Pleomorphic Liposarcoma of the Uterus: Case Report and Literature Review

Abstract

A 62-year-old woman with a history of breast carcinoma being treated with tamoxifen presented with a rapidly enlarging pelvic mass. Imaging studies suggested a uterine leiomyoma with possible sarcomatous transformation. Laparotomy revealed a 15-cm, oval, well-circumscribed mass emanating from the posterior cervix and left uterosacral ligament. The tumor had a variegated fleshy, tan, myxoid, and necrotic sectioned surface. Microscopic examination revealed a variety of patterns and cell types characteristic of liposarcoma that included myxoid/round cell, storiform/pleomorphic, epithelioid, and spindle cell areas. Lipogenic areas exhibited a "crow's feet" vasculature and characteristic lipoblasts. The tumor cells were highly pleomorphic with numerous mitotic figures, some of them atypical. The tumor cells were immunoreactive for vimentin, estrogen receptors, and S-100. The tumor recurred 9 months postoperatively. Although a variety of uterine tumors have been associated with tamoxifen treatment, this appears to be the first example of tamoxifen-associated uterine liposarcoma.

Liposarcoma Arising in Uterine Lipoleiomyoma

“…Abnormal vaginal bleeding was the most common presentation, 4,14,25,31,41,43 and other symptoms included pelvic pain, increasing abdominal girth, dysuria, weight loss, and constipation. 4,14,18,20,39 Only 1 of 3 of our patients presented with uterine bleeding. The diagnoses of the previously reported 10 uterine liposarcomas were based strictly on histopathologic and immunohistochemical findings.…”

“…To date, 10 cases within the uterus 4,14,18,20,25,31,32,39,41,43 have been described in the literature. Patients with uterine liposarcomas have ranged in age from 23 to 78 (mean, 56) years, which is similar to the age range found in our patients.…”

“…Liposarcoma rarely involves the female genital tract and in this region it most frequently develops within the uterus with 10 cases having been reported. 4,14,18,20,25,31,32,39,41,43 Of these, 2 arose in association with a leiomyoma.…”

Uterine Lipoleiomyomas

“…One leiomyosarcoma was reported arising from a lipoleiomyoma (7). Liposarcoma of the uterus is rare; one case report found that it is histologically similar to its soft tissue counterpart, showing myxoid/round cell, storiform/pleomorphic, epithelioid, and spindle cell components (8). More common than pure liposarcoma of the uterus is endometrial carcinosarcoma (malignant mixed mullerian tumor) with heterologous liposarcomatous differentiation, a tumor that may on occasion be predominated by or completely overgrown by the liposarcomatous component.…”

An unusual case of dyspareunia

“…Various lesions have been reported as causing distortion or swelling of the uterosacral ligament. These include endometriotic lesions, peritoneal pregnancy, ectopic ovarian tissue, cystic teratoma [8], liposarcoma [9], ependymoma [10], endomyometriosis [11], midgut carcinoid tumour [12], and metastatic deposits of local malignancies, such as cervical carcinoma [13,14].…”