Primary Vaginal Leiomyosarcoma Research Articles

Primary vaginal leiomyosarcoma: case report of a rare gynaecological malignancy and diagnostic challenge in a resource-constraint setting

ABSTRACTPrimary vaginal leiomyosarcoma (VLMS) is an extremely rare variant of primary vaginal cancers with very poor prognosis irrespective of the stage at presentation and the type of treatment received. It is easily recurrent and has a high propensity for haematogenous spread especially to the lungs. We present the case of a 34-year-old Para 1 + 1 (1 alive) woman with recurrent vaginal mass of 8 years duration after two surgical excisions without histological evaluation. She had examination under anaesthesia and a wide local excision of the vaginal mass. Histological examination of the mass revealed poorly differentiated VLMS with positive surgical margins and she was commenced on adjuvant chemo-radiation. Histological evaluation remains the hallmark for diagnosing rare malignancies like VLMS, which unfortunately is not a standard practice in some resource-constraint settings.

Primary Vaginal Leiomyosarcoma: A Case Report and Review of the Articles

Primary Vaginal Leiomyosarcoma: A Case Report and Review of the Articles

Primary vaginal leiomyosarcoma, a rare tumour: case report and review

Primary vaginal leiomyosarcomas (pvLMS) are rare, recurrent tumours accounting for ca. 2% of all vaginal cancers. The etiology is still unknown, the prognosis is poor and there is no consensus guideline on its management. Diagnosis is usually made during the 5th decade due to the presence of a vaginal mass or nodule [1-2]. Current medical literature reports about 200 cases (PubMed®); only 3 studies have considered the ultrastructure [2-4]. Herein a pvLMS is presented and discussed. A nodular, 25 x 23 x 28 mm-mass, infiltrating the urethra but not the rectovaginal septum, was widely excised from the superior vaginal wall of a 58-year-old previously hysterectomized woman. Macroscopic images and MRI were performed. Iliac lymph nodes and HMB-45 were negative. The sample was fixed and prepared for light microscopy, transmission (TEM) and scanning (SEM) electron microscopy. Semithin sections showed a storiform pattern of spindle shaped cells with blunt-ended nuclei. Cells arranged in interwoven fascicles within a dense and richly vascularised stroma (neoangiogenesis). Some atypic mitotic figures and focal necrosis were seen. SEM evidenced a dense collagenous stroma with numerous microvessels. TEM showed neoplastic and pleomorphic cells with complex cytoplasm projections containing paranuclear crowds of dilated mitochondria, free ribosomes and a well-developed rough endoplasmic reticulum. Nuclei were large, mostly hyperchromatic, usually indented, with prominent nucleoli and nucleolonema. The dense intercellular space contained dense bundles of collagen fibers. A high and reactive endothelium lined blood vessels. After 4 follow-ups, the patient is fine and without recurrence. Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as it was for this case. As there are different kinds of LMS, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice.

A large primary retroperitoneal vaginal leiomyosarcoma: a case report

IntroductionPrimary vaginal leiomyosarcomas are uncommon, especially those growing outside the vagina.Out of all malignant vaginal neoplasms, leiomyosarcomas account for about 2%. Reports in the literature mostly concern the pathology of these tumors; few reports have been published that discuss how to surgically remove them.Case presentationA 69-year-old Chinese woman presented with a mass in her buttocks that had been present for more than four months. Computed tomography demonstrated a mass of approximately 12.0×9.5×8.0cm in her retroperitoneal space. We resected the tumor via a posterior incision, and resected part of her sacrum and coccyx. The resected tumor was diagnosed by its pathological features as a leiomyosarcoma. Our patient received adjuvant chemotherapy after surgery. She was free of disease at a one-year follow-up and her general condition is good.ConclusionsWe report a rare case of a primary vaginal leiomyosarcoma that was resected through an approach that has not, to the best of our knowledge, been previously reported. This case report adds valuable knowledge to the sparse available literature on the surgical treatment of vaginal leiomyosarcomas.

A large primary vaginal leiomyosarcoma diagnosed postoperatively and uterine leiomyomas treated with surgery and chemotherapy

Primary vaginal leiomyosarcomas comprise less than 2% of all malignant vaginal neoplasms (Suh and Park 2008). An extensive search of the literature disclosed 140 case reports published over the pas...

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

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.

Thoracotomy for the management of recurrent vaginal leiomyosarcoma

Vaginal leiomyosarcoma is a rare malignancy for which little data exists to guide treatment decisions. We describe a patient diagnosed with primary vaginal leiomyosarcoma who underwent hysterectomy and upper vaginectomy followed by whole pelvic radiation. Approximately 3 months after her initial treatment, she presented with an isolated pulmonary recurrence, which resolved after 12 cycles of chemotherapy. Nineteen months later, a second recurrence was found at the same site. This metastasis was resected and she has remained without evidence of further disease for more than 24 months. Similar to patients diagnosed with uterine sarcomas, resection of pulmonary metastases may offer women with recurrent vaginal leiomyosarcoma improved survival with good quality of life. Thoracotomy should be considered for women diagnosed with pulmonary recurrences of this disease.

Combined laparoscopic and radical vaginal treatment of primary vaginal leiomyosarcoma in a patient with unicornuate uterus and pelvic kidney

We report a case of primary vaginal leiomyosarcoma occurring in a patient with a unicornuate uterus and pelvic kidney. The patient was treated with radical partial vaginectomy, unilateral groin dissection, total laparoscopic hysterectomy, and left pelvic laparoscopic lymphadenectomy, followed by adjuvant chemotherapy. Twenty-five months after her original procedure, the patient is alive and free of disease. The exact association between müllerian anomalies and primary malignancies of the genitourinary tract is unclear. It is nonetheless important to be aware of the close embryonic association between the genital and urinary tracts when evaluating such patients and choosing the appropriate surgical and therapeutic approach.

Thoracotomy for the management of recurrent vaginal leiomyosarcoma

Vaginal leiomyosarcoma is a rare malignancy for which little data exists to guide treatment decisions. We describe a patient diagnosed with primary vaginal leiomyosarcoma who underwent hysterectomy and upper vaginectomy followed by whole pelvic radiation. Approximately 3 months after her initial treatment, she presented with an isolated pulmonary recurrence, which resolved after 12 cycles of chemotherapy. Nineteen months later, a second recurrence was found at the same site. This metastasis was resected and she has remained without evidence of further disease for more than 24 months. Similar to patients diagnosed with uterine sarcomas, resection of pulmonary metastases may offer women with recurrent vaginal leiomyosarcoma improved survival with good quality of life. Thoracotomy should be considered for women diagnosed with pulmonary recurrences of this disease.

Primary leiomyosarcoma of the vagina: a case report involving a TVT allograft

Introduction Primary malignant lesions of the vagina represent less than 2% of all gynecologic malignancies. Primary vaginal sarcomas account for about 2% of all malignant vaginal lesions, with leiomyosarcoma being the most common vaginal sarcoma found in adult women. Case We report a case of primary vaginal leiomyosarcoma occurring in the field of a prior tension-free vaginal tape (TVT) procedure using a Bard Duraderm allograft. Conclusion This report represents the first report, to our knowledge, of a vaginal sarcoma arising in the field of a Bard Duraderm TVT allograft. Although the product is no longer available for this use, the ongoing studies of the TVT procedure and outcomes should include this potential complication in their review.

Primary vaginal leiomyosarcoma in pregnancy☆

Background Primary vaginal sarcoma constitutes about 2% of all malignant vaginal lesions, with leiomyosarcoma being the most common in adult women. To our knowledge, this is the first case of vaginal leiomyosarcoma occurring during pregnancy. Case A 21-year-old woman, at 39 weeks of gestation, presented with a pedunculated vaginal mass. Local excision of the mass was performed immediately. Histopathologic evaluation revealed a grade 2 leiomyosarcoma. The patient delivered a healthy infant 2 weeks after resection. She has had no evidence of recurrence in 28 months of follow-up. Conclusions Previous cases of vaginal leiomyosarcoma and sarcomas of the female genital tract occurring during pregnancy are reviewed. The histopathologic criteria for vaginal smooth muscle tumors are well established. Primary management of vaginal leiomyosarcoma is surgical.

Primary leiomyosarcoma of the vagina. A case report and literature review.

Primary vaginal leiomyosarcoma is a rare tumor. We report a unique case of a 27-year-old woman with stage I, high-grade primary leiomyosarcoma of the vagina treated with surgical resection and adjuvant radiation therapy. She returned within 6 months with an abdominal-pelvic recurrence and lung metastases. The patient died of disease 9 months after diagnosis. A comprehensive review of primary vaginal leiomyosarcoma was performed and factors affecting survival were analyzed. A Medline search of the English-language literature revealed 66 previously reported cases. Forty-eight of these had follow-up data. Survival probabilities were calculated using the Kaplan-Meier method, and the effects of age, stage, grade, tumor location, and treatment modality were analyzed. Stage III and IV data were combined. The overall 5-year survival rate was 43%. Patients more than 50 years of age had a 5-year survival rate of 26% compared with 51% for those less than 40 years. Five-year survival for stage I and II tumors was 55% and 44%, respectively. Patients with stage III/IV disease had 25% survival at 18 months. No patient treated primarily with chemotherapy or radiation therapy survived beyond 36 months. In contrast, patients treated primarily with surgery had a 5-year survival rate of 57%. Only stage remained an independent predictor of survival on Cox regression analysis. We continue to recommend surgical resection as primary treatment. Exenteration may be an option for select patients, but ultimately management should continue on a case-by-case basis.

Primary leiomyosarcoma of the vagina

A case of primary leiomyosarcoma of the vagina is described and discussed. The tumor recurred and the patient died 8.5 years after the diagnosis and primary treatment. This is the longest survival time reported in the literature for a primary vaginal leiomyosarcoma.

Primary leiomyosarcoma of the vagina: A study of five cases

The clinical and light and electron microscopic features of five cases of primary vaginal leiomyosarcoma, representing 2.9% of all vaginal malignancies registered at the Swedish Cancer Registry, are presented. The ages of the patients ranged from 31 to 69 years. The most common clinical presentation was an increasing mass and/or local tenderness. The tumor was located in the anterior wall in three cases and in the lateral wall in two. The size of the tumors ranged from 2 to over 10 cm. Four patients had tumors of high histologic malignancy grade and were all dead within 36 months. One patient had a tumor of low grade and is still alive 10 years after the initial excision. The ultrastructural observations of abundant myofilaments with focal elongated densities in primary paraffin-embedded material conform with the light microscopic diagnoses in all cases and indicate the usefulness and value of such material for electron microscopy in order to arrive at the diagnosis of leiomyosarcoma. The therapeutic and diagnostic aspects are discussed.