CC BY-NC-ND 4.0 · Revista Chilena de Ortopedia y Traumatología 2021; 62(03): e221-e226
DOI: 10.1055/s-0041-1740233
Caso Clínico | Case Report

Primary Bone Leiomyosarcoma in the Distal Femur with Clavicle Metastasis. A Case Report

Article in several languages: español | English
Francisco Linares R
1  Especialista en Cirugía Ortopédica Oncológica, Hospital Universitario San Ignacio, Bogotá, Colombia
,
Helbert Martín V
2  Residente del IV año de Ortopedia y Traumatología, Hospital Universitario San Ignacio, Bogotá, Colombia
,
Natalia Correal A
3  Estudiante de XII semestre, Unidad de Ortopedia, Hospital Universitario San Ignacio, Bogotá, Colombia
› Author Affiliations
Funding The present research has not received any specific grants from public, commercial, or non-profit sector agencies.

Abstract

Leiomyosarcoma (LMS) is a type of spindle-cell tumor of very low incidence that tumor has an aggressive behavior, with high mortality rates; therefore, its management must be surgical, with a wide resection of the lesion. The role of radio and chemotherapy in its management is not clear. We present the case of a 28-year-old female patient who consulted for pain lasting 2 months in the right knee. Radiographically, it was characterized as a pure osteolytic lesion in the distal femur. Contrast magnetic resonance imaging (MRI) showed hypervascular areas within the tumor. The scintigraphy showed a marked increase in radiotracer uptake. A biopsy was taken, with a pathology report of well-differentiated osseous LMS. It was treated with 3 cycles of preoperative neoadjuvant chemotherapy with ifosfamide 1,000 mg/m2 in the first 3 days, as well as doxorubicin 70 mg/m2, and surgical resection of the lesion and limb salvage with knee endoprosthesis. Once the lesion was resected, the patient underwent adjuvant chemotherapy, with 4 cycles of gencitabine 1,000 mg/m2 between days 1 and 8, and doxetacel 70 mg/m2 on day 1. During the 2-month follow-up, the patient presented a fracture in the middle third of the clavicle, which was compatible with a pathological lesion on radiographs and positron-emission tomography (PET) scans. The biopsy showed a metastatic lesion of bone LMS, which was treated by surgical resection of the clavicle. This is a unique case, given that, during the follow-up, the patient underwent adjuvant treatment with chemotherapy, and was evaluated with a PET scan, with a satisfactory clinical evolution and no evidence of new lesions.

Level of evidence IV.



Publication History

Received: 14 May 2020

Accepted: 21 January 2021

Publication Date:
22 December 2021 (online)

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