Primary ovarian leiomyosarcoma in a woman in her 70s: A case report

Primary ovarian leiomyosarcoma is a rare clinical entity within the spectrum of gynecologic sarcomas. Accounting for less than 0.1% of all ovarian malignancies, ovarian leiomyosarcomas are highly aggressive mesenchymal tumours that arise from smooth muscle. This report describes the case of a 78-year-old postmenopausal woman who presented with non-specific lower abdominal discomfort, bloating and immobile palpable pelvic mass. Cross-sectional computed tomography demonstrated a large heterogenous adnexal mass with indeterminate features arising from the right ovary. The patient underwent primary cytoreductive surgery, including a total abdominal hysterectomy, bilateral salpingo-oophorectomy, peritoneal washings and infracolic omentectomy. Histopathology confirmed a stage IA right ovarian sarcoma favouring leiomyosarcoma morphology, with no evidence of uterine involvement or other primary source. Primary ovarian leiomyosarcomas tend to masquerade as epithelial neoplasms preoperatively. The aggressive clinical course, resistance to conventional chemotherapy and absence of established treatment protocols underscore the diagnostic challenges posed by primary ovarian leiomyosarcomas. This case highlights the importance of considering mesenchymal tumours in the differential diagnosis of atypical adnexal masses and underscores the need for formalized therapeutic guidelines for this rare tumour subtype.