Clinical Outcome of Partial Spondylectomy and Adjuvant Therapy of a Metastatic Leiomyosarcoma to the Thoracic Spine: A Case Report

Siamak Shabani; Maziar Malekzadeh; Babak Mirzashahi

doi:10.18502/jost.v11i3.19412

Siamak Shabani Spine Fellowship, Department of Spine Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Maziar Malekzadeh Spine Fellowship, Department of Spine Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Babak Mirzashahi Assistant Professor, Department of Spine Surgery, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran

DOI: https://doi.org/10.18502/jost.v11i3.19412

Keywords: Leiomyosarcoma; Spinal Neoplasms; Cytoreduction Surgical Procedures; Adjuvant Therapy; Neoplasm Metastasis; Thoracic Spine

Abstract

Background: Leiomyosarcoma (LMS) is a rare malignant tumor of smooth muscle origin, most commonly arising in the uterus. Spinal metastases from uterine LMS are extremely uncommon and represent diagnostic and therapeutic challenges. Due to its relative resistance to radiotherapy and chemotherapy, surgical management remains the cornerstone of treatment.

Case Report: A 42-year-old woman, with a history of uterine myomectomy 12 years earlier, presented with progressive thoracic back pain. Imaging [computed tomography (CT) and magnetic resonance imaging (MRI)] revealed a destructive extradural lesion at T5-T6. CT-guided biopsy confirmed LMS. She underwent partial spondylectomy with spinal stabilization, followed by postoperative adjuvant chemotherapy and radiotherapy. Serial follow-up with MRI, positron emission tomography (PET)-CT, and technetium-99m scintigraphy at 6, 12, and 24 months ‒ and again at 7 years ‒ showed no evidence of residual or recurrent tumor. She remained disease-free.

Conclusion: This case demonstrates that combined surgical cytoreduction and adjuvant therapy can achieve long-term disease control in patients with rare spinal metastases of uterine LMS. Reporting such extended follow-up cases provides valuable insights into treatment strategies and prognosis.