Primary pleural leiomyosarcoma with rapid progression and fatal outcome: a case report

Our plain-English summary of Primary pleural leiomyosarcoma with rapid progression and fatal outcome: a case report, by G. Rais, S. Raissouni, H. Mouzount, et al (Journal of Medical Case Reports, 2012).

The study

• Authors: G. Rais, S. Raissouni, H. Mouzount, M. Aitelhaj, S. Khoyaali, F. El Omrani, H. Mrabti, A. Jelthi, H. Errihani
• Journal: Journal of Medical Case Reports
• Published: 2012;6:101
• Cited by: 9 articles, as counted by NIH iCite
• Read it: PubMed · Publisher · Free full text

Abstract

Introduction: Leiomyosarcomas are neoplasms of smooth muscles that most commonly arise from the uterus, gastrointestinal tract, or soft tissue. Primary pleural leiomyosarcoma is extremely rare. To the best of our knowledge, only nine cases have been published to date. Because of the rarity of pleural leiomyosarcoma and its similarity (clinical and histological) to other pleural neoplasms, particularly sarcomatous mesothelioma, diagnosis is often difficult.

Case Presentation: A 58-year-old North African man was admitted with complaints of dyspnea and chest pain to our hospital. Chest computed tomography revealed right pleural effusion and pleural thickening. A transthoracic needle biopsy yielded a diagnosis of leiomyosarcoma, and tumor cells were strongly and uniformly positive for vimentin, a smooth muscle actin at immunohistochemical analysis. A general examination did not show any metastatic lesions in other areas. One month after diagnosis, the tumor grew rapidly, with pulmonary invasion, and therefore he was treated only by palliative care. He died from respiratory failure one month later. Because no organ of origin of the leiomyosarcoma, other than the pleura, was detected, this case was diagnosed as a primary pleural leiomyosarcoma.

Conclusions: Although leiomyosarcoma originating from the pleura is rare, this entity is increasingly described. The purpose of presenting this case report is to raise awareness among clinicians to consider this clinical entity as a differential diagnosis when a pleural mass is identified.

In plain English

This was a case report from the National Institute of Oncology in Rabat, Morocco, describing one patient with primary pleural leiomyosarcoma, a cancer of smooth muscle cells arising in the pleura (the lining around the lungs). The patient was a 58-year-old North African man. He had shortness of breath and right-sided chest pain for two months, and he had smoked for 25 years. The article does not mention asbestos. Fluid drained from his chest showed no cancer cells, and the authors reported that the tumor was at first misdiagnosed as pleural tuberculosis. A CT scan showed a thick-walled cavity in the pleural space, fluid, and a partly collapsed right lung. A needle biopsy showed spindle-shaped cancer cells that stained positive for vimentin and smooth muscle actin and negative for the other markers tested. The authors said these results ruled out sarcomatous mesothelioma, among other tumors. A whole-body CT scan found no other tumor. The tumor grew rapidly. He received only palliative care and died one month later of acute respiratory failure. The authors concluded that clinicians should consider this tumor when a pleural mass is found.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report (single patient), with a discussion of published literature
• Who was studied: One 58-year-old North African man treated at the National Institute of Oncology, Rabat, Morocco; dates of care not given
• Exposure: Asbestos exposure is not mentioned. The only exposure reported is tobacco smoking (one pack per day for 25 years); the authors state he had no additional risk factors.
• Main results:
  • Pleural fluid cytology in this patient was negative for malignant cells
  • Chest CT showed a right-sided cavity with thick, irregular walls in the right lower lobe, pleural effusion, and a partially collapsed right lung
  • The needle biopsy showed spindle cell tumor with frequent mitoses (greater than 10 mitoses per 10 high-power fields)
  • Tumor cells were strongly and uniformly positive for vimentin and smooth muscle actin and negative for all other markers tested; the authors state this ruled out carcinoma, sarcomatous mesothelioma (calretinin), solitary fibrous tumor and neurogenic sarcoma
  • A whole-body CT scan found no other tumors, so the lesion was diagnosed as primary pleural leiomyosarcoma
  • The tumor was initially misdiagnosed as pleural tuberculosis, which the authors attribute to how frequent that infection is in Morocco
  • The patient received only palliative care and died one month later of acute respiratory failure
• The authors' conclusion: The authors concluded that the case should raise awareness among clinicians to consider pleural leiomyosarcoma as a differential diagnosis when a pleural mass is identified

Topics

Medical terms in this study, explained in our Lexicon: Neoplasm, Mesothelioma, Dyspnea, Pleural Effusion, Pleural Thickening, Needle Biopsy, Palliative Care, Pleura.

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