Abstract:

Leiomyosarcomas represent a rare soft tissue malignancy that represent <7% of soft tissue sarcomas. Leiomyosarcomas are categorized into dermal and subcutaneous based on dermatopathology. Each subcategory varies in terms of derivation, clinical features, treatment modalities, and prognostic factors. A 58-year-old Caucasian female with a history of atrial fibrillation, hypertension, hyperlipidemia, and obstructive sleep apnea presented for evaluation of a solitary lesion present on her left anterior shoulder that had been present for approximately 9 months prior to examination. She reported rapid growth since its onset, but denied any cutaneous symptoms. Physical exam demonstrated a 1.5-cm erythematous to violaceous polypoid nodule with superficial telangiectasias. She denied any prior history of trauma or radiation to the area. There was no significant lymphadenopathy. Review of systems was grossly unremarkable. Histology revealed cellular fascicles of atypical smooth muscle cells with scattered atypical mitotic figures. The lesion was positive for smooth muscle actin and desmin immunohistochemical stains. Stains for pan-cytokeratin, cyokeratin 5/6, S100, SOX-10, CD34 and Factor XIIIa were negative. The above clinical and histopathological correlation confirmed the diagnosis of a primary cutaneous leiomyosarcoma. Per the current treatment guidelines, a wide-local excision with 1-cm margins down to the subcutaneous fat was performed with negative margins. The patient was staged as T1N0M0G1 Stage 1, based on the American Joint Committee on Cancers classification for soft tissue sarcoma of the trunk and extremities. While primary dermal leiomyosarcomas carry an excellent prognosis, there is still a risk for recurrence and potential metastasis. Therefore, the patient is scheduled regularly for ongoing cutaneous oncologic surveillance.

Financial Disclosure:
No current or relevant financial relationships exist.

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Robert Daze, DO