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Leiomyosarcoma
Eric Walker, MD, MHA, FACR, FACHE; Catherine C. Roberts, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Terminology

    • Imaging

      • Pathology

        • Clinical Issues

          TERMINOLOGY

          • Definitions

            • Malignant neoplasm composed of cells showing smooth muscle differentiation
          • Can Be Divided Into 3 Subgroups

            • (1) Cutaneous and subcutaneous forms
              • Cutaneous (dermal) lesions are believed to derive from erector pili muscles or genital dartoic muscle
              • Subcutaneous lesions are thought to arise from smooth muscle in vessels
            • (2) Major vessel
            • (3) Soft tissue
              • Subdivided into peripheral or somatic soft tissues of extremities and those arising in retroperitoneum and abdomen
                • Retroperitoneum/abdomen leiomyosarcomas are ~ 2x as common as those located in somatic soft tissue
                • Soft tissue lesions are usually intimately associated with small vessel
                  • Veins affected 4-5x more frequently than arteries

          IMAGING

          • General Features

            • Imaging Recommendations

              • Radiographic Findings

                • CT Findings

                  • MR Findings

                    • Ultrasonographic Findings

                      • Angiographic Findings

                        DIFFERENTIAL DIAGNOSIS

                          PATHOLOGY

                          • General Features

                            • Staging, Grading, & Classification

                              • Gross Pathologic & Surgical Features

                                • Microscopic Features

                                  CLINICAL ISSUES

                                  • Presentation

                                    • Demographics

                                      • Natural History & Prognosis

                                        • Treatment

                                          Selected References

                                          1. Renn A et al: Overview of malignant soft-tissue sarcomas of the limbs. Clin Radiol. 76(12):940.e1-16, 2021
                                          2. Tillman BN et al: Cutaneous sarcomas. Otolaryngol Clin North Am. 54(2):369-78, 2021
                                          3. Dry SM: Leiomyosarcoma. In Fletcher CDM et al: WHO Classification of Tumours: Soft Tissue and Bone Tumours. 5th ed. IARC Press. 195-7, 2020
                                          4. Kransdorf MJ et al: Muscle tumors. In Kransdorf MJ et al: Imaging of Soft Tissue Tumors. Lippincott Williams & Wilkins. 373-9, 2014
                                          5. Gordon RW et al: MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients. Skeletal Radiol. 43(5):615-22, 2014
                                          6. Weiss SW et al: Leiomyosarcoma. In Weiss SW et al: Enzinger and Weiss' Soft Tissue Tumors. 5th ed. Elsevier. 545-64, 2008
                                          7. Petscavage-Thomas JM et al: Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics. 34(4):964-80, 2014
                                          8. Walker EA et al: Magnetic resonance imaging of malignant soft tissue neoplasms in the adult. Radiol Clin North Am. 49(6):1219-34, vi, 2011
                                          9. Walker EA et al: Magnetic resonance imaging of soft-tissue masses. Semin Roentgenol. 45(4):277-97, 2010
                                          10. Efstathopoulos N et al: Inflammatory leiomyosarcoma of the ankle: a case report and review of the literature. J Foot Ankle Surg. 45(2):127-30, 2006
                                          11. Massi D et al: Prognostic factors in soft tissue leiomyosarcoma of the extremities: a retrospective analysis of 42 cases. Eur J Surg Oncol. 30(5):565-72, 2004
                                          12. Evans HL et al: Leiomyosarcoma. In Fletcher CDM et al: WHO Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press. 131-4, 2002
                                          13. Abdelwahab IF et al: Radiation-induced leiomyosarcoma. Skeletal Radiol. 24(1):81-3, 1995
                                          14. Hartman DS et al: From the archives of the AFIP. Leiomyosarcoma of the retroperitoneum and inferior vena cava: radiologic-pathologic correlation. Radiographics. 12(6):1203-20, 1992
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Terminology

                                            • Imaging

                                              • Pathology

                                                • Clinical Issues

                                                  TERMINOLOGY

                                                  • Definitions

                                                    • Malignant neoplasm composed of cells showing smooth muscle differentiation
                                                  • Can Be Divided Into 3 Subgroups

                                                    • (1) Cutaneous and subcutaneous forms
                                                      • Cutaneous (dermal) lesions are believed to derive from erector pili muscles or genital dartoic muscle
                                                      • Subcutaneous lesions are thought to arise from smooth muscle in vessels
                                                    • (2) Major vessel
                                                    • (3) Soft tissue
                                                      • Subdivided into peripheral or somatic soft tissues of extremities and those arising in retroperitoneum and abdomen
                                                        • Retroperitoneum/abdomen leiomyosarcomas are ~ 2x as common as those located in somatic soft tissue
                                                        • Soft tissue lesions are usually intimately associated with small vessel
                                                          • Veins affected 4-5x more frequently than arteries

                                                  IMAGING

                                                  • General Features

                                                    • Imaging Recommendations

                                                      • Radiographic Findings

                                                        • CT Findings

                                                          • MR Findings

                                                            • Ultrasonographic Findings

                                                              • Angiographic Findings

                                                                DIFFERENTIAL DIAGNOSIS

                                                                  PATHOLOGY

                                                                  • General Features

                                                                    • Staging, Grading, & Classification

                                                                      • Gross Pathologic & Surgical Features

                                                                        • Microscopic Features

                                                                          CLINICAL ISSUES

                                                                          • Presentation

                                                                            • Demographics

                                                                              • Natural History & Prognosis

                                                                                • Treatment

                                                                                  Selected References

                                                                                  1. Renn A et al: Overview of malignant soft-tissue sarcomas of the limbs. Clin Radiol. 76(12):940.e1-16, 2021
                                                                                  2. Tillman BN et al: Cutaneous sarcomas. Otolaryngol Clin North Am. 54(2):369-78, 2021
                                                                                  3. Dry SM: Leiomyosarcoma. In Fletcher CDM et al: WHO Classification of Tumours: Soft Tissue and Bone Tumours. 5th ed. IARC Press. 195-7, 2020
                                                                                  4. Kransdorf MJ et al: Muscle tumors. In Kransdorf MJ et al: Imaging of Soft Tissue Tumors. Lippincott Williams & Wilkins. 373-9, 2014
                                                                                  5. Gordon RW et al: MRI, MDCT features, and clinical outcome of extremity leiomyosarcomas: experience in 47 patients. Skeletal Radiol. 43(5):615-22, 2014
                                                                                  6. Weiss SW et al: Leiomyosarcoma. In Weiss SW et al: Enzinger and Weiss' Soft Tissue Tumors. 5th ed. Elsevier. 545-64, 2008
                                                                                  7. Petscavage-Thomas JM et al: Soft-tissue myxomatous lesions: review of salient imaging features with pathologic comparison. Radiographics. 34(4):964-80, 2014
                                                                                  8. Walker EA et al: Magnetic resonance imaging of malignant soft tissue neoplasms in the adult. Radiol Clin North Am. 49(6):1219-34, vi, 2011
                                                                                  9. Walker EA et al: Magnetic resonance imaging of soft-tissue masses. Semin Roentgenol. 45(4):277-97, 2010
                                                                                  10. Efstathopoulos N et al: Inflammatory leiomyosarcoma of the ankle: a case report and review of the literature. J Foot Ankle Surg. 45(2):127-30, 2006
                                                                                  11. Massi D et al: Prognostic factors in soft tissue leiomyosarcoma of the extremities: a retrospective analysis of 42 cases. Eur J Surg Oncol. 30(5):565-72, 2004
                                                                                  12. Evans HL et al: Leiomyosarcoma. In Fletcher CDM et al: WHO Classification of Tumours. Pathology and Genetics of Tumours of Soft Tissue and Bone. IARC Press. 131-4, 2002
                                                                                  13. Abdelwahab IF et al: Radiation-induced leiomyosarcoma. Skeletal Radiol. 24(1):81-3, 1995
                                                                                  14. Hartman DS et al: From the archives of the AFIP. Leiomyosarcoma of the retroperitoneum and inferior vena cava: radiologic-pathologic correlation. Radiographics. 12(6):1203-20, 1992