Uterine leiomyosarcoma: a rare clinical entity.

Area of Science:

• Gynecologic Oncology
• Surgical Pathology
• Medical Imaging

Background:

• Uterine leiomyosarcoma (LMS) is a rare, aggressive malignant mesenchymal tumor comprising 1% of uterine malignancies.
• It frequently presents in perimenopausal women (median age 50) and is often diagnosed incidentally after surgery for presumed benign uterine conditions.
• Rapid intraperitoneal and hematogenous spread characterizes LMS, leading to challenging clinical management.

Observation:

• Patients may present with symptoms like vaginal or abdominal pressure and a palpable pelvic mass that can hemorrhage.
• Diagnostic imaging, including MRI and CT scans, is essential for evaluating pelvic masses, assessing local invasion, and detecting distant metastases.
• A case is presented of a 44-year-old woman with symptoms suggestive of a uterine fibroid, who was found to have advanced uterine LMS with lung metastases.

Findings:

• Laboratory findings in the presented case included leukocytosis, neutrophilia, and thrombocythemia.
• Pelvic MRI revealed a large, heterogeneous, malignant-appearing mass compressing the right ureter, consistent with a uterine origin.
• Staging CT confirmed multiple lung metastases, indicating advanced disease at diagnosis.

Implications:

• Current treatment relies on surgery, with adjuvant therapies and radiotherapy showing no benefit.
• Systemic chemotherapy (gemcitabine/docetaxel, doxorubicin) offers benefits for advanced or recurrent LMS.
• There is a critical need for novel early detection strategies and targeted therapies to improve outcomes for this aggressive sarcoma subtype.