10.35279_jowm202104

10.35279_jowm202104SCIENCE, PRACTICE AND EDUCATION DOI: 10.35279/jowm202104.06 Leiomyosarcoma - A rare neoplasia arising from a chronic venous ulcer. Case report and literature review Ion A 1 , Giurcaneanu C 1,2 , Nichita M 1 , Orzan OA 1,2 , Popa LG 1,2 , Beiu C 1,2 , Tudose I 3 , Mihai MM 1,2 1. Dermatology and Allergology Department, “Elias” Emergency University Hospital, Bucharest, Romania 2. Oncologic Dermatology Department, “Elias” Emergency University Hospital, „Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania 3. Pathology Department, “Elias” Emergency University Hospital, Bucharest, Romania Correspondence: drmaramihai@gmail.com · Conflicts of Interest: None Keywords: Chronic ulcer, chronic wound, atypical wound, leiomyosarcoma, skin cancer ABSTRACT Background Long-standing wounds are at risk of developing ma- lignant degeneration, including leiomyosarcomas. These exceedingly rare malignant tumours originate from smooth muscle cells and are considered super- ficial if they affect the dermis and/or subcutis. Hypothesis To exclude malignancy, a biopsy should be per- formed on chronic skin ulcers with atypical features or evolutions. Methods We report the case of a 62-year-old male with a his- tory of a two-year old chronic venous ulcer who pre- sented with a tumour developing over three months, progressively increasing in size on the surface of the wound. As the clinical aspect strongly suggested a malignant tumour arising within a chronic venous ulcer (the initial suspicion was of squamous cell car- cinoma), a biopsy from the edge of the lesion was performed. Results Histopathological and immunohistochemical exami- nations revealed a diagnosis of leiomyosarcoma. The patient refused further medical care. The tumour arose in the context of severe cutaneous changes of venous insufficiency and had aggressive clinical behaviour. Histopathological and immunohisto- chemical analysis of the tissue sample is essential for establishing the final diagnosis, as no pathog- nomonic clinical features of leiomyosarcoma exist. Conclusions Our case emphasises the importance of considering malignancy in chronic ulcers with atypical features or evolution. Biopsy of atypical skin ulcers is crucial for establishing a diagnosis and initiating therapy at the rightful moment. Implications for clinical practice The findings from this case highlight the impor- tance of an early diagnosis of atypical, non-healing wounds, based on tissue samples, to decide the op- timal approach. Patient denial may interfere with the proper management of this particular clinical context. INTRODUCTION Leiomyosarcoma (LMS) is an exceedingly rare ma- lignant tumour that originates from smooth muscle cells, common locations being the dermis, subcuta- neous tissue, retroperitoneum, and gastrointestinal tract. 1 Leiomyosarcomas found in the dermis and subcutis are considered superficial, while those de- veloped in the gastrointestinal tract and retroperi- toneum are considered deep variants. 2 The dermal subtype may arise from the arrector pili muscle or areola complex, while the subcutaneous type origi- nates from the smooth muscle of the vessels in the subcutaneous tissue. 3 Leiomyosarcomas are usually diagnosed in middle-aged and elderly men. 4 Table 1 lists the case reports of leiomyosarcomas of the ex- 52 JOURNAL OF WOUND MANAGEMENT OFFICIAL JOURNAL OF THE EUROPEAN WOUND MANAGEMENT ASSOCIATIONPage 51Page 53