title: Unusual evolution of leiomyosarcoma of the rectum: a case report and review of the literature.
abstract: BACKGROUND
  Leiomyosarcoma of the rectum is a rare entity that comprises less than 0.1 % of all rectal malignancies. Given the uncommon nature of this tumor and the controversy about its treatment we report one case and review the literature in an attempt to report a particular evolution and to discuss the most appropriate treatment.
  
  
  METHODS
  This case report describes the presentation of leiomyosarcoma of the rectum. A 30-year-old man from the north of Morocco presented with rectorrhagia and constipation. On physical examination we found a mass in his rectum approximately 6 cm from his anal margin. Pelvic magnetic resonance imaging showed a rectal mass with a parietal attachment that invaded the fascia and his perirectal tissue. Before any treatment he defecated spontaneously the tumor. On histopathological examination a diagnosis of leiomyosarcoma was made. An anterior resection of his rectum was performed with adjuvant radiotherapy at a dose of 50 Gy. After 1 year of surveillance, he has not presented any clinical symptoms and pelvic magnetic resonance imaging was normal. Unfortunately, histological analysis of a superficial biopsy of a rectal leiomyosarcoma may not be reflective of the entire tumor mass, and a diagnosis is based essentially on postoperative pathological examination. The optimal treatment modality in patients with rectal leiomyosarcomas is controversial. Prognosis is also poor; tumor size, histological grade, mitotic index, and local staging are the most known prognosis factors.
  
  
  CONCLUSIONS
  The prognosis of rectal leiomyosarcoma is poor; more investigations are necessary to understand the progression of these tumors and to define an optimal treatment modality.
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco. extranadir@gmail.com.
authors.forename: N
authors.initials: N
authors.lastname: Sahli
authors.affiliation: Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: M
authors.initials: M
authors.lastname: Khmou
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: J
authors.initials: J
authors.lastname: Khalil
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: S
authors.initials: S
authors.lastname: Elmajjaoui
authors.affiliation: Department of Pathology, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: B
authors.initials: B
authors.lastname: El Khannoussi
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: T
authors.initials: T
authors.lastname: Kebdani
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: H
authors.initials: H
authors.lastname: Elkacemi
authors.affiliation: Department of Radiotherapy, National Institute of Oncology, University Mohammed V, Rabat, Morocco.
authors.forename: N
authors.initials: N
authors.lastname: Benjaafar
mesh_terms: D000328:Adult; D003672:Defecation; D005500:Follow-Up Studies; D006801:Humans; D007890:Leiomyosarcoma / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D008279:Magnetic Resonance Imaging; D008297:Male; D011879:Radiotherapy Dosage; D018714:Radiotherapy, Adjuvant; D012004:Rectal Neoplasms / Q000175:diagnosis* / Q000473:pathology / Q000532:radiotherapy; D012007:Rectum / Q000473:pathology*; D016896:Treatment Outcome
keywords: Evolution; Leiomyosarcoma; Rectum; Treatment