|Year : 2014 | Volume
| Issue : 4 | Page : 271-273
Leiomyosarcoma of tongue
SV Dhanasekaran, Jiji Sanjeevan Nair, Mithun Eldhose Joyce
Department of Ear Nose Throat, Vinayaka Mission Kirupananda Variyar Medical College, Salem, Tamil Nadu, India
|Date of Web Publication||16-Oct-2014|
Dr. S V Dhanasekaran
Department of Ear Nose Throat, Vinayaka Mission Kirupananda Variyar Medical College, Seeragapadi P.O., Salem - 636 308, Tamil Nadu
Source of Support: None, Conflict of Interest: None
Leiomyosarcoma is a malignant smooth muscle tumour. Oral leiomyosarcoma in particular of the tongue is extremely rare and poorly documented. We report a case of 38 year old woman with 1 year history of painless growing mass on the left hemi tongue with difficulty in swallowing diagnosed as Leiomyosarcoma tongue on histopathology. Surgical excision was done under general anesthesia. After 3 months of regular follow up and radiotherapy patient is doing fine without any recurrence or metastasis.
Keywords: Excision, leiomyosarcoma, tongue
|How to cite this article:|
Dhanasekaran S V, Nair JS, Joyce ME. Leiomyosarcoma of tongue. CHRISMED J Health Res 2014;1:271-3
| Introduction|| |
Leiomyosarcoma is an uncommon malignant mesenchymal tumor that frequently occurs in the gastrointestinal tract and female genital tract.  It is aggressive and tends to recur and metastasize. Its clinical behavior is unpredictable. It accounts for only 4% head and neck sarcoma. Thus far, 38 cases of leiomyosarcoma of head and neck have been reported.  Diagnostic assessment of oral leiomysarcoma is often challenging mostly found on its peculiar immunohistological features. The age of presentation ranges from 2 months to 88 years, with average age being 45 years. 
| Case Report|| |
A 38-year-old female patient reported with complaints of enlargement in left lateral side of tongue for 1 year and difficulty in swallowing for 6 months. Enlargement of tongue was fast in progression. On examination, large round to ovoid soft discrete mass was palpable on left middle 1/3 rd and posterior 1/3 rd tongue [Figure 1] No induration and no palpable neck nodes were present.
|Figure 1: Showing soft discrete mass was palpable on left middle 1/3rd and posterior 1/3rd tongue|
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The ultrasound scan reported a left-sided, large, well-defined, hypoechoic mass lesion of 47 mm × 29 mm size seen on the base of the tongue. Magnetic resonance imaging (MRI) study of neck showed a large ovoid encapsulated heterogeneous mass lesion with peripheral enhancement on left side of the base of the tongue [Figure 2]. Fine needle aspiration cytology showed acinar cell with basophilic cytoplasm, giving diagnosis of pleomorphic adenoma.
|Figure 2: MRI report showing encapsulated heterogeneous mass lesion with peripheral enhancement|
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We performed surgical excision of the mass under general anesthesia. An incision was placed over peripheral margin around lesion with safe margin over l cm. The flap was elevated, tumor ensue was removed, and the flap was sutured. Postoperatively, the patient showed little change in speech articulation and swallowing.
Surprisingly, biopsy report after immunohistochemistry was consistent with leiomyosarcoma [Figure 3]. Metastatic work up was done immediately by taking a neck MRI but no evidence of metastasis was detected.
After surgery, the patient was given radiotherapy at a dosage of 6500 rads/28 fractions/3 months. After 3 months of regular follow up, the patient is doing fine without evidence of recurrence or metastasis.
| Discussion|| |
Leiomyosarcoma usually begin as a rapidly growing painless swelling. Generally, they cause very few symptoms and become large before they are diagnosed.  Pain and tenderness are rare in leiomyosarcoma whereas they are a more prominent feature of leiomyoma. Primary leiomyosarcomas arising from within the tongue are extremely rare. Only eight cases have been previously reported on Medline. ,
Most commonly discrete, firm mass. The lesion is either submucosal or subcutaneous. Grossly, lesions are smooth, firm, and discretely circumscribed. Diagnosis should also be strongly suspected for smooth muscle tumors of soft tissue that are large, necrotic, and hemorrhagic even if mitotic count is low. Microscopically, the pattern of growth is predominantly fascicular with tumor bundles intersecting each other at wide angles Merging of tumor cells with blood vessel wall is an important diagnostic clue. The degree of mitotic activity and tumor size appears to be the most important predictor of malignant behavior. One or more mitotic bodies per high power field and a tumor larger than 2.5 cm are indicator of aggressive behavior; immunohistochemical identification of desmin and vimentin smooth muscle action are helpful in diagnosis.
Musio et al. stated that it is necessary to discriminate leiomyosarcoma from fibrosarcoma, myofibrosarcoma, synovial sarcoma, malignant peripheral nerve-sheath tumor, solitary neurofibroma, rhabdomyosarcoma, liposarcoma, and malignant fibrous histiocytoma, and they concluded that the final diagnosis should not be made only from an Hematoxylin-Eosin stain. 
As in soft tissue sarcomas, wide local excision with 1 cm margin is treatment of choice. Generally, radiation therapy is used as surgical adjuvant. Radical neck dissection is done in the presence of palpable neck disease. Leiomyosarcoma are locally aggressive neoplasm and local recurrence is common. Metastasis occurs via hematogenous spread and most commonly involve the lungs. 
The main treatment is excision with sufficient tumor free borders and postoperative irradiation when necessary. Radical neck dissection is reserved for cases with regional node involvement. Chemotherapy is generally reserved for palliative care and occasionally improves the survival time and quality of life of patients with metastatic disease or inoperable tumors. 
| Conclusion|| |
Although primary leiomyosarcoma of the tongue is a rare mesenchymal tumor, it is critical that the otolaryngologist be familiar with these unusual lesions because early diagnosis and aggressive initial management are the mainstay of therapy.
| Acknowledgement|| |
I wish to acknowledge the guidance and support extended by our Head of the Institution, Professor, Dr. K Jayapal for conducting this study and his valuable advices for completing the manuscript.
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[Figure 1], [Figure 2], [Figure 3]