 patients from the Scandinavian Sarcoma Group. Cancer. 2007; 109:282–291

18. Gladdy RA, Qin LX, Moraco N et al Predictors of survival and recurrence in primary leiomyosarcoma. Ann Surg Oncol. 2013; 20:1851–1857
19. Mankin HJ, Casas-Ganem J, Kim JI et al. Leiomyosarcoma of somatic soft tissues. Clin Orthop Relat Res 2004; 421:225–231

20. Kamran Harati, Adrien Daigeler, Kim Lange et al. Somatic Leiomyosarcoma of the Soft Tissues: A Single- Institutional Analysis of Factors Predictive of Survival in 164 Patients. World J Surg (2017) 41:1534–1541

21. Abraham JA, Weaver MJ, Hornick JL et al Outcomes and prognostic factors for a consecutive case series of 115 patients with somatic leiomyosarcoma. J Bone Joint Surg Am 2012; 94:736–744