Uterine leiomyosarcoma: an unusual presentation

Uterine leiomyosarcomas are rare aggressive tumors, with high recurrence rates, even when confined to the uterine corpus at the time of diagnosis. It arises from smooth muscle of uterus and is a rare tumor that accounts for 2-5% of all uterine malignancies. These tumors typically spread hematogenously. Patients present with vague symptoms similar to those of patients with leiomyomas. Most patients are diagnosed with leiomyosarcoma postoperatively. Although prognosis remains dismal, various ongoing studies are investigating the role of advanced imaging, multimodality treatment, prognostic nomograms, and unique biomedical pathways to increase understanding of leiomyosarcoma and improve therapeutic options for patients. 46 years old para2 live2 postmenopausal (since 1.5 year) female presented to outpatient clinic with complaints of bleeding per vaginum, foul smelling discharge, unquantified weight loss and something coming out of vagina since 1.5 months. On abdominal examination, an irregular midline mass arising from pelvis corresponding to 20 weeks gestational size of uterus was present. On vaginal examination, 3 infected vaginal growths were present in vagina maximum 4x4cm. Intra-operatively, uterus was nearly 20 weeks size with irregular surface. A 3×3 cm subseroal fibroid with necrotic surface was present on posterior wall of uterus. Cut section of the operative specimen showed myohyperplasia which was compressing the uterine cavity, some necrotic areas were also present. Vaginal growths - 4×4 cm on left vaginal wall near introitus with necrotic surface, 3×3 cm on right vaginal wall, 1×1 cm on right upper vaginal wall present. Excision of vaginal growth was done and was sent for histopathology. Histopathologic examination of sections of uterus showed all features were suggestive of leiomyosarcoma uterus.

Clinical and color Doppler ultrasound features of uterine sarcoma / 解放军医学杂志

Objective: To investigate the clinical characteristics of uterine sarcoma and clinical application of color Doppler ultrasonography in the sarcoma. Methods: We conducted a retrospective analysis on the clinical and ultrasonographic features in 128 surgically and pathologically confirmed uterine sarcoma patients from December 2011 to May 2018 in Tongji Hospital. The clinical features included age, clinical manifestation, serum tumor marker CA125 and clinical stage, and the features of ultrasonography included the size, boundary, echo type of the lesion and characteristics of blood flow signals. Results: The majority of uterine sarcoma in this study were endometrial stromal sarcoma and leiomyosarcoma. Endometrial stromal sarcoma occurred mostly in women in reproductive period, while leiomyosarcoma occurred mainly in perimenopausal and postmenopausal women. The predilection age of uterine sarcoma was 49.6 ± 13.4 years. The main clinical manifestations were abnormal uterine bleeding, including postmenopausal vaginal bleeding or irregular vaginal bleeding (47.7%), and abdominal pain (32.0%). About 20.3% of patients had no symptoms. Serum CA125 was detected before operation in all the patients, and it was in normal range (≤ 35 U/ml) in 59 patients, slightly higher than normal level (35-100 U/ml) in 51 women and significantly higher than normal range (>100 U/ml) in 18 women. Pelvic three-dimensional ultrasonography was usually characterized by large uterine tumors with solid, unclear boundary, heterogeneous echo structures with or without cystic degeneration and rich blood flow signals, which can be roughly classified as malignant tumors. Conclusion: Combined with clinical manifestations such as vaginal bleeding, abdominal pain, abdominal distension, ultrasonograms can help us identify and early predict large, ill-defined, hypoechoic or heterogeneous hypoechoic tumors with rich blood flow signals, and grasp the treatment opportunity reasonably and formulate treatment plans.

Metastatic Cervical Lymphadenopathy from Uterine Leiomyosarcoma with Good Local Response to Radiotherapy and Chemotherapy / 대한방사선종양학회지

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.