Localized leiomyosarcoma of the uterine cervix with rapid lung metastases

Abstract

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

Primary leiomyosarcoma of the uterine cervix: report of 4 cases, systematic review, and meta-analysis

“…Therefore, the initial treatment should be surgery including hysterectomy with or without BSO. 29 Type of hysterectomy (extrafascial, modified radical, or radical) was not a prognostic indicator for recurrence but having hysterectomy performed had statistical significance for predicting DSS in our study. Likewise, Wright et al 1 concluded that different hysterectomy types do not improve survival in all types of cervical sarcomas.…”

An unusual case of cervical leiomyosarcoma in an adoloscent girl

“…Amongst these factors, stage, grade and mitotic index were more significant prognostic factors. 5 An 18-year-old female gravida 3 para 1011 presented to an outside clinic with several months of vaginal bleeding and abdominal pain. She was diagnosed with an intrauterine pregnancy with an estimated gestational age (EGA) of 27 weeks based on dating by ultrasound.…”

Multimodality management of leiomyosarcoma of the cervix

“…Casanova et al [ 6 ] reported a case of localised leiomyosarcoma of the cervix in a 63-year-old woman who presented with lung metastasis after 1 year of diagnosis. There are various prognostic factors including tumour stage, grade, mitotic index, tumour size, age and menopausal status.…”

“…There are various prognostic factors including tumour stage, grade, mitotic index, tumour size, age and menopausal status. Amongst these factors, stage, grade and mitotic index were more significant prognostic factors [ 6 ].…”

“…Microscopic study shows spindle-shaped cells can be seen which may be both hypercellular and hypocellular in nature. The presence of tumour cell necrosis, mitotic index of 10/10 high power field and atypia of cells ranging from moderate to diffuse are histopathological diagnostic criteria [ 6 ]. Various morphological varieties of leiomyosarcoma of the cervix myxoid type, epithelioid type, conventional type and certain variants contain abundant xanthomatous cells [ 7 ].…”