Abstract
Leiomyosarcoma (LMS) is a type of spindle-cell tumor of very low incidence that tumor
has an aggressive behavior, with high mortality rates; therefore, its management must
be surgical, with a wide resection of the lesion. The role of radio and chemotherapy
in its management is not clear. We present the case of a 28-year-old female patient
who consulted for pain lasting 2 months in the right knee. Radiographically, it was
characterized as a pure osteolytic lesion in the distal femur. Contrast magnetic resonance
imaging (MRI) showed hypervascular areas within the tumor. The scintigraphy showed
a marked increase in radiotracer uptake. A biopsy was taken, with a pathology report
of well-differentiated osseous LMS. It was treated with 3 cycles of preoperative neoadjuvant
chemotherapy with ifosfamide 1,000 mg/m2 in the first 3 days, as well as doxorubicin 70 mg/m2, and surgical resection of the lesion and limb salvage with knee endoprosthesis.
Once the lesion was resected, the patient underwent adjuvant chemotherapy, with 4
cycles of gencitabine 1,000 mg/m2 between days 1 and 8, and doxetacel 70 mg/m2 on day 1. During the 2-month follow-up, the patient presented a fracture in the middle
third of the clavicle, which was compatible with a pathological lesion on radiographs
and positron-emission tomography (PET) scans. The biopsy showed a metastatic lesion
of bone LMS, which was treated by surgical resection of the clavicle. This is a unique
case, given that, during the follow-up, the patient underwent adjuvant treatment with
chemotherapy, and was evaluated with a PET scan, with a satisfactory clinical evolution
and no evidence of new lesions.
Level of evidence IV.
Keywords
bone tumor - leiomyosarcoma - bone metastasis
