Smooth muscle is a component of many tissues and organs. As a result, leiomyosarcoma can arise at almost any anatomic site in the human body. In women, approximately one third of leiomyosarcomas originate in the gastrointestinal tract, particularly the small bowel and colon and another one third are found in the uterus.
Stage, age, tumor size and delivery status of the patient were found to be the most important prognostic factors as regards survival. Interestingly, it seems that higher parity (up to three deliveries) had a negative influence on survival in cases of uterine sarcoma. The relationship between parity and survival in cases of uterine sarcoma should be evaluated more closely in larger series in the future .
Extrafascial hysterectomy with pelvic lymph node sampling with or without salpingo-oophorectomy is the surgical gold standard. Debate concerning removal of adnexa and the value of lymph node dissection (LND) is still ongoing . The survival of younger patients with leiomyosarcoma without oophorectomy has been better in one study which is very controversial. The rate of lymph node metastasis has been between 0–47%, and in some studies survival has not been significantly affected as regards LND . The role of adjuvant therapies is controversial. Radiotherapy (RT) seems to improve local control but not survival. Adjuvant chemotherapy (CT) does not decrease the risk of metastatic spread or improve survival. In recurrent uterine sarcomas the response rates in different chemotherapeutic regimens have been between 0–57%. However, the conclusion after a review of the literature was that it is reasonable to offer palliative CT to patients with advanced uterine sarcoma. The effects of hormone therapy in cases of recurrent uterine sarcoma have been assessed in only a few studies .
A case of uterine leiomyosarcoma with synchronous lung and cutaneous skull metastasis is presented.
Lung and breast cancers are the commonest epithelial malignancies metastasizing to the skin in men and women respectively. Clinically, cutaneous metastases manifest as nodules, ulceration, cellulitis like lesions, bullae or fibrotic processes .
Cutaneous metastases as a first sign of internal malignancy occur infrequently. More commonly, they are early indicators of metastatic disease . Diagnosis may delay several months, unless the skin lesion grows rapidly or other sites such as the lung or liver affected by tumor spread. In our case, the cutaneous metastasis was diagnosed simultaneously with the lung lesion.
Uterine leiomyosarcoma has a strong metastatic potential to distant sites, because of its aggressiveness and propensity for hematogenous spread. Cutaneous metastasis although rare indicates tumor relapse. Early detection requires high index of suspicion. Therefore, close inspection of new skin lesions in patients with history of malignancy is imperative and diagnostic biopsy is essential.