Leiomyosarcoma
Key Facts
Clinical Issues
Incidence
More common in adults
Range: 25-70 years of age
Anatomic site
Tumor may appear in anterior or posterior mediastinum
Treatment
Complete surgical resection of tumor
Depending on surgical staging, radiation or chemotherapy may be considered
Symptoms
Chest pain
Dyspnea
Cough
Pleural effusion
Asymptomatic
Microscopic Pathology
Solid spindle cellular proliferation
Spindle cells with cigar-like nuclei and eosinophilic cytoplasm
Variable nuclear atypia depending on degree of differentiation (grade of tumor)
Top Differential Diagnoses
Solitary fibrous tumor
Monophasic synovial sarcoma
Spindle cell thymoma
Metastatic leiomyosarcoma
 Mediastinal leiomyosarcoma shows a malignant spindle cell proliferation  with areas of necrosis  . Note the presence of residual thymic epithelium  . |
 Mediastinal leiomyosarcoma shows prominent nuclear atypia and numerous mitotic figures  . These features are similar to those tumors occurring in soft tissues. |
TERMINOLOGY
Abbreviations
Leiomyosarcoma (LMS)
Synonyms
Malignant smooth muscle tumor
Definitions
Malignant mesenchymal neoplasm of smooth muscle origin
CLINICAL ISSUES
Epidemiology
Incidence
Unusual tumor in mediastinal compartment
Age
More common in adults
Range: 25-70 years old
Gender
There is no gender predilection although LMS may be slightly more common in males
Site
Tumor may appear in anterior or posterior mediastinum
Presentation
Chest pain
Dyspnea
Cough
General malaise
Pleural effusion
Asymptomatic
Treatment
Surgical approaches
Complete surgical resection of tumor
Adjuvant therapy
Depending on surgical staging, radiation or chemotherapy may be considered
Prognosis
Depends on staging of tumor
Patients with advanced stage may follow a more aggressive behavior
Patients with more limited disease (early stage) may follow a more favorable outcome
MACROSCOPIC FEATURES
General Features
Well-defined but not encapsulated tumors
Rubbery tumor mass at cut surface
May show cystic changes
Light brown to tan in color
Necrosis &/or hemorrhage may be present
Size
Varies from 5 cm to > 12 cm in greatest diameter
MICROSCOPIC PATHOLOGY
Histologic Features
Solid spindle cellular proliferation
Spindle cells with cigar-like nuclei and eosinophilic cytoplasm
Variable nuclear atypia depending on degree of differentiation (grade of tumor)
Variable mitotic activity depending on degree of differentiation (grade of tumor)
DIFFERENTIAL DIAGNOSIS
Solitary Fibrous Tumor
Tumor shows different growth patterns
Immunohistochemical studies for CD34 and Bcl-2 are commonly seen positive
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