A case of unsuspected leiomyosarcoma diagnosed following laparoscopy-assisted vaginal hysterectomy performed for presumed myoma after GnRH treatment

Abstract

A 37-year-old woman who had received two courses of gonadotropin-releasing hormone (GnRH) analogue for preparation to hysteroscopic resection of a presumed submucous myoma after a benign endometrial sampling had no improvement of bleeding episodes and no regression in the size of the myoma. The patient chose to have a hysterectomy and laparoscopic hysterectomy was performed uneventfully. The mass, consisting of haemorrhagic and necrotic tissues, was found to be located intramurally with dimensions 8×6 cm. Pathological diagnosis was leiomyosarcoma, as examination of the specimen showed diffuse cytologic atypia with coagulative necrosis and 7-8 mitosis per high-power field. The possibility of delaying the definitive treatment of leiomyosarcoma by giving GnRH analogue to patients who were presumed to have myomas should be considered, even in young patients.