Keywords: immunohistochemistry leiomyosarcoma lung metastases smooth muscle cells uterine cervix a b s t r a c t Cervical sarcomas are extremely rare tumors associated with a poor prognosis. We report the case of a 63-year-old woman who was admitted to our institution due to abnormal vaginal bleeding and abdominal pain. Physical examination revealed a large cervical mass that was biopsied. Pathological features were compatible with a leiomyosarcoma of the uterine cervix. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy. All histological and Immunohistochemical findings confirmed the diagnosis of leiomyosarcoma of the cervix. Adjuvant chemotherapy was started but unfortunately the disease progressed and 1 year after completion of the chemotherapy the patient developed lung metastases and eventually died. IntroductionPrimary sarcomas of the cervix are extremely rare neoplasms. Due to the relative infrequency of this disease, there is a paucity of reports in the literature and the available data regarding the natural history of cervical sarcomas derive from case reports. 1e7 To date, Bansal et al 1 have published the largest series, the authors identified 323 patients with cervical sarcomas from a total of 33,074 women with invasive cervical neoplasms. Among cervical sarcomas, leiomyosarcomas are exceedingly rare. In the literature, they account for 21% of all cervical sarcomas, representing roughly 0.21% of all invasive cervical cancer cases. 1 We present an unusual case of a cervical leiomyosarcoma with lung metastasis in a postmenopausal woman. Case ReportA postmenopausal 63-year-old woman, Gravida 9/Para 8 (gravidity/parity) (G9P8), presented to the outpatient department with complaints of worsening lower abdominal pain of~1 month duration. Pelvic examination revealed a large cervical mass and a moderately enlarged uterus (~10 weeks gestation size). A biopsy of the mass was obtained and the pathology report revealed findings compatible with leiomyosarcoma. The endometrial stripe was very difficult to assess by transvaginal ultrasound due to the size of tumor.Magnetic resonance imaging (MRI) showed a large tumor involving the uterine corpus and cervix, the right parametrium and the paracervical area, measuring 11 Â 11 Â 14 cm (Fig 1A). A positron emission tomography scan (PET) demonstrated only an isolated increased uptake of the radioactive tracer confined to the lower pelvis. No distant metastases were evident. Laboratory studies including CA-125 were within normal limits.The patient underwent an exploratory laparotomy. No evidence of ascites, retroperitoneal lymphadenectomy, or metastatic spread

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BackgroundIn contrast to most other forms of cancer, data from some developing and developed countries show surprisingly similar survival rates for ovarian cancer. We aimed to compare ovarian cancer survival in Philippine residents, Filipino-Americans and Caucasians living in the US, using a high resolution approach, taking potential differences in prognostic factors into account.MethodsUsing databases from the SEER 13 and from the Manila and Rizal Cancer Registries, age-adjusted five-year absolute and relative survival estimates were computed using the period analysis method and compared between Filipino-American ovarian cancer patients with cancer patients from the Philippines and Caucasians in the US. Cox proportional hazards modelling was used to determine factors affecting survival differences.ResultsDespite more favorable distribution of age and cancer morphology and similar stage distribution, 5-year absolute and relative survival were lower in Philippine residents (Absolute survival, AS, 44%, Standard Error, SE, 2.9 and Relative survival, RS, 49.7%, SE, 3.7) than in Filipino-Americans (AS, 51.3%, SE, 3.1 and RS, 54.1%, SE, 3.4). After adjustment for these and additional covariates, strong excess risk of death for Philippine residents was found (Relative Risk, RR, 2.45, 95% confidence interval, 95% CI, 1.99-3.01). In contrast, no significant differences were found between Filipino-Americans and Caucasians living in the US.ConclusionMultivariate analyses disclosed strong survival disadvantages of Philippine residents compared to Filipino-American patients, for which differences in access to health care might have played an important role. Survival is no worse among Filipino-Americans than among Caucasians living in the US.

Few studies have assessed and compared cervical cancer survival between developed and developing countries, or between ethnic groups within a country. Fewer still have addressed how much of the international or interracial survival differences can be attributed to ethnicity or health care. To determine the role of ethnicity and health care, 5-year survival of patients with cervical cancer was compared between patients in the Philippines and Filipino-Americans, who have the same ethnicity, and between Filipino-Americans and Caucasians, who have the same health care system. Cervical cancer databases from the Manila and Rizal Cancer Registries and Surveillance, Epidemiology, and End Results 13 were used. Age-adjusted 5-year survival estimates were computed and compared between the three patient groups. Using Cox proportional hazards modeling, potential determinants of survival differences were examined. Overall 5-year relative survival was similar in FilipinoAmericans (68.8%) and Caucasians (66.6%), but was lower for Philippine residents (42.9%). Although late stage at diagnosis explained a large proportion of the survival differences between Philippine residents and Filipino-Americans, excess mortality prevailed after adjustment for stage, age, and morphology in multivariate analysis [relative risk (RR), 2.07; 95% confidence interval (CI), 1.68-2.55]. Excess mortality decreased, but persisted, when treatments were included in the multivariate models (RR, 1.78; 95% CI, 1.41-2.23). A moderate, marginally significant excess mortality was found among Caucasians compared with Filipino-Americans (adjusted RR, 1.22; 95% CI, 1.01-1.47). The differences in cervical cancer survival between patients in the Philippines and in the United States highlight the importance of enhanced health care and access to diagnostic and treatment facilities in the