We report the clinical, histopathologic, immunohistologic, and prognostic findings in 19 patients with cutaneous leiomyosarcoma, eight males and 11 females (mean age, 66 years; age range, 41-93 years). The tumors presented mainly as solitary lesions and were located on the head and neck (eight lesions), trunk (four lesions), upper extremities (three lesions), and lower extremities (four lesions). Histopathologically, two predominant growth patterns were observed: nodular (12 cases) and diffuse (seven cases). Neoplasms with a nodular growth pattern were characterized by high cellularity and prominent nuclear atypia, and they showed conspicuous mitoses, several necrotic cells, and sometimes extensive necrotic areas. By contrast, most cutaneous leiomyosarcomas with a diffuse growth pattern revealed low cellularity, well-differentiated smooth muscle cells, inconspicuous mitotic figures, and few or no necrotic cells. Immunohistologic investigations revealed all cutaneous leiomyosarcomas to express vimentin and smooth muscle actin. Pan-muscle actin (HHF-35) was also expressed in most cases (15 lesions). However, only 12 lesions showed positive staining for desmin. Remarkable was the expression of cytokeratins in five lesions. Clinical follow-up revealed local recurrences in five patients (three cases with nodular pattern and two lesions with a diffuse pattern) after a period ranging from 8 months to 3 years after surgical excision. No distant metastases have been observed in our series. We conclude that cutaneous leiomyosarcoma with a diffuse growth pattern may constitute a pitfall in histopathologic diagnosis because of the presence of only subtle criteria for malignancy. Cutaneous leiomyosarcoma may show different immunophenotypes, thus emphasizing the importance of using a large panel of antibodies (smooth muscle actin, HHF-35, desmin, vimentin, cytokeratins, and S-100 protein) in immunohistologic diagnosis. Cutaneous leiomyosarcoma sometimes reveals local recurrences, but it has negligible potential for distant metastases.
Leiomyosarcoma of the skin and subcutaneous tissue
In a study of 65 primary cutaneous leiomyosarcomas and 15 primary superficial subcutaneous leiomyosarcomas, tumors occurred at any age but were more common in middle age and most common on the extremities. They developed as solitary painful or tender intracutaneous or subcutaneous nodules. Microscopically, the cutaneous leiomyosarcomas consist of a poorly delineated proliferation of spindle-shaped atypical myomatous cells arranged in interlacing fascicles which merge into collageous stroma. Subcutaneous leiomyosarcomas are more sharply circumscribed and typically include a vascular pattern. About 40% of the cutaneous leiomyosarcomas recurred, but none metastasized despite a high mitotic frequency and marked cytologic atypia. Among the 12 patients with subcutaneous leiomyosarcomas, one-half of the tumors recurred and one-third eventuated in metastasis or tumor-related death. Cutaneous leiomyosarcomas have a relatively benign biologic course and may be excised conservatively, but are less likely to recur if the local excision is wide enough to require a skin graft for closure of the surgical defect. For primary subcutaneous leiomyosarcoma, early wide local excision with adequate clear histologic borders constitutes rational treatment.
Treatment of uterine leiomyosarcoma
We reviewed 46 cases treated at the Gynecology Service of Memorial Sloan-Kettering Cancer Center from 1970-1984 to evaluate the impact of modern multimodal therapy on survival of patients with uterine leiomyosarcoma. Eighteen patients had their primary treatment at Memorial Hospital, whereas the remaining 28 patients were referred either after primary surgery (ten) or after the development of recurrent disease (18). Thirty-four patients initially had disease confined to the uterus. Twelve of these patients received various adjuvant treatment regimens after hysterectomy, and 83.3% developed recurrent disease; 68.2% of 22 patients who received no adjuvant therapy developed recurrent disease. Twelve patients who presented with extrauterine disease all died within two years of initial treatment. Thirty-seven patients were treated for persistent or recurrent disease after primary treatment. No objective responses to radiation therapy were seen in these patients. Doxorubicin used alone or in combination produced a 16.7% response rate (average duration four months), whereas there were no responses to chemotherapeutic regimens not containing doxorubicin. The disease-free survival rate for all patients in this study was 22%; those patients who presented with stage I and II disease had a 29% survival rate.
Leiomyosarcoma of the Kidney: Case Report and Brief Literature Review
Primary leiomyosarcoma of the kidney is a rare tumor with an aggressive behavior. However, reported literature is very limited. We report a case of renal leiomyosarcoma in a 46 years old woman presenting with a left sided abdominal mass. Computed tomography scan of the abdomen revealed the mass to be renal in origin and involving the ipsilateral renal hilus and vein. Microscopyreflected a malignant spindle cell neoplasm which showed strong reactivity for smooth muscle actin with negative epithelial markers, thereby confirming the diagnosis of renal leiomyosarcoma. Induction chemotherapy was indicated. After two cycles, the patient died of disease progression. Renal leiomyosarcomas have a very poor prognosis, radical nephrectomy should be the primary therapeutic method to offer the best chances of cure.
Ileo-ileal Intussusception Caused by Primary Monophasic Synovial Sarcoma (SS) of the Ileum
Synovial Sarcoma (SS) is an uncommon neoplasm, very rare in gastrointestinal tract. We report a case of 57 years old man who reported a previous diagnosis of primary left atrial leiomyosarcoma referred for a follow-up CT, that showed findings compatible with ileo-ileal intussusception. The patient underwent surgical resection and pathological analysis showed that the lead point of intussusception were two polypoid lesions referable to SS. The present case report suggests that, although the incidence of SS is rare, it should be considered in the differential diagnosis of any gastrointestinal non-epithelial malignancy.
 Kaddu, S., Beham, A., Cerroni, L., Humer-Fuchs, U., Salmhofer, W., Kerl, H. and Soyer, H.P., 1997. Cutaneous leiomyosarcoma. The American journal of surgical pathology, 21(9), pp.979-987.
 Stout, A.P. and Hill, W.T., 1958. Leiomyosarcoma of the superficial soft tissues. Cancer, 11(4), pp.844-854.
 Berchuck, A.N.D.R.E.W., Rubin, S.C., Hoskins, W.J., Saigo, P.E., Pierce, V.K. and Lewis Jr, J.L., 1988. Treatment of uterine leiomyosarcoma. Obstetrics and gynecology, 71(6 Pt 1), pp.845-850.
 Amaadour, L., Maazouz, A., Tahiri, Y., Benhayoune, K., Arifi, S., Amarti, A., Khallouk, A. and Mellas, N., 2015. Leiomyosarcoma of the Kidney: Case Report and Brief Literature Review. Journal of Cancer and Tumor International, pp.32-36.
 Di Cesare, E., Amicarelli, I., Di Sibio, A., Gennarelli, A., Felli, V., Vellucci, V., Perri, M., Marsecano, C., Michelini, G., Sanzà, G.F. and Splendiani, A., 2016. Ileo-ileal Intussusception Caused by Primary Monophasic Synovial Sarcoma (SS) of the Ileum. Journal of Advances in Medicine and Medical Research, pp.1-7.