Demographic and Clinicopathological Analysis of Leiomyosarcoma at Various Anatomical Sites: A Tertiary Care Hospital Experience

Introduction Leiomyosarcoma (LMS) is a malignant tumor of smooth muscle origin, most prevalent in soft tissues and the gynecologic tract. The molecular alteration associated with this condition is genomic instability, leading to complex genotypes. Aim This study aimed to study the demographic and histopathological profile of LMS cases (80 cases) diagnosed in our hospital over seven years. Materials and methods This is a retrospective study of histologically proven LMS cases from January 2017 to December 2023 using the laboratory information system from our institution. The variables to be studied included clinical demographic data and histopathological findings. Results Out of 80 cases studied, 45 were resected specimens, 25 were biopsies, and 10 were referral cases. Fifty-eight out of 80 cases were primary LMS, 17 were metastases from various sites, and five were recurrent lesions. The most common site of primary lesion was the uterus, with 26% (n=15), followed by the retroperitoneum, with 21% (n=12), and the thigh, with 12% (n=7). Infrequent sites included the prostate, intestine, omentum, kidney, and testis, each constituting about 2% (n=1), with a male:female ratio of 1:1.7 and a mean age of presentation of 55 years. The average size of the excised tumor ranged from 5.5 cm to 15 cm, and around 73% presented with histological grade 2. Almost all the cases tested for immunohistochemical (IHC) expression of smooth muscle actin (SMA) and desmin showed positivity, along with a median Ki-67 labeling index of 30%. Metastatic lesions were found primarily in the liver, lungs, and soft tissues and rarely in bone. Conclusion The results of our study witnessed the incidence of LMS at diverse anatomical locations and dimensions along with advanced grade at presentation that determined the overall prognosis, though uterine LMS tend to be more aggressive and are prone to metastasize. Hence, the comprehensive assessment at the time of diagnosis, along with close follow-up of the patients, is recommended for early detection and management of metastatic lesions.