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Local recurrence and assessment of sentinel lymph node biopsy in deep soft tissue leiomyosarcoma of the extremities.

Lamyman MJ, Giele HP, Critchley P, Whitwell D, Gibbons M, Athanasou NA - Clin Sarcoma Res (2011)

Bottom Line: Lymph node metastasis was seen in only two cases (7%); intratumoural lymphatics were identified in the primary tumours of both these cases.Local recurrence occurred in 25.9% of cases despite complete excision and post-operative radiotherapy; the mean time to recurrence was 10.1 months.On the basis of this study, we do not advocate sentinel lymph node biopsy in this group of patients except in those cases in which intratumoural lymphatics can be demonstrated.

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ABSTRACT

Background: Leiomyosarcoma of deep soft tissues of the extremities is a rare malignant tumour treated primarily by surgery. The incidence of local recurrence and lymph node metastasis is uncertain and it is not known whether a sentinel lymph node biopsy is indicated in these tumours.

Methods: A retrospective review of patients treated for extremity deep soft tissue leiomyosarcoma at our institution over a 10-year period was conducted. Patients developing local recurrence or lymph node metastasis were identified. The presence or absence of lymphatics in the primary tumours was assessed by immunohistochemical expression of LYVE-1 and podoplanin.

Results: 27 patients (mean age 62 years) were included in the study. 15 were female and 12 male. Lymph node metastasis was seen in only two cases (7%); intratumoural lymphatics were identified in the primary tumours of both these cases. Local recurrence occurred in 25.9% of cases despite complete excision and post-operative radiotherapy; the mean time to recurrence was 10.1 months.

Conclusion: On the basis of this study, we do not advocate sentinel lymph node biopsy in this group of patients except in those cases in which intratumoural lymphatics can be demonstrated. Close follow up is important especially for high grade leiomyosarcomas, particularly in the first year, as these tumours have a high incidence of local recurrence.

No MeSH data available.


Related in: MedlinePlus

Intratumoural lymphatic vessels in a primary leiomyosarcoma, showing podoplanin expression by lymphatic endothelial cells.
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Figure 3: Intratumoural lymphatic vessels in a primary leiomyosarcoma, showing podoplanin expression by lymphatic endothelial cells.

Mentions: A review of the pathology of the primary tumour in these two cases showed that both tumours contained intratumoural lymphatics, as assessed by endothelial cell expression of the lymphatic markers, podoplanin and LYVE-1. (Figure 3) The remaining tumours, which did not metastasise to lymph nodes, were negative for lymphatic markers. In one patient the nodal recurrence was extensive, encasing femoral vessels and was not resectable. In the second patient an inguinal and iliac lymph node dissection was performed. In this patient the lymph node metastasis occurred early, before radiotherapy was instituted.


Local recurrence and assessment of sentinel lymph node biopsy in deep soft tissue leiomyosarcoma of the extremities.

Lamyman MJ, Giele HP, Critchley P, Whitwell D, Gibbons M, Athanasou NA - Clin Sarcoma Res (2011)

Intratumoural lymphatic vessels in a primary leiomyosarcoma, showing podoplanin expression by lymphatic endothelial cells.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3351718&req=5

Figure 3: Intratumoural lymphatic vessels in a primary leiomyosarcoma, showing podoplanin expression by lymphatic endothelial cells.
Mentions: A review of the pathology of the primary tumour in these two cases showed that both tumours contained intratumoural lymphatics, as assessed by endothelial cell expression of the lymphatic markers, podoplanin and LYVE-1. (Figure 3) The remaining tumours, which did not metastasise to lymph nodes, were negative for lymphatic markers. In one patient the nodal recurrence was extensive, encasing femoral vessels and was not resectable. In the second patient an inguinal and iliac lymph node dissection was performed. In this patient the lymph node metastasis occurred early, before radiotherapy was instituted.

Bottom Line: Lymph node metastasis was seen in only two cases (7%); intratumoural lymphatics were identified in the primary tumours of both these cases.Local recurrence occurred in 25.9% of cases despite complete excision and post-operative radiotherapy; the mean time to recurrence was 10.1 months.On the basis of this study, we do not advocate sentinel lymph node biopsy in this group of patients except in those cases in which intratumoural lymphatics can be demonstrated.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Leiomyosarcoma of deep soft tissues of the extremities is a rare malignant tumour treated primarily by surgery. The incidence of local recurrence and lymph node metastasis is uncertain and it is not known whether a sentinel lymph node biopsy is indicated in these tumours.

Methods: A retrospective review of patients treated for extremity deep soft tissue leiomyosarcoma at our institution over a 10-year period was conducted. Patients developing local recurrence or lymph node metastasis were identified. The presence or absence of lymphatics in the primary tumours was assessed by immunohistochemical expression of LYVE-1 and podoplanin.

Results: 27 patients (mean age 62 years) were included in the study. 15 were female and 12 male. Lymph node metastasis was seen in only two cases (7%); intratumoural lymphatics were identified in the primary tumours of both these cases. Local recurrence occurred in 25.9% of cases despite complete excision and post-operative radiotherapy; the mean time to recurrence was 10.1 months.

Conclusion: On the basis of this study, we do not advocate sentinel lymph node biopsy in this group of patients except in those cases in which intratumoural lymphatics can be demonstrated. Close follow up is important especially for high grade leiomyosarcomas, particularly in the first year, as these tumours have a high incidence of local recurrence.

No MeSH data available.


Related in: MedlinePlus