First Case Report of Uterine Leiomyosarcoma Diagnosed After Transcervical Fibroid Ablation

Background: Uterine fibroids are benign monoclonal neoplasms of the myometrium, representing the most common female pelvic neoplasms globally. Treatments may be invasive, such as hysterectomy and myomectomy, non-invasive, such as medical therapy or focused ultrasound, or minimally invasive, such as transcervical radiofrequency ablation (TFA). To date, more than 12,000 women have been treated worldwide using TFA with the Sonata^® System. Case Presentation: We present the first case report of TFA on a presumptive fibroid that was initially reclassified as a STUMP (smooth muscle tumor of uncertain malignant potential) and, after additional surgical treatment, leiomyosarcoma. Conclusion: This case highlights that, while uterine sarcoma is rare, inadvertent treatment may still result due to a lack of reliable diagnostic modalities. Nonetheless, TFA with the Sonata System represents a minimally invasive option that might not alter the prognosis of an undiagnosed uterine sarcoma as this treatment is not intraperitoneal and does not resect/morcellate tissue.