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- Title
Leiomyosarcoma: a commonly misdiagnosed uterine tumor.
- Authors
Yumi Seo; Wooyoung Kim; Sun Paik, E.
- Abstract
Uterine leiomyosarcoma (LMS) is a rare gynecologic tumor, accounts for 1% of all uterine malignancies. It is an aggressive tumor associated with high risk of recurrence and death, regardless of stage. Here we report a case of a huge LMS initially mistaken as myoma or ovarian malignancy. A 50-year-old women visited emergency room with massive vaginal bleeding and dyspnea for 3 days. Laboratory tests showed anemia to 4.5 g/dL which prompted a blood transfusion, and elevated serum cancer antigen 125 of 63.2 U/mL. Computed tomography (CT) scan showed 24 cm-uterine tumor suggesting myoma with hemorrhagic degeneration and 22cm-multiseptated cystic mass in right pelvic cavity compressing inferior vena cava. Positron emission tomography/CT scan documented a hypermetabolic mass suggesting malignancy, without definite metastasis. She was operated under the diagnose of myoma and ovarian malignancy. Surgical exploration showed huge myoma with some port of cystic degeneration. Total abdominal hysterectomy with right salpingo-oophorectomy was performed. Pathology demonstrated well-differentiated, low-grade LMS involving uterus, parametrium and right ovary. Surgical margins were free from tumor. She was referred to hemato- and radiation-oncologic part. No additional treatment was added due to the unsure benefit of chemotherapy or radiation. No signs of recurrence were shown 3 months postoperatively. Most uterine LMSs are diagnosed following surgery for presumed benign leiomyoma. There is no reliable method to distinguish sarcoma from benign leiomyoma preoperatively. The patient in our case also planned surgery for uterine masses presumed as benign leiomyoma or ovarian malignancy. Surgery is considered the mainstay of treatment, while chemotherapy or radiation is sometimes considered.
- Subjects
UTERINE tumors; LEIOMYOSARCOMA; SMOOTH muscle tumors; HYSTERO-oophorectomy; POSITRON emission tomography; VENA cava inferior; PELVIS
- Publication
Journal of Gynecologic Oncology, 2024, Vol 35, p62
- ISSN
2005-0380
- Publication type
Article
- DOI
10.3802/jgo.2024.35.S2.P86