A Rare Case of Testicular Leiomyosarcoma with a Four-Year Latency Before Pulmonary Metastasis: A Case Report

Case Report

Abstract

Introduction
Leiomyosarcoma (LMS) is a rare, aggressive smooth muscle malignancy that can metastasize to the lungs. Testicular LMS is particularly uncommon; therefore, this case is unique due to its latency period before metastatic recurrence. Recurrence of LMS usually occurs within months to a year, and here we present a case of recurrence four years after diagnosis, followed by an integrative approach to care that included conventional and naturopathic oncology treatment.

Case Presentation
A 49-year-old Syrian male with a history of testicular LMS, initially treated in 2019 at NMC Hospital in Abu Dhabi, developed bilateral pulmonary nodules that presented as shortness of breath. He came to Burjeel Cancer Institute (BCI) for evaluation in August 2023 on self-referral and underwent biopsy and scanning, which confirmed metastatic recurrence of the original testicular LMS, prompting the initiation of conventional treatment consisting of chemotherapy followed by surgery. When his insurance coverage stopped, he started working with naturopathic oncology in combination with conventional therapies to help reduce side effects and prevent further progression.

Results and Discussion
This case presents a rare instance of testicular LMS with metastatic recurrence four years after initial surgical treatment, highlighting the potential for prolonged tumor dormancy. Most LMS recurrences occur within a few years, making this delayed metastasis an unusual and clinically significant event. The extended latency raises important considerations about tumor dormancy mechanisms, including immune evasion, dormant tumor stem cells, microenvironmental changes, and circulating tumor cells. While dormancy markers have been identified in other cancers, their role in LMS remains unexplored. This gap underscores the need for further research into specific biomarkers that could guide risk stratification and inform surveillance protocols. Additionally, the integration of naturopathic oncology in this case draws attention to its potential immunomodulatory and anti-angiogenic effects, suggesting a possible role in prolonging dormancy or preventing recurrence. Although limited literature on naturopathic oncology care is available, the role of this modality in cancer management warrants further investigation, with naturopathy being part of an integrative oncology plan as a comprehensive, long-term management strategy.

This case emphasizes the nature of LMS recurrence and supports the consideration of long-term follow-up guidelines, as well as exploration of integrative and naturopathic oncology therapies to enhance outcomes in patients with soft tissue sarcomas.