EP29.11: Giant pedunculated leiomyosarcoma of the uterus: case report

Abstract

Leiomyosarcoma (LMS) of the uterus is an extremely rare but highly aggressive tumour that accounts for only 1-2% of uterine malignancies. Presenting symptoms are nonspecific and include abdominal pain, abnormal vaginal bleeding, and abdominal distension. It usually appears as a large, single myometrial tumour. Ultrasound findings include heterogeneous echogenicity, irregular cystic areas, no shadowing, and moderate or high vascularisation. There are no data on the ideal imaging evaluation for women with suspected LMS. A 60-year-old postmenopausal woman presented to our department with complaints of abdominal distension. Her past medical history was unremarkable. Physical examination revealed an enlarged abdominal mass which extended from the pelvis to the epigastrium. Abdominal and pelvic ultrasonography showed a solid heterogeneous mass, moderately vascularised, with shadowing, located above the uterus. The mass seemed to have cleavage planes with surrounding tissues and clear 'sliding' signs with the uterus. The right ovary could not be seen. A multilocular cyst with 58x26x28 mm, colour score 2, was seen in the left ovary. Serum CA 125 was 55 U/ml. Magnetic resonance imaging features suggested the diagnosis of a leiomyosarcoma of the peritoneum. The patient underwent exploratory laparotomy. A large pedunculated mass arising from the uterus was seen. Subsequent histopathologic examination resulted in a final diagnosis of leimyosarcoma of the uterus. This case highlights the variety of sonographic findings of this rare tumour.