Unexpected Histopathological Diagnosis of Undifferentiated Uterine Sarcoma after Simple Hysterectomy: Extrapolating Limited Evidence.

Amenda Ann Davis

doi:10.7759/cureus.6783

Abstract

Uterine sarcomas are a rare malignancy, often retrospectively diagnosed after myomectomy or hysterectomy. Undifferentiated uterine sarcomas (UUS) are a particularly aggressive variant of this condition. Little evidence exists regarding the postoperative management of undifferentiated sarcomas diagnosed after hysterectomy performed for presumed benign conditions. We describe the case of a 33-year-old woman who presented with heavy bleeding and subsequently underwent hysterectomy on an emergency basis after failed medical management. Cut-section of the uterus revealed a grossly benign-looking sub-mucosal fibroid. However, the final histopathology report revealed undifferentiated uterine sarcoma. We worked up the patient postoperatively with MRI to rule out metastasis and performed bilateral salpingo-oophorectomy based on hormone receptivity status. We followed this with single-agent chemotherapy with adriamycin, which was followed by continuous therapy with oral letrozole (aromatase inhibitor). The patient was found doing well at the two-year follow-up, with no evidence of relapse. Postoperative diagnosis of UUS should include imaging to rule out metastasis, consideration for completion of surgery based on hormone receptivity of tumour, and lymphadenectomy based on the subtype of tumour.

Highlights

Uterine sarcomas are a rare malignancy and often a post-operative diagnosis
We describe the case of a 33-year-old woman who presented with acutely heavy bleeding, which precluded a complete preoperative workup
We performed emergency hysterectomy due to non-responsive acute menorrhagia. She was diagnosed with undifferentiated uterine sarcoma (UUS), with positivity for estrogen receptor (ER) and progesterone receptor (PR)

Summary

Introduction

Uterine sarcomas are a rare malignancy and often a post-operative diagnosis. High-grade undifferentiated uterine sarcomas (UUS) are an aggressive subtype of uterine sarcomas and are often associated with poor prognosis [1]. We performed emergency hysterectomy due to non-responsive acute menorrhagia She was diagnosed with undifferentiated uterine sarcoma (UUS), with positivity for estrogen receptor (ER) and progesterone receptor (PR). Our patient was a 33-year-old homemaker who presented in the emergency with the chief complaint of heavy vaginal bleeding for the past 14 days. The mass was firm, occupying the entire vagina, and non-tender Her uterus could not be felt separately, and fornices could not be reached. We attempted to control the bleeding with intravenous tranexamic acid and a high dose of oral norethisterone, but our patient continued to have torrential bleeding We took her for an emergency total abdominal hysterectomy on the same day. At the twoyear follow-up, the patient was found doing well, with no evidence of relapse

Discussion

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Disclosures