Case Of Uterine Leiomyosarcoma Research Articles

A Complex Case: Solid Unilateral Ovarian Mucinous Carcinoma Masquerading as Leiomyosarcoma in Postmenopausal Women

Introduction:: Ovarian cancers are the third most common gynecological and 8th most common cancer in women, associated with high mortality rates globally. Case Presentation:: A 60-year-old postmenopausal woman presented to the Gynecological outpatient department with complaints of pain in the abdomen for 2-3 months and loss of appetite with weight loss for 1-2 months. She was diagnosed as a case of uterine leiomyosarcoma or left adnexal mass on ultrasound and MRI. Intra-operatively, she was diagnosed with a unilateral left ovarian malignant mass, predominantly solid in consistency with metastasis to the left fallopian tube, uterus, cervical stroma, and omentum. The right ovary and tube were healthy. On histopathological examination, the final diagnosis of primary mucinous ovarian carcinoma was made. The patient tolerated staging laparotomy (total abdominal hysterectomy with bilateral salpingo-oophorectomy and infracolic omentectomy) well and was started on six cycles of adjuvant chemotherapy with Paclitaxel and Carboplatin injections along with Bevacizumab. Conclusion:: Primary mucinous ovarian carcinomas are rare and distinct subtypes of epithelial ovarian carcinomas. Due to their strong resemblance to other ovarian tumors and leiomyosarcoma, their diagnosis becomes challenging. Hence, it is crucial to consider leiomyosarcomas in the differential diagnosis of ovarian masses, especially in postmenopausal women.

Diagnosis and treatment in a case of uterine leiomyosarcoma - case report and review of the literature

Introduction: Uterine leiomyosarcoma accounts for approximately 3%–7% of all uterine cancers and it is the most common subtype of uterine sarcoma. They are associated with high potential to both local recurrence and distant metastases, and they contribute to a significant proportion of uterine cancer deaths. Tumor stage is the single most important prognostic factor for uterine sarcomas. Presenting symptoms may be vague and mimic other benign uterine conditions.The aim of the study: This study aims to describe a case of uterine leiomyosarcoma and summarize current knowledge about classification, diagnostics and treatment.Materials and methods: The research method was a case study. This review was based on available data collected in the PubMed database and Google Scholar web search engine, using the key words: uterine leiomyosarcoma, uterine sarcoma, hysterectomy, gynecologic oncology.Conclusion: Surgery is considered the mainstay of treatment for sarcomas limited to the uterus. In patients with carcinosarcomas postoperative radiotherapy increases the local control. High rate of distant metastases suggests potential role of systemic therapy. However, the benefits of postoperative chemotherapy and endocrine therapy in high-risk patients are of no proven value in the adjuvant setting. These methods, in addition to palliative radiotherapy and surgery are used in recurrent and advanced disease.Keywords: uterine leiomyosarcoma, uterine sarcoma, hysterectomy, gynecologic oncology

18-CENTIMETER PULMONARY METASTATIC UTERINE LEIOMYOSARCOMA: IS THAT EVEN POSSIBLE?

SESSION TITLE: Lung Cancer 1 SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Uterine Leiomyosarcoma (ULS) is an extremely rare malignancy that arises from the smooth muscle of uterine wall. They are estimated to occur in 6 out of every 1,000,000 women in the US. We report a case of ULS in a 69 year old female with metastasis to lung and high grade treatment related Myelodysplatic Syndrome (MDS) CASE PRESENTATION: 69 year old female with no significant past medical history, presented in 2005 with chronic pelvic pain and dysfunctional uterine bleeding. Further workup led to diagnosis of a moderately differentiated ULS, which measured 13 cm. She was treated with total abdominal hysterectomy but declined adjuvant chemotherapy. Five years later, she presented again: this time complaining of shortness of breath and weight loss. Computerized Tomography (CT) showed a large 18 cm mass replacing the entire left lung. She underwent resection and pathological analysis demonstrated high grade metastatic sarcoma. This time she agreed to chemotherapy and received a total of 8 cycles of doxorubicin and dacarbazine achieving great clinical response. Once she reached maximum dose of doxorubicin, she was left on dacarbazine as a single agent and completed 74 doses. Five years after initiating treatment, therapy was discontinued due to development of high-grade MDS. She was started on Azacitidine regimen at that time and, as of today, continues to follow up with her oncologist. DISCUSSION: The novelty in this case is dual. First of all, 5 year survival for metastatic ULS is reported from 8-17% (2). Our patient has survived for 12 years; whereas the longest reported survival in the literature is only 9 years. Secondly, a metastatic tumor larger than the primary is extremely unusual in ULS. There are no cases reported with this characteristic. In our review we did not find literature describing the average size of pulmonary metastasis, in fact, multiple lung lesions are more common than a single lesion making this 18 cm secondary tumor exceptionally unique. CONCLUSIONS: ULS is a very aggressive tumor that accounts for less than 1% of all malignancies. It most commonly metastasizes to the lung, followed by peritoneum, bone and liver (1). Several risk factors have been described including: Increasing age, African American race, Tamoxifen use and pelvic radiation. Although ULS is a rare disease process, the nuances in each reported case help to shed light on the pathogenesis and ultimately lead to improved treatment modalities. We urge clinicians to use our case as reference and to report personal experiences as well. Reference #1: Tropé CG, Abeler VM, Kristensen GB. Diagnosis/treatment of sarcoma of the uterus. A review. Acta Oncol 2012; 51:694. Reference #2: Sandberg AA. Updates on the cytogenetics and molecular genetics of bone and soft tissue tumors: leiomyosarcoma. Cancer Genet Cytogenet 2005; 161:1. Reference #3: Park JY, Kim DY, Suh DS, et al. Prognostic factors and treatment outcomes of patients with uterine sarcoma: analysis of 127 patients at a single institution, 1989-2007. J Cancer Res Clin Oncol 2008; 134:1277. DISCLOSURES: No relevant relationships by Fernando Figueroa Rodriguez, source=Web Response No relevant relationships by Daniel Keena, source=Web Response

Uterine Leiomyosarcoma with Breast Metastasis: A Case Report

Uterine leiomyosarcoma (LMS) is rare malignant neoplasm. Approximately 2% to 5% of all uterine malignancies [1]. Uterine leiomyosarcoma usually occur with vaginal bleeding, in the less frequently seen pelvic pain, pelvic mass, and uterine enlargement. Surgery is the primary treatment for uterine leiomyosarcoma. A 56 year old woman presented at vaginal bleeding. On admission, CT scan revealed lung and breast metastatic nodules. First she underwent surgery and then received chemotherapy. After 2 years than surgery she underwent total mastectomy. Histopathology report showed metastasis of leiomyosarcoma. In this report we describe an unusual case of uterine leiomyosarcoma with metastases to the breast.

A nonrandom association of sarcoidosis in patients with gastrointestinal stromal tumor and other sarcomas.

e22521 Background: Sarcoidosis can mimic metastatic cancer. Although sarcoidosis is associated with carcinomas, there are limited data supporting its association with GIST and other sarcomas. Prior reports on cancer related sarcoidosis are inconsistent in terms of prognosis; while some reports link sarcoidosis with a favorable prognosis, others associate it with recurrence and secondary malignancies. Here we describe a series of 7 patients with diagnosis of sarcoma and sarcoidosis seen at a single sarcoma center in South Florida. Methods: Seven patients with diagnosis of both sarcoma and sarcoidosis were identified over the period of 2007 to 2016. Data of presentation, treatment, histology and outcome was tabulated for analysis. The Standardized Incidence Ratio (SIR) was calculated for the state of Florida and for our hospital catchment area. Results: Of the seven patients, 4 cases were GIST, 1 case of unclassified spindled and epithelioid cell sarcoma that coexisted with tenosynovial giant cell tumor, 1 case of uterine leiomyosarcoma, and 1 case of myxofibrosarcoma. Sarcoidosis was diagnosed before sarcoma in 3 patients, after the diagnosis of sarcoma in 3 patients and at the same time of sarcoma diagnosis in 1 patient. All cases of sarcoidosis involved the lungs. From our series, 3 patients have shown no progression of sarcoma, 1 is alive with sarcoma, 2 died due to progression of sarcoma and 1 was lost to follow up. Statistical analyses showed a SIR = 268 (95% CI 106-503), when comparing to the expected incidence in the state of Florida and SIR = 831 (95% CI 329-1562), when comparing to the expected incidence in our catchment area. Conclusions: This case series points to a statistically robust, non-random, association between Sarcoma and Sarcoidosis that has not been previously described. Our study found the lung is not only the most common site of sarcoma metastasis but also the most common site of sarcoidosis. These results infer that patients with presumed metastatic sarcoma should be considered for a biopsy to rule out a benign process such as sarcoidosis. Additionally, the presence of sarcoidosis could be associated with risk of sarcoma. The mechanism of sarcoidosis-associated sarcoma is ongoing.

Broadening the spectrum of SMARCB1-associated malignant tumors: a case of uterine leiomyosarcoma in a patient with schwannomatosis

Schwannomatosis is a tumor predisposition syndrome characterized by development of multiple intracranial, spinal, and peripheral schwannomas. Constitutional alterations in either SMARCB1 or LZTR1 on 22q are responsible of the phenotype. We describe a 34-year-old woman who developed multiple benign peripheral sheath tumors and a uterine leiomyosarcoma. The patient carried a de novo constitutional alteration in exon 8 of SMARCB1, c.1118G > A, which destroyed the splice donor site of intron 8. Two schwannomas and the leiomyosarcoma of the patient retained the SMARCB1 mutation; in addition, the tumors showed loss of the normal chromosome 22. In conclusion, our findings enlarged the spectrum of SMARCB1-predisposing tumors and demonstrated, for the first time, the association of a malignant smooth muscle tumor to schwannomatosis. Therefore, clinicians should definitely be aware that a constitutional SMARCB1 mutation, which mainly predisposes to benign nerve sheath tumors, may also predispose to aggressive neoplasms throughout life, within an unexpected spectrum.

Rare Endobronchial metastasis from uterine leiomyosarcoma.

Uterine sarcomas are rare and represent approximately 3.2% of all invasive uterine cancers. The annual incidence rate is less than two per 100,000 women. The median age at which uterine sarcoma diagnosed is 56 years. The most common histologic pattern is leiomyosarcoma (LMS) which originates from the myometrium or myometrial vessels. Uterine LMSs are aggressive tumors with high rates of recurrence. The most common mode of spread is hematogenous, with lymphatic spread being rare. Recurrences of up to 70% are reported in stage I and II disease with the site of recurrence being distal, most commonly the lungs or the upper abdomen. But the intra bronchial spread is extremely rare. Here we are reporting a case of uterine LMS with endobronchial metastasis causing whole lung collapse.

Obstructive Small Bowel Metastasis from Uterine Leiomyosarcoma: A Case Report

Background. Uterine leiomyosarcoma is a rare and aggressive gynecologic malignancy with an overall poor prognosis. Lungs, bones, and brain are common sites of metastases of uterine leiomyosarcoma. Metastases of uterine leiomyosarcoma to the small bowel are extremely rare, and only four case reports have been published to date. Case presentation. A 55-year-old Saudi woman diagnosed with a case of uterine leiomyosarcoma treated with total abdominal hysterectomy (TAH) and bilateral salpingooophorectomy (BSO) presented in emergency room after sixteen months with acute abdomen. Subsequent work-up showed a jejunal mass for which resection and end-to-end anastomosis were performed. Biopsy confirmed the diagnosis of small bowel metastasis from uterine leiomyosarcoma. Further staging work-up showed wide spread metastasis in lungs and brain. After palliative cranial irradiation, systemic chemotherapy based on single agent doxorubicin was started. Conclusion. Metastatic leiomyosarcoma of small bowel from uterine leiomyosarcoma is a rare entity and is sign of advanced disease. It should be differentiated from primary leiomyosarcoma of small bowel as both are treated with different systemic chemotherapeutic agents.

Uterine leiomyosarcoma – a potential pitfall in the pap smear

Leiomyosarcomas are the most common uterine sarcomas, and present with non-specific symptoms of abnormal vaginal bleeding, lower abdominal pain or mass. We describe a case of uterine leio-myosarcoma in a 54-year-old Malay woman with extension and ulceration through the cervical epithelium, permitting cytological analysis via a PAP smear. The smear showed dispersed cells with various abnormal shapes, ranging from epithelioid to spindled and the nuclear chromatin was coarsely granular and hyperchro-matic, resulting in an erroneous diagnosis of severe squamous dyskaryosis, with suspicion for invasion. We review the literature on uterine leiomyosarcomas diagnosed on the cervical smear. This report is, to the best of our knowledge, the first cytological description of a uterine leiomyosarcoma in a liquid-based PAP smear.

Pancreaticoduodenectomy for metastasis of uterine leiomyosarcoma to the pancreas

Metastasis of uterine leiomyosarcoma to the pancreas is rare. A 46-year-old woman was diagnosed with uterine leiomyosarcoma and underwent surgery. Thereafter, recurrences in the lung and subsequently in the pancreas were diagnosed. These lesions were resected and diagnosed as metastasis of uterine leiomyosarcoma. We report a rare case of uterine leiomyosarcoma with metastasis to the lung and pancreas, both of which were resected using aggressive surgery.

Uterine leiomyosarcoma—Magnetic resonance imaging

Magnetic resonance (MR) scanning shows great promise as an imaging tool to evaluate the pelvis as a result of contrast resolution and lack of ionizing radiation. For these reasons, it is assuming an important role in staging gynecologic neoplasms, and evaluating diseases in the gravid pelvis. A case of uterine leiomyosarcoma is presented in which MR imaging was able to delineate the extent and tissue characteristics of the lesion more precisely than CT scan.

Alkaline phosphatase-producing leiomyosarcoma of the uterus

A case of uterine leiomyosarcoma in a fifty-two year old white woman is presented. The clinical picture was characterized by intermittent fever, eosinophilia, and a high blood alkaline phosphatase level. After removal of the leiomyosarcoma the temperature, eosinophil count, and high alkaline phosphatase level returned to normal values. The development of metastatic tumors caused another increase of the blood alkaline phosphatase. Chemical analysis of the tumor tissue showed a high alkaline phosphatase content. The conclusion was drawn that the high alkaline phosphatase-producing ability of this tumor caused the increase in serum alkaline phosphatase.