Primary leiomyosarcoma of the vagina: a clinical analysis of 9 cases

Abstract

To analyze the clinical characteristics, diagnoses, treatments and prognoses of vaginal leiomyosarcoma (LMS). The clinical and pathological recordings of 9 patients suffering from vaginal leiomyosarcoma from January 1973 to May 2011 were analyzed retrospectively. The study group constituted 2.7% (9/330) of all the malignant vaginal tumor admitted to our hospital in the same period. The major clinical manifestations were asymptomatic vaginal mass (3/9), bellyache and vaginal bleeding (2/9), vaginal pain (2/9), and difficulty in defecation (1/9) and micturition (1/9). Preoperative diagnosis was highly unreliable. Based on the sample chose, the diagnosis were made in 3 cases by preliminary biopsy before undertaking surgery, while 6 cases were confirmed shortly after simple tumor excision or unexpected recurrence. All the patients were pathologically confirmed diagnosis by tumor resection specimen or biopsy, 5 cases of them were also confirmed by virtue of immunohistochemistry staining. All 9 patients, 8 cases received initial surgery, four of them patients received postoperative adjuvant chemotherapy or radiation therapy, the remaining 1 patients received initial chemotherapy and radiotherapy. Follow-up was performed for all the 9 patients, of which 3 cases were lost, the median follow-up time was 50 months (range 7 - 134). Four patients underwent local recurrence and adjacent organ metastases within two years, with 5 years survival rate 4/9. Primary vaginal leiomyosarcoma is a rare and difficult to diagnose preoperatively tumor. In this regard, It is strongly recommend preoperative biopsy for definitive diagnosis and perform surgery as the principal approach, in conjunction with radiotherapy or chemotherapy when needed to improve survival.