Pulmonary Metastases From Primary Thigh Leiomyosarcoma: A Case Report and Review of the Literature

Figures

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  Figure 1. Ultrasound scan of the lump above left lateral knee area A) longitudinal view showed a heterogeneous hypoechoic mass, B) longitudinal view with Doppler study where the neovascular formation was visualized.

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  Figure 2. Magnetic resonance imaging (MRI) with and without contrast showed heterogeneous solid enhancing soft tissue mass A) - axial view B) - coronal view C) - sagittal view.

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  Figure 3. Ultrasound-guided core needle biopsy of left thigh mass displayed A) pleomorphic spindle cell sarcoma, high-grade with tumor cells arranged in storiform pattern (H&E, x100), B) on higher magnification sheets of polygonal, spindled, and epithelioid cells are seen, with eosinophilic cytoplasm, marked nuclear pleomorphic, multinucleation and conspicuous mitotic activity (yellow arrows), including atypical forms (H&E, x400). H&E: hematoxylin and eosin stain

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  Figure 4. Immunohistochemical analysis showed tumor cells with multifocal positivity for A) Desmin (400x) and B) smooth muscle actin (SMA) (200x) in a subset of neoplastic cells, while caldesmon, SOX-10, and SATB2 were negative. Additionally, the melanoma markers (Melan A and HMB45) and epithelial (CK AE1:AE3) immunostains were negative.

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  Figure 5. Histology of left thigh mass, resection showed (A-H&E 100x) fascicular architecture of high-grade pleomorphic spindle cell sarcoma, most suggestive of leiomyosarcoma, composed of cellular, intersecting fascicles of spindle cells, focally invading skeletal muscle, B-H&E 400x - pleomorphic cells have abundant eosinophilic, fibrillary cytoplasm, multinucleated giant cells, and mitotic figures can be seen.​ C - H&E 40x - tumor cells present on ink at the anterior surgical margin.

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  Figure 6. Left knee CT with contrast showed a postoperative seroma along the distal and lateral aspect of the left thigh superficial to the vastus lateralis musculature.

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  Figure 7. CT chest axial view one year after radiation therapy displayed the presence of six new pulmonary nodules.

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  Figure 8. CT chest axial view one year after radiation therapy displayed the presence of six new pulmonary nodules (rest of nodules)

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  Figure 9. CT-guided needle biopsy of the left lung, upper lobe, showed A) lung parenchymal infiltration by a spindle cell malignant neoplasm with pleomorphic cells that are morphologically similar to the patient's prior known diagnosis of pleomorphic/dedifferentiated leiomyosarcoma, FNCLCC grade 3, (100X, H&E)​. B) tumor cells with bizarre nuclei and surrounding stromal hyalinization (400X, H&E).

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  Figure 10. CT chest with contrast showed progression of the metastatic disease with an interval increase in the size of a right middle lobe nodule measuring 10.71 mm (A - axial view) and an interval increase in the size of a left upper lobe nodule at 33.15 x 35.70 mm (B - axial view).