J Pathol Transl Med.  2024 Jan;58(1):35-39. 10.4132/jptm.2023.11.14.

Primary leiomyosarcoma of the bone: a case report

• Abu-Dayeh A
• Alhyassat S

• KMID: 2550499
• DOI: http://doi.org/10.4132/jptm.2023.11.14

Abstract

Primary leiomyosarcoma of the bone is rare. Histologically, it resembles leiomyosarcoma of soft tissue. Given the rarity of this entity, its diagnosis should be made only after clinical studies and workup have excluded metastasis from other sites. Herein, we describe an additional case of primary bone leiomyosarcoma. We report a 32-year-old female patient, who presented with right knee pain and was found to have a right distal femur mass by imaging studies. Biopsy showed a neoplasm composed of fascicles of spindle cells, arranged in different patterns, with significant pleomorphism. The tumor cells were positive for smooth muscle actin, focally positive for desmin and H-caldesmon. No other masses in the body were detected by imaging studies. The diagnosis of leiomyosarcoma of the bone was rendered. Given the broad diagnostic differential of primary bone leiomyosarcoma, it is important to be aware of this rare bone tumor phenotype and of its histomorphologic and immunohistochemical features for an accurate diagnosis.

Keyword

Bone; Sarcoma; Leiomyosarcoma; Case report

Figure

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  Fig. 1. Magnetic resonance imaging shows an intraosseous metaphyseal central lytic lesion (red arrow), completely replacing the medullary cavity of the distal third of the right femoral shaft for a 10 cm span in craniocaudal dimension with multiple areas of cortical bone destruction.

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  Fig. 2. Microscopic and immunohistochemical features of primary bone leiomyosarcoma. (A) Photomicrograph shows fascicles of pleomorphic spindle and epithelioid cells arranged in fascicular, storiform, and haphazard patterns. (B) High-power view demonstrates cellular pleomorphism in the form of hyperchromasia, high nucleus-to-cytoplasmic ratios, and irregular nuclear contours. Some cells show vesicular nuclei and prominent nucleoli. (C) Photomicrograph shows fat lobules infiltrated by tumor cells. (D) The tumor cells are positive for smooth muscle actin. (E) The tumor cells show focal reactivity for Desmin. (F) The tumor cells show focal reactivity for H-caldesmon. (G) The tumor cells are negative for estrogen receptor.

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  Fig. 3. A computerized tomography scan of the pelvis reveals no uterine lesions.

Reference

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