Leiomyosarcoma (LMS) is a rare and aggressive soft tissue tumor with various clinical characteristics and treatment challenges. Inflammatory leiomyosarcoma (ILMS) has been identified as a distinct entity, characterized by a primitive myogenic phenotype and frequent co-expression of smooth and skeletal muscle markers. A study reported on nine cases of ILMS, highlighting its indolent clinical course despite a lack of long-term follow-up data. Genetic profiling of ILMS revealed a near haploid genome and upregulation of genes crucial for skeletal muscle differentiation, suggesting a unique biological behavior that may influence treatment strategies (ref: Michal doi.org/10.1007/s00428-020-02774-z/). Additionally, primary iliocaval leiomyosarcomas (ICLM) present significant treatment challenges, as they are aggressive and typically require surgical intervention. A study focused on chemotherapy-naïve ICLM patients emphasized the need for further research to improve oncological outcomes, particularly regarding the role of chemoradiotherapy in the neo/adjuvant setting (ref: Ong doi.org/10.1016/j.ejso.2020.01.034/). Furthermore, a population-based analysis of adult genitourinary sarcomas revealed that leiomyosarcomas originating in the bladder had the longest median survival time of 62 months, contrasting sharply with carcinosarcomas, which had a median survival of only 9 months. This study underscores the variability in outcomes based on tumor location and histological subtype (ref: Nazemi doi.org/10.1016/j.urolonc.2019.12.004/).

Surgical management of soft tissue sarcomas (STS) is critical for patient outcomes, and recent studies have focused on comparing the effectiveness of planned versus unplanned excisions. A study evaluating oncological outcomes, functional results, and costs associated with unplanned excision (UPE) versus planned excision (PE) found that while oncological and functional outcomes were comparable, UPE resulted in higher treatment costs, longer hospital stays, and more surgeries. This highlights the importance of preoperative planning and the potential benefits of avoiding unplanned procedures (ref: Morattel doi.org/10.1016/j.ejso.2020.01.025/). In the context of iliocaval leiomyosarcomas, surgical intervention remains the primary treatment modality, but the lack of consensus on the role of adjuvant therapies complicates management strategies. The study on ICLM emphasizes the need for improved oncological outcomes through better surgical techniques and postoperative care (ref: Ong doi.org/10.1016/j.ejso.2020.01.034/). Additionally, the accuracy of preoperative biopsies in retroperitoneal sarcomas is crucial for determining treatment pathways. A study demonstrated that accurate histopathological assessment from biopsies significantly influences surgical decisions and neoadjuvant strategies, reinforcing the necessity of reliable biopsy techniques in managing these complex tumors (ref: Young doi.org/10.1111/ans.15723/).

The role of biopsy and histopathology in the management of sarcomas is pivotal, particularly for retroperitoneal sarcomas, which account for a significant proportion of soft tissue tumors. A study assessing the correlation between percutaneous biopsy results and final histopathology found that accurate preoperative histopathological subtype and grade are essential for guiding treatment decisions. This study emphasizes that the precision of biopsy can significantly impact surgical planning and the choice of neoadjuvant therapies, ultimately affecting patient prognosis (ref: Young doi.org/10.1111/ans.15723/). Furthermore, the population-based analysis of adult genitourinary sarcomas highlighted the importance of understanding the clinical characteristics and survival outcomes associated with different sarcoma types. The findings indicated that leiomyosarcomas, particularly those in the bladder, had a notably longer median survival compared to other subtypes, underscoring the need for tailored management approaches based on histological classification (ref: Nazemi doi.org/10.1016/j.urolonc.2019.12.004/). Collectively, these studies illustrate the critical interplay between accurate histopathological assessment and effective treatment planning in sarcoma management.