Solitary skin nodule in a young male: a case of cutaneous leiomyosarcoma

A case of cutaneous leiomyosarcoma in a young male is reported and literature reviewed. A 31-year old Asian male presented to the Dermatology OP with the complaint of a solitary swelling in the posterior aspect of the upper third of left thigh. On examination a skin colored nodule of about 1.6 cm diameter was found. It was dome-shaped, firm to hard, fixed to the skin and tender. An excision biopsy was done and the specimen was sent for HPE study. The result of biopsy was reported as cutaneous leiomyosarcoma. Cutaneous leiomyosarcomas are uncommon malignant soft tissue tumors which arise from the smooth muscles of the skin, the superficial type from arectorpilori muscle and the deep from the vascular wall of the capillaries. They comprise about 2-3% of soft tissue sarcomas. Our patient was an apparently healthy male who wanted to remove a small swelling in the thigh which had recently appeared. There were no remarkable clinical features to make a clinical diagnosis of cutaneous leiomyosarcoma. It was only when the skin biopsy was done that the histopathological examination revealed a cutaneous leiomyosarcoma. Hence a histopathological examination is most useful and necessary for the diagnosis of soft tissue tumors. The prognosis of the condition can be predicted using criteria laid down by Jenson et al. Long term follow up is necessary because of the risk of recurrence and metastasis

Uterine clear cell adenocarcinoma with adenomyosis: a case report with review of literature

Corpus cancer is the most frequently occurring female genital cancer. Clear cell carcinoma is a rare form of endometrial cancer accounting for 1-1.5% of all endometrial carcinomas and is often associated with an aggressive clinical behaviour and poor clinical outcome. The molecular pathways involved in development of clear cell carcinoma are still unclear with the present presumption that it arises from atrophic endometrium. Patients with clear cell carcinoma often experience relapse in pelvis, in para-aortic nodes and at distant sites. Total abdominal hysterectomy and bilateral salphingo-oopharectomy with comprehensive surgical staging is the standard surgical treatment of patients with clear cell carcinoma of endometrium, whereas pelvic irradiation, para-aortic irradiation, whole abdominal irradiation and chemotherapy have been widely employed as post operative therapy. This is a case report of a rare case of clear cell carcinoma of endometrium with adenomyosis. A 65 years menopausal lady presented with bleeding per vagina for the past 6 months. She was married and nulliparous. She was a hypertensive patient on irregular treatment. Physical examination was unremarkable. She was evaluated for her post menopausal bleeding. She had an unsatisfactory colposcopy. MRI showed a large polypoidal endometrial mass lesion with an impression of neoplastic endometrial growth. With a provisional diagnosis of endometrial polyp/ carcinoma endometrium she was planned for total abdominal hysterectomy and bilateral salphing-oopharectomy surgery. Following a difficult surgery for a suspected uterine malignancy she had a good post operative recovery. Histopathological report revealed a high grade endometrial clear cell carcinoma with focal papillary serous differentiation with adenomyosis and leiomyoma. In view of high grade invasive carcinoma of endometrium she was referred to a radiotherapy unit for post operative radiotherapy. This case was analyzed with review of other reported case. Review re-emphasised the need of accurate histopathological diagnosis in addition to clinical staging especially in rare variants of endometrial carcinomas like clear cell carcinoma and squamous carcinoma in optimizing the treatment. However the importance of myometrial invasion cannot be overlooked especially when adenomyosis co-exists with adenocarcinoma. It is important to have a clear distinction between a true myometrial invasion by adenocarcinoma and involment of adenomyotic foci by malignant cells without myometrail invasion in determining the staging and prognosis. In view of non-availability of commonly accepted guidelines for the management of patients with clear cell carcinoma of endometrium, and adequate molecular, characterization of clear cell carcinoma is strongly warranted in order to identify new biological prognostic variables of the disease and to develop novel molecular targeted therapies