ReviewMechanismMixed resultsLimited evidenceTier 4 · clinical
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · Jan 2026
uterine leiomyosarcoma
This is a narrative review of the immune environment of uterine leiomyosarcoma and the potential role of immune checkpoint inhibitors. The authors report variable PD-L1 expression, heterogeneous lymphocytic infiltration, and interactions with tumor-associated macrophages, note modest response rates to checkpoint inhibitors in clinical trials, and discuss that dual PD-1/CTLA-4 blockade and chemotherapy-induced immunogenic cell death may enhance immune activation in select patients. They conclude that combinatorial and personalized strategies, improved immune profiling, and macrophage-targeted approaches merit further study.
Studied with: anti-CTLA-4 + anti-PD-1 dual checkpoint blockade, chemotherapy (to induce immunogenic cell death), targeted immunomodulation, macrophage-targeted therapies.
Key findings
- Uterine leiomyosarcoma has a variable tumor immune microenvironment including variable PD-L1 expression and differential lymphocytic infiltration.
- Interactions with tumor-associated macrophages shape immune responses in leiomyosarcoma.
- Clinical trials of immune checkpoint inhibitors in leiomyosarcoma have produced modest response rates.
- Molecular analyses suggest that specific sub-groups of leiomyosarcoma patients may derive greater benefit from checkpoint inhibition.
- Dual-checkpoint blockade combining anti-PD-1 and anti-CTLA-4 has demonstrated enhanced immune activation in select patients.
- Chemotherapy-induced immunogenic cell death has been explored as a complementary approach to immunotherapy.
- Authors recommend innovative combinatorial strategies, improved patient selection, enhanced macrophage-targeted therapies, and optimized immune profiling for future research.
Limitations: Narrative review only—no new primary experimental or patient-level data are presented.; Conclusions are based on heterogeneous published studies and molecular analyses rather than definitive randomized trial evidence.; Abstract reports only 'modest response rates' in trials without quantitative pooled estimates or meta-analysis.; Leiomyosarcoma heterogeneity and rarity limit generalizability of existing trial results (as noted by authors)..
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed
Human · observationalMixed resultsModerate evidenceTier 3 · early humann = 661
Journal of surgical oncology · Nov 2025 · nationwide population-based cohort study (patients diagnosed 1980–2022)
cutaneous leiomyosarcomasubcutaneous leiomyosarcomadermal leiomyosarcomaleiomyosarcomaskin neoplasms
This nationwide Danish cohort study (1980–2022) compared outcomes in 196 patients with subcutaneous and 465 patients with dermal cutaneous leiomyosarcoma (total n=661). At 10 years the local recurrence rates were similar (15% vs 11%, p=0.13), but subcutaneous tumors had a much higher 10-year metastasis risk (25% vs 2.7%, p<0.001) and lower 10-year overall survival (56% vs 64%, p=0.02). The authors conclude that grade 2–3 subcutaneous leiomyosarcoma should be considered high-risk and recommend 5 years of follow-up including clinical exam plus PET/CT or chest CT, while dermal leiomyosarcoma can have clinical follow-up for 4 years.
Reported effects: 10-year local recurrence 15%, p 0.13, n=196 · 10-year risk of metastasis 25%, p <0.001, n=196 · +1 more
Key findings
- Cohort included 196 patients with subcutaneous leiomyosarcoma and 465 with dermal leiomyosarcoma (total n=661).
- The 10-year local recurrence rate was similar: subcutaneous 15% and dermal 11% (p = 0.13).
- The 10-year risk of metastasis was substantially higher for subcutaneous leiomyosarcoma (25%) versus dermal (2.7%), p < 0.001; metastases were primarily observed in grade 2 and 3 tumors.
- Ten-year overall survival was lower for subcutaneous compared with dermal leiomyosarcoma (56% vs. 64%), p = 0.02.
- Authors recommend classifying grade 2–3 subcutaneous leiomyosarcoma as high-risk and performing clinical examinations plus PET/CT or CT thorax for 5 years; dermal leiomyosarcoma follow-up can focus on clinical exams for 4 years given very low metastasis risk.
Limitations: Observational, registry-based cohort (potential for residual confounding and unmeasured variables).; Long study period (1980–2022) during which diagnostic methods, staging, and treatments likely changed, which may affect outcomes.; Abstract does not report details on treatments, adjuvant therapy, or timing of interventions that could influence recurrence, metastasis, or survival.; Potentially incomplete or variable clinical data quality across decades and centers (not detailed in abstract).; Findings are from Denmark and may not generalize to other healthcare settings or populations..
Provides 10-year estimates of local recurrence, metastasis, and overall survival for dermal versus subcutaneous cutaneous leiomyosarcoma and gives follow-up recommendations.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text
Human · observationalMechanismMixed resultsLimited evidenceTier 3 · early humann = 39
International journal of gynecological cancer : official journal of the International Gynecological Cancer Society · Apr 2025 · retrospective multicenter study using the national NetSarc database
primary ovarian leiomyosarcomaovarian neoplasmsleiomyosarcoma
This retrospective multicenter study analyzed 39 patients with primary ovarian leiomyosarcoma from the French Sarcoma Group database to describe clinical, surgical, pathological features and outcomes. Median tumor size was large (134 mm); 15 patients (44%) died of disease. Certain pathologic features (high mitotic counts, progesterone receptor negativity) were associated with worse survival. The authors conclude surgery is the mainstay for early-stage disease and the role of adjuvant therapy remains unclear.
Reported effects: total patients included 39 · localized disease - n 35 · +14 more
Key findings
- 39 patients were included (35 localized, 4 metastatic).
- Median tumor size was 134 mm.
- Radical surgery was performed in 21 patients (62%) and wide surgery in 13 patients (38%).
- Tumor grade 3 reported in 17 of 34 patients (50%); necrosis in 29 of 34 (85%); mitoses ≥20/HPF in 17 of 34 (50%); Ki-67 >30% in 17 of 27 patients (63%).
- Estrogen receptor positive in 14 of 27 patients (52%); progesterone receptor positive in 10 of 27 patients (37%).
- Adjuvant chemotherapy given in 12 of 34 patients (35%); pelvic adjuvant radiotherapy in 8 of 34 (23%).
- Among early-stage cases, 9 had isolated pelvic recurrence and 18 had parenchymal distant metastases.
- Fifteen patients (44%) died of disease.
- High mitotic counts and progesterone receptor negativity were associated with worse survival in early-stage disease.
Limitations: Retrospective study design.; Small sample size (n=39) for subgroup and prognostic analyses.; Heterogeneous and incompletely reported treatment approaches (adjuvant therapies given in subsets).; Some pathological and biomarker data were available only in subsets (denominators vary: data reported for 34 or 27 patients), indicating missing data.; No control group or prospective follow-up protocol reported..
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed
Human · observationalReported positiveLimited evidenceTier 3 · early humann = 10
BMC cancer · Dec 2024 · retrospective cohort
Trastuzumab-deruxtecan-t-dxdTrastuzumab-deruxtecanendometrial neoplasmsovarian neoplasmscervical neoplasmsuterine carcinosarcomauterine leiomyosarcomauterine serous carcinomaovarian carcinosarcomahigh-grade serous ovarian carcinomamucinous ovarian carcinomasquamous cervical carcinoma This retrospective single-center study identified 10 patients with HER2-expressing (IHC 2+/3+) recurrent or metastatic gynecological cancers who received trastuzumab deruxtecan (5.4 mg/kg IV every 3 weeks). The cohort had a median progression-free survival of 5.4 months (95% CI 0.8-9.8). Five patients had a partial response, one had stable disease at 12 weeks, and four had disease progression at initial assessment. Clinical benefit was observed mainly in tumors with HER2 IHC 3+.
Reported effects: median PFS 5.4 mo [0.8–9.8], n=10 · partial responses 5, n=10 · +2 more
Key findings
- 10 patients with recurrent/metastatic HER2-expressing gynecological malignancies were treated with T-DXd.
- Histologies included uterine neoplasms (n=5), cervical squamous carcinoma (n=1) and ovarian cancers (n=4).
- Median age was 65.4 years (25th-75th percentile, 58.1-75.2 years).
- HER2 by IHC: 5 patients were 3+ and 5 patients were 2+.
- Median number of prior therapy lines was 4 (range 2-6); 2 uterine serous carcinoma patients were pretreated with trastuzumab and 4 patients had prior immunotherapy.
- Dose: T-DXd 5.4 mg/kg IV every 3 weeks until progression/toxicity.
- Median progression-free survival (PFS) in the cohort was 5.4 months (95% CI 0.8-9.8 months).
- Responses: 5 patients had partial response (including 2 previously treated with trastuzumab), 1 patient had stable disease at 12 weeks, 4 patients had disease progression at initial assessment.
- Most patients who derived clinical benefit had HER2 IHC 3+ expression.
Limitations: Retrospective, single-center design; Very small sample size (n=10); No control or comparator arm; Heterogeneous mix of gynecologic histologies; Heavily pre-treated population limits generalizability; Limited/absent reporting of safety or adverse event data in the abstract; Potential selection and reporting bias inherent to retrospective series.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text
Case reportReported negativeLimited evidenceTier 3 · early humann = 1
The Journal of international medical research · Sep 2024 · case report
This is a case report of a woman in her late 50s diagnosed with primary ovarian leiomyosarcoma who underwent surgery. One month after surgery she received gemcitabine plus docetaxel chemotherapy for six months. Recurrence in the pelvic cavity was detected eight months after surgery. The report aims to raise awareness of this rare disease.
Reported effects: chemotherapy_duration 6 mo, n=1 · time_to_recurrence 8 mo, n=1
Studied with: gemcitabine + docetaxel.
Key findings
- A woman in her late 50s presented with a 6-month history of abdominal pain and imaging revealed a pelvic mass.
- She underwent surgery and was diagnosed with primary ovarian leiomyosarcoma.
- One month postoperatively she began gemcitabine and docetaxel chemotherapy and continued this treatment for 6 months.
- Eight months postoperatively recurrence was detected in the pelvic cavity.
Limitations: Single-patient case report (n=1), limiting generalizability; No chemotherapy doses or detailed regimen parameters provided; Short follow-up reported (recurrence at 8 months) with no long-term outcome data; No control or comparator group.
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text
ReviewMechanismInconclusiveLimited evidenceTier 4 · clinical
Yi chuan = Hereditas · Aug 2024 · review
uterine leiomyosarcoma
This article is a review of the molecular pathology of uterine leiomyosarcoma (uLMS). The authors summarize molecular genetic features, epigenetic variants, experimental models, and clinical research progress, and note that understanding of uLMS pathogenesis is inadequate and disease models are limited, which hinders development of effective therapies.
Key findings
- uLMS is an aggressive malignant soft-tissue tumor arising from the myometrium that is difficult to distinguish from benign leiomyoma in early stages and has a poor prognosis.
- Current studies of uLMS pathogenesis and disease biology are inadequate.
- uLMS disease models are very limited, which hinders development of effective therapeutics.
- The review systematically summarizes molecular genetic features, epigenetic alterations, experimental models, and clinical research progress, and discusses directions including tumor evolution, the tumor microenvironment, and therapy development.
Limitations: This publication is a review and does not present new primary experimental or clinical data.; Abstract does not describe review methods in detail (e.g., search strategy, inclusion criteria).; Field-level limitations noted by the authors include inadequate pathogenesis studies and limited disease models, which constrain conclusions about therapeutic development..
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed
Case reportInconclusiveLimited evidenceTier 3 · early humann = 1
International journal of surgery case reports · Aug 2024 · case report
leiomyosarcomasoft tissue sarcomaischiorectal leiomyosarcoma
This is a single-patient case report of a 25-year-old woman who presented with a left buttock swelling. MRI showed a large ischiorectal mass measuring 9 by 9.5 by 18 cm; the tumor was completely excised and immunohistochemistry confirmed leiomyosarcoma. The authors discuss diagnostic and therapeutic challenges due to the tumor's rarity and size and recommend individualized, multidisciplinary management.
Reported effects: tumor_dimension_1 9, n=1 · tumor_dimension_2 9.5, n=1 · +1 more
Key findings
- Single case of ischiorectal leiomyosarcoma in a 25-year-old female presenting with a left buttock swelling.
- MRI measured the tumor as 9 by 9.5 by 18 cm.
- Complete surgical excision of the tumor was performed.
- Immunohistochemistry confirmed the diagnosis of leiomyosarcoma.
- Authors highlight rarity, diagnostic/therapeutic challenges, and recommend a multidisciplinary, individualized approach.
Limitations: Single-patient case report limits generalizability.; No long-term follow-up or outcomes (recurrence, survival) reported.; No control or comparative data to inform management decisions.; No details on surgical margins, adjuvant therapy, or postoperative course in the abstract..
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text
Case reportReported positiveLimited evidenceTier 3 · early humann = 1
Annals of thoracic surgery short reports · Jul 2024 · case report
primary sternal leiomyosarcoma
A 70-year-old man had an incidentally discovered sternal lesion on PET-CT performed for prostate cancer staging. Biopsy showed spindle cells suggesting probable leiomyosarcoma and contrast CT found no other primary site, suggesting a primary sternal tumor. The patient underwent sternotomy and reconstruction with methyl methacrylate and had an uneventful recovery. The authors note primary sternal leiomyosarcoma is very rare (<0.7% of primary malignant bone tumors).
Key findings
- Lesion was incidentally found on PET-CT during prostate cancer staging.
- Interventional radiology biopsy showed spindle cells indicating probable leiomyosarcoma.
- Contrast CT found no other primary site, supporting the interpretation of a primary sternal tumor.
- Patient underwent sternotomy and reconstruction with methyl methacrylate and recovered uneventfully.
- Primary sternal leiomyosarcoma is rare, comprising less than 0.7% of primary malignant bone tumors.
Limitations: Single case report (n=1) limits generalizability.; Diagnosis described as 'probable' leiomyosarcoma from biopsy; the abstract does not state whether resection pathology confirmed the diagnosis.; No long-term follow-up or oncologic outcomes reported beyond an 'uneventful recovery.'; No information on margins, adjuvant therapy, or postoperative oncologic surveillance provided..
AI summary of the abstract, human-reviewed · Jun 2026. Describes what this study reported, not medical advice. View on PubMed · Full text