Subcutaneous Epithelioid Sarcoma Originating from Multiple Metastases of Uterine Leiomyosarcoma

Abstract

We present a rare case of loin subcutaneous epithelioid sarcoma originating from the multiple metastases of a uterine leiomyosarcoma. A 54-year-old postmenopausal woman, gravida 6, para 6, presented to the general surgery outpatient department (OPD). Loin mass excisional surgery was performed on August 6, 2002, and she was diagnosed with epithelioid sarcoma. Sharp intermittent lower abdominal pain, low grade fever and back pain were noted on the fifth day after this surgery. She was transferred to the gynecology OPD. Laparotomy, on August 26, 2002, found an enlarged uterus with multiple nodules on the liver surface, mesentery, small intestine surface, omentum and sub-diaphragm. Total abdominal hysterectomy and bilateral salpingo-oophorectomy were performed because uterine fibroid was the most suspicious originating site of these metastatic lesions. After laparotomy, the abdominal distension and pain continued with little improvement. She died on September 17, 2002, as a result of multiple metastases of leiomyosarcoma in both lung fields and respiratory failure. The abrupt appearance of skin or subcutaneous nodules should prompt the clinician to consider the possibility of metastatic disease, even in patients with no known history of malignant neoplasms. Uterine leiomyosarcomas are rarely diagnosed preoperatively, and the prognosis of uterine sarcoma is notorious for its difficult determination. The frequent development of distant metastases is the main reason for the poor survival observed in uterine sarcoma compared with other uterine malignancies.