Document Type : Case Report

Authors

1 Dept. of Oral and Maxillofacial Surgery, Head of Dental Research Center, Research Institute of Dental Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

2 Dept. Oral and Maxillofacial Surgery Dental School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.

Abstract

Leiomyosarcoma is a malignant tumor arising from smooth muscle cells accounting for 10-20% of soft tissue sarcomas and less than 2% are located in head and neck region. We report a case of leiomyosarcoma of maxilla in a 26-year-old female patient referred to Shahid-Beheshti University of Medical Sciences, Faculty of Dentistry. Patient complained of swelling of left side of the face from 5 months ago without a history of significant illness. Clinical examination showed asymmetric swelling of left side of the face with tenderness. The lesion in the left buccal vestibule was tender to the touch and contained erythematous mucosa with a firm tissue. Results of the neck computed tomography (CT) scan indicated mucosal thickening in the left maxillary sinus. In the preoperative magnetic resonance imaging (MRI), a mass with an estimated size of 4.7×3.1×3.0cm was found, extending from the posterior wall to the posterolateral wall of the left maxillary sinus, causing impression and remodeling of the sinus wall. Incisional biopsy was preformed and immunohistochemistry suggested leiomyosarcoma. Partial maxillectomy of the posterior maxillary walls was performed, using an intraoral incision and dissection from the maxillary vestibule up to the mandibular vestibule. The tumor was excised using frozen section. Pathological examination reported the lesion compatible with leiomyosarcoma, with all surgical margins free of tumor. Post-operative MRI showed no definite mass in the region. In conclusion, according to the present results, the clinical features of leiomyosarcoma of the maxilla are clear, and diagnosis is feasible. 

Keywords

  • Zieler G. Uberein malignes myome der haut. Virch Dtsch Pathol Ges. 1908; 12: 142.
  • Serrano C, George S. Leiomyosarcoma. Hematol Oncol Clin North Am. 2013; 27: 957-974.
  • Yadav J, Bakshi J, Chouhan M, Modi R. Head and neck leiomyosarcoma. Indian J Otolaryngol Head Neck Surg. 2013; 65(Suppl 1): 1-5.
  • Freedman AM, Reiman HM, Woods JE. Soft-tissue sarcomas of the head and neck. Am J Surg.1989; 158: 367-372.
  • Sandhu SV, Sodhi SPS, Rai S, Bansal H. Primary leiomyosarcoma of the maxilla: An investigative loom-report of a challenging case and review of literature. J Oral Maxillofac Pathol. 2014; 18: 453-459.
  • Taghipour Zahir S, Sharahjin NS. Leiomyosarcoma of the maxilla in a 24-year-old man who initially presented with odontalgia, and suffered from tumour mismanagement. BMJ Case Rep. 2013; 2013: bcr2013200933.
  • Chew YK, Noorizan Y, Khir A, Brito-Mutunayagam S. Leiomyosarcoma of the maxillary sinus. Med J Malaysia. 2009; 64: 174-175.
  • Indell RS, Calcaterra TC, Ward PH. Leiomyosarcoma of the head and neck: a review of the literature and report of two cases. Laryngoscope. 1975; 85: 904-910.
  • Montgomery E, Goldblum JR, Fisher C. Leiomyosarcoma of the head and neck: a clinicopathological study. Histopathology. 2002; 40: 518-525.
  • Tanaka H, Westesson P, Wilbur D. Leiomyosarcoma of the maxillary sinus: CT and MRI findings. Br J Radiol. 1998; 71: 221-224.
  • Prasad KC, Alva TB, Khadilkar U, Madhu D. Leiomyosarcoma of the maxillary sinuses: report of two cases. Ear Nose Throat J. 2004; 83: 122-127.
  • Wada S, Yue L, Furuta I, Takazakura T. Leiomyosarcoma in the maxilla: A case report. Int J Oral Maxillofac Surg. 2002; 31: 219-221.
  • Kawabe Y, Kondo T, Hosoda S. Two Cases of Leiomyosarcoma of the Maxillary Sinuses. Arch Otorhinolaryngol. 1969; 90: 492-495.
  • Izumi K, Maeda T, Cheng J, Saku T. Primary leiomyosarcoma of the maxilla with regional lymph node metastasis: Report of a case and review of the literature. Oral Surg Oral Med Oral Patho Oral Radio Endo. 1995; 80: 310-319.
  • Ohashi Y, Nakai Y, Muraoka M, Takano H. Asymptomatic leiomyosarcoma of maxillary sinus accompanied by primary mucocele. Arch Otorhinolaryngol. 1984; 240: 73-78.
  • McLeod AJ, Zornoza J, Shirkhoda A. Leiomyosarcoma: computed tomographic findings. Radiology. 1984; 152: 133-136.
  • Nishi M, Mimura T, Senba I. Leiomyosarcoma of the maxilla. J Oral Maxillofac Surg. 1987; 45: 64-68.
  • Wada S, Yue L, Furuta I, Takazakura T. Leiomyosarcoma in the maxilla: a case report. Int J Oral Maxillofac Surg. 2002; 31: 219-221.
  • Nikitakis NG, Lopes MA, Bailey JS, Blanchaert RH Jr., Ord RA, Sauk JJ. Oral leiomyosarcoma: review of the literature and report of two cases with assessment of the prognostic and diagnostic significance of immunohistochemical and molecular markers. Oral Oncol. 2002; 38: 201-208.
  • Ethunandan M, Stokes C, Higgins B, Spedding A, Way C, Brennan P. Primary oral leiomyosarcoma: a clinico-pathologic study and analysis of prognostic factors. Int J Oral Maxillofac Surg. 2007; 36: 409-416.