Primary leiomyosarcoma of the axilla in a 70-year-old female: a case report of multidisciplinary management from a resource-limited setting

Introduction and importance: Soft tissue sarcomas are a heterogeneous group of neoplasms of mesenchymal origin. Sarcomas constitute a rare subgroup that usually affects younger age groups. Case presentation: We report the case of a 70-year-old female who presented with a right axillary mass that had gradually increased in size over the last 8 months. Imaging revealed a heterogeneously enhancing mass that was free from the underlying muscle and joint capsule but was splaying the axillary vessels. Upfront resection of the mass was planned in the multidisciplinary meeting. Mass was excised with an intact capsule, sparing the neurovascular bundle. The patient developed transient right wrist and arm paresis with swift recovery in 3 days. The histopathology of the excised mass was leiomyosarcoma. The workup for whole-body primaries was inconclusive; therefore, the diagnosis of primary axillary leiomyosarcoma was made. Adjuvant radiation therapy (50 Gy in 20 fractions) was given, with no recurrence at 16-month follow-up. Clinical discussion: There is a wide range of differential diagnoses of axillary masses because the axilla contains both lymph nodes and non-lymphatic tissue such as accessory breast tissue, skin, fat, muscles, nerves, blood vessels, and bone. Clinicians should be familiar with the axillary anatomy and imaging features of different axillary lesions. Current guidelines recommend multidisciplinary discussion with radiologists, surgeons, and oncologists who can collaborate in the management of soft-tissue sarcomas in specialized centers. Conclusion: This case signifies the surgical management of atypical anatomical locations of leiomyosarcoma. Complete surgical resection with adequate resection margins should be the optimum treatment protocol wherever possible, with adjuvant radiation, reducing the recurrence.