Leiomyosarcoma of the uterus in a 15-year-old with acute abdominal pain

Abstract

Sarcomas account for only 0.9% of all uterine cancers and represent 0.05% of all gynecological neoplasms (1,2). Endometrial stromal sarcoma, mixed mesodermal tumor (MMT), and leiomyosarcoma (LMS) are the three major histologic types. Leiomyosarcoma, originating in the myometrial cells, is one of the most common, accounting for approximately 25% of all uterine sarcomas (1,3). Uterine sarcomas usually occur after menopause, ranging from 24 to 95 years of age in some series, in which 90% were age 45 years or older. The most common presenting symptom is metrorrhagia, followed by abdominal pain and presence of an abdominal and pelvic mass. Uterine LMS tends to occur in younger women than does MMT (2,3). Although some series have shown a higher number of LMS (32%) than MMT (9%) in premenopausal patients, uterine LMS is very rare during childhood and adolescence (3,4). A review of the literature from the past 20 years revealed only one case of a leiomyosarcoma of the uterine cervix in a 15-year-old girl, which presented as an endocervical polyp and genital bleeding (4). An LMS presenting as a pelvic mass and acute abdominal pain in a female adolescent has not been previously reported. The objective of this case report was to increase awareness of health care providers of the existence and severity of this pathology within adolescence, and to present the different diagnostic tools and treatment approaches available for these young patients.