Bilateral Renal Metastases In Oral Leiomyosarcoma: A Case Report

A primary leiomyosarcoma in the oral cavity with bilateral renal metastasis in a 22-year-old female is reported. The tumour started during pregnancy and progressed to form a large unresectable mass post delivery. CT scan showed an extensive soft tissue lesion in the maxilla extending to the floor of the middle cranial fossa, oral cavity, parapharyngeal space and facial soft tissue. FNA and biopsy from maxilla showed a spindle cells lesion, which expressed smooth muscle actin and desmin in immunohistochemistry and was diagnosed as leiomyosarcoma. The tumour did not express estrogen and progesterone receptors, which have been reported in some uterine and extrauterine leiomyosarcomas. CT scan abdomen showed bilateral heterogeneously enhancing masses in right and left kidneys. CT guided FNA showed clusters of malignant spindle cells. The patient is being treated with chemotherapy consisting of Adriamycin 60mg (Day1) and Ifosfamide 2g (Day1 to Day3) to be given in 6 courses at an interval of 21 days. The case is interesting due its presentation in association with pregnancy and the presence of bilateral renal metastases. Renal metastases from sarcomas are very rare and have not been reported in primary leiomyosarcoma of oral cavity, which in turn is a rare tumor.