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Leiomyosarcoma is a rare malignant tumour derived from smooth muscle, making up five to ten per cent of soft tissue sarcomas. Subcutaneous forms are even less frequent, typically presenting on the limbs, and their occurrence on the anterior abdominal wall is exceptionally unusual. A clinical case describes a patient with a progressively enlarging mass in the left rectus abdominis muscle. Imaging confirmed a localised soft tissue growth with no signs of distant spread. Diagnosis required histopathological examination alongside immunohistochemical testing. Treatment consisted of a wide surgical excision that removed the affected muscle and adjacent peritoneum to ensure clear margins. Following an uncomplicated recovery, the patient commenced regular clinical monitoring. The case demonstrates the critical role of tissue analysis for accurate identification and shows that wide surgical resection remains the primary strategy for achieving local disease control.
Soft tissue sarcomas that emerge in unexpected anatomical sites can present significant diagnostic dilemmas. Documenting unusual presentations, such as tumours within the abdominal musculature, helps clinicians distinguish rare malignancies from more common abdominal masses. This awareness reinforces the importance of timely tissue-based testing and appropriate surgical planning to clear margins, which directly affects patient management and recovery prospects.
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Background: Leiomyosarcoma is a rare malignant mesenchymal tumour arising from smooth muscle cells and accounts for approximately 5–10% of all soft tissue sarcomas. Subcutaneous leiomyosarcomas are particularly uncommon, representing only 1–2% of all superficial soft tissue malignancies. They occur most frequently on the extensor surfaces of the extremities, while involvement of the anterior abdominal wall remains exceptionally rare. Case Presentation: We report a rare case of subcutaneous leiomyosarcoma arising from the left rectus abdominis muscle of the anterior abdominal wall. The patient presented with a progressively enlarging abdominal wall mass. Radiological investigations demonstrated a localised soft tissue tumour without evidence of distant spread. The diagnosis was established through histopathological examination and confirmed by immunohistochemical analysis. The patient underwent wide surgical excision of the lesion, including the involved rectus abdominis muscle and adjacent peritoneum, with the objective of achieving tumour-free margins. Histopathological evaluation confirmed the diagnosis of subcutaneous leiomyosarcoma. The postoperative course was uneventful, and the patient was enrolled in regular follow-up. Conclusion: This case highlights the exceptional rarity of subcutaneous leiomyosarcoma of the anterior abdominal wall and emphasises the importance of histopathological and immunohistochemical assessment for accurate diagnosis. Complete surgical resection with adequate margins remains the cornerstone of treatment and offers the best chance for long-term local control.
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DOI: 10.9734/ajrs/2026/v9i2424
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