Advanced cervical leiomyosarcoma with severe comorbidities: a clinical conundrum for optimal management (original) (raw)
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Primary leiomyosarcoma of the uterine cervix: an unusual case and critical appraisal
Journal of Surgical Case Reports
Leiomyosarcomas of the uterine cervix are rare, mostly occurring in perimenopausal women. Diagnosis is based on pathology and immunohistochemistry. Surgery with a total abdominal hysterectomy and bilateral salpingo-oophorectomy remains the standard. A female patient in her 60s presented with heavy postmenopausal bleeding. Vaginal ultrasound scan and magnetic resonance imaging showed a large strongly vascularized cervical mass with features suspicious of sarcomatous degeneration. Positron Emission Tomography-Computed Tomography (PET-CT) did not reveal any evidence of metastases nor lymphadenopathy, but presence of right hydronephrosis. An abdominal hysterectomy with bilateral salpingo-oophorectomy, and end-to-end anastomosis of the right ureter, was performed. Pathology showed an International Federation of Gynecology and Obstetrics (FIGO)-stage 1B leiomyosarcoma of the uterine cervix. No adjuvant treatment was given. Adjuvant radiotherapy reduces the risk of recurrence but no surviv...
Gynecologic Oncology, 2003
Background. Epithelioid leiomyosarcoma arising from the uterine cervix is extremely rare, with only three cases reported in the world literature. We present the case report of a 14-cm epithelioid leiomyosarcoma arising from the uterine cervix.
Polypectomy as a Complete Therapy for Leiomyosarcoma of the Cervix Uteri: An Unusual Treatment
International Journal of Women's Health and Reproduction Sciences
Objectives: Leiomyosarcoma (LMS), which arises from the uterine cervix, is an extremely rare neoplasm and is presented with vaginal bleeding and discharge. In our case report, we intended to highlight the role of polypectomy as a practical option for routine hysterectomy and the surgical cure of cervical LMS. Case Report: A 50-year-old woman (Para 8+0, 6A) presented to the Gynecological Clinic of ATB University Teaching Hospital with vaginal discharge and fleshy mass protruding from the vulva. Examination revealed a cervical polyp on the anterior lip of the cervix. Polypectomy was performed subsequently, and histologic examination including immunohistochemical staining confirmed LMS of the uterine cervix. The patient underwent hysterectomy with bilateral salpingo-oophorectomy with the histological confirmation of a complete excision. Conclusions: Generally, no specific management option is taken for this tumor due to its rare occurrence. However, polypectomy with a wide excision of ...
Cervical Leiomyoma in Pre-Menopausal Woman: A Case Report
Journal of Biomedicine and Translational Research
Background: The most common pelvic tumors in women of reproductive age are uterine fibroids or known as leiomyomas, the frequency of cervical leiomyomas is about 1 to 2%. Leiomyoma which causes symptoms requires surgery, the most frequent surgical procedure is hysterectomy. Nevertheless, the management of cervical leiomyomas in premenopausal women remains a challenge in order to preserve the uterus whereas future pregnancy is still possible. Therefore, hysterectomy is not the preferred procedure. We present a case of a 47-year-old, multiparous woman with cervical leiomyoma that was treated with myomectomy and curettage to give an overview of how to treat cervical leiomyoma in patients who wanted to preserve their fertility.Case Presentation: A 47-year-old woman, P3A0, presented to the emergency department at Sultan Agung Islamic Hospital with a mass spontaneously protruding from the vagina a few hours before admission with a mass spontaneously protruding from the vagina, lower abdom...
Emergency Hysterectomy in a Hemodynamically Unstable Patient: A Case of Uterine Leiomyosarcoma
Cureus, 2020
Abnormal uterine bleeding (AUB) is a common gynecological complaint in reproductive aged women. In this case report, we present a case of emergency total hysterectomy performed in a hemodynamically unstable patient due to AUB. Based on pelvic ultrasound (US) and CT scan along with the prevalence of uterine smooth muscle tumors, leiomyomatous uterus was the most likely preoperative diagnosis. The histological examination of the surgical specimen revealed a leiomyosarcoma with coagulative necrosis, cellularity, mitotic index greater than 20 mitotic figures per 10 high-power-fields, and local invasion of the myometrium at the tumor's stalk. A positron emission tomography (PET) scan was performed postoperatively. The results revealed multiple hypermetabolic secondary lesions at the lungs bilaterally, liver, vaginal cuff, peritoneal involvement, and a small lesion at the left rectus femoris muscle. Thus, tumor was classified as stage IVB uterine leiomyosarcoma according to the International Federation of Gynecology and Obstetrics (FIGO) staging. The patient was referred to an oncology center for chemotherapy and hormonal therapy. Uterine leiomyosarcomas are the most common uterine sarcomas, but remain a rare entity among uterine smooth muscle tumors. Notably, the US imaging of both leiomyosarcomas and other uterine smooth muscle tumors are practically indistinguishable. Thus, diagnosis is difficult to be established prior to surgical treatment. Overall, prognosis in case of leiomyosarcoma is poor, and tumor stage III/IV, tumor size greater than 10 cm, mitotic index greater than or equal to 20 mitotic figures per 10 high-powerfields, and reactive nuclei for Ki67 more than or equal to 10% are associated with shorter survival period. Reliable risk scores to stratify the risk of malignancy in case of leiomyomatous uterus and guide the timing of surgical treatment are totally lacking, and, thus, hindering earlier diagnosis of leiomyosarcoma and improved prognosis.
Advanced leiomyosarcoma of the uterus: a case report and literature review
International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2021
Uterine leiomyosarcoma is a rare malignancy accounting for 1-2% of uterine malignancies with an annual incidence of 0.5-7 per 100,000 women. It occurs mostly between the 5th to 7th decades of life hence found more among postmenopausal women. The aetiology is mostly unknown however, in 0.2% of cases, it originates from sarcomatous degeneration in a pre-existing benign uterine fibroid. Leiomyosarcoma can be mistaken for uterine leiomyoma also known as the uterine fibroid. It is an aggressive tumour that has a poor prognosis, with or without treatment. This case report aimed to report and discuss the occurrence of leiomyosarcoma as a differential diagnosis of abnormal uterine bleeding in this environment among other conditions. This will bring to the fore awareness among gynaecologists, pathologists, radiologists and oncologists that leiomyosarcoma of the uterus, though rare, should be considered in cases of menorrhagia with suspected uterine fibroid to avoid mistaking it for a diagn...
Uterine leiomyosarcoma: 14-year two-center experience of 31 cases
Cancer research and treatment : official journal of Korean Cancer Association, 2009
The aim of this study was to evaluate the clinicopathological characteristics of uterine leiomyosarcoma (LMS) and possible prognostic factors. This study included 31 patients with histologically proven LMS at Samsung Medical Center and Ajou University Hospital between 1994 and 2007. The medical records and available histological slides were reviewed retrospectively. The median age was 46 years (range, 32~63). The most common symptom was vaginal bleeding (11 patients, 35.5%). There were 23 patients with stage I, one patient with stage III, seven patients with stage IV disease. The median follow up time was 29 months (range, 1~94). The most common recurrence site was lung (5 case), followed by pelvis and upper abdomen (2 case). Nine patients died of disease with a 5-year overall survival rate of 63%. Early tumor stage and mitotic count were the prognostic factor in univariate analysis (p<0.0001 and p=0.0031, respectively), but early tumor stage only was associated with prognosis in...
Uterine Leiomyosarcoma: A Case Report and Review of Relevant Literatures
Journal of Advances in Medicine and Medical Research
Leiomyomas are benign soft tissue neoplasms that arise from smooth muscles. Leiomyosarcoma is a malignant lesion of smooth muscle origin. This is a rare lesion in the uterus with 1-2 % of its benign counterpart, leiomyoma, transforming into the lesion. It is often aggressive and could develop at any site where the smooth muscle is found. We present a case of a 48-year-old farmer with pelvic mass with Ultra-sonography(USS) suggestive of leiomyoma. Hysterectomy was done and histologic diagnosis of leiomyosarcoma (LMS) was made. The patient was discharged 7 days post operation but was lost to follow up. Uterine LMS is an aggressive tumour, therefore, a high index of suspicion is needed especially for huge uterine nodules and such patients must be closely monitored for adequate management.
Uterine leiomyosarcoma: A case report
Journal of Mid-life Health, 2014
Uterine leiomyosarcoma is a rare uterine malignancy that arises from the smooth muscles of uterine wall. It accounts for only 1-2% of uterine malignancies. We report a case of a 60-year-old female who presented with postmenopausal bleeding and was diagnosed later to be a case of leiomyosarcoma of uterus. The diagnosis of leiomyosarcoma is made by histopathological examination, and surgery is the only treatment. The prognosis for female with uterine sarcoma primarily depends on the extent of disease at the time of diagnosis and the mitotic index.