Unexpected Uterine Leiomyosarcoma After Hysterectomy for Presumed Leiomyoma: A Case Report
DOI:
https://doi.org/10.22487/2tyt7840Keywords:
Histopathology, Leiomyoma, Leiomyosarcoma, Smooth muscle tumor, UterusAbstract
Background: Uterine leiomyosarcoma is a rare malignant smooth muscle tumor that may remain unsuspected until definitive histopathological examination. Objectives: To describe diagnostic discordance between benign preoperative and gross impressions and malignant microscopic findings in uterine leiomyosarcoma. Methods: This case report retrospectively describes clinical presentation, computed tomography findings, surgical management, histopathological examination, and immunohistochemical results. Results: A 47 year old multiparous woman presented with six months of progressive abnormal uterine bleeding and abdominal enlargement. Non contrast computed tomography revealed a well circumscribed intramural uterine mass measuring 7.0 × 6.8 × 7.0 cm without detectable extrauterine disease. Total abdominal hysterectomy was performed for presumed leiomyoma. Gross examination revealed a firm whorled mass without evident hemorrhage or geographic necrosis. Microscopy demonstrated moderate to severe cytologic atypia, coagulative tumor cell necrosis, and more than 10 mitoses per 10 high power fields. Strong desmin and h caldesmon positivity supported smooth muscle differentiation. The patient was referred for multidisciplinary oncologic assessment. Conclusions: Benign appearing imaging and gross morphology cannot exclude uterine leiomyosarcoma. Accurate diagnosis requires adequate histological sampling and integrated clinicopathological assessment.
Downloads
References
1. Yang Q, Madueke Laveaux OS, Cun H, et al. Comprehensive review of uterine leiomyosarcoma: pathogenesis, diagnosis, prognosis, and targeted therapy. Cells. 2024;13(13):1106. doi:10.3390/cells13131106
2. Ray Coquard I, Casali PG, Croce S, et al. ESGO EURACAN GCIG guidelines for the management of patients with uterine sarcomas. Int J Gynecol Cancer. 2024;34(10):1499–1521. doi:10.1136/ijgc-2024-005823
3. Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol. 2017;145(1):208–216. doi:10.1016/j.ygyno.2017.02.019
4. Cao H, Li L, Yang B, Luo G, Lou J, Xi M. Unexpected uterine sarcomas after hysterectomy and myomectomy for presumed leiomyoma: a retrospective study of 26,643 patients. Cancer Manag Res. 2019;11:7007–7014. doi:10.2147/CMAR.S208405
5. Tantitamit T, Huang KG, Manopunya M, Yen CF. Outcome and management of uterine leiomyosarcoma treated following surgery for presumed benign disease: review of literature. Gynecol Minim Invasive Ther. 2018;7(2):47–55. doi:10.4103/GMIT.GMIT_10_18
6. Raffone A, Raimondo D, Neola D, et al. Diagnostic accuracy of MRI in the differential diagnosis between uterine leiomyomas and sarcomas: a systematic review and meta analysis. Int J Gynaecol Obstet. 2024;165(1):22–33. doi:10.1002/ijgo.15136
7. Woo S, Beier SR, Tong A, Hindman NM, Vargas HA, Kang SK. Utility of ADC values for differentiating uterine sarcomas from leiomyomas: systematic review and meta analysis. AJR Am J Roentgenol. 2024;223(3):e2431280. doi:10.2214/AJR.24.31280
8. Höhn AK, Brambs CE, Hiller GGR, May D, Schmoeckel E, Horn LC. Practical diagnostic aspects of uterine leiomyosarcoma in the context of the 2020 WHO classification. Geburtshilfe Frauenheilkd. 2021;81(10):1145–1153. doi:10.1055/a-1545-4279
9. Tinelli A, D’Oria O, Civino E, et al. Smooth muscle tumor of uncertain malignant potential: a comprehensive multidisciplinary update. Medicina (Kaunas). 2023;59(8):1371. doi:10.3390/medicina59081371
10. Nielsen GP, Oliva E, Young RH, Rosenberg AE, Prat J, Scully RE. Diagnostic immunohistochemistry in uterine sarcomas: a study of 397 cases. Int J Gynecol Pathol. 2011;30(3):222–232. doi:10.1097/PGP.0b013e318200caff
11. Chen L, Yang B. Immunohistochemical analysis of p16, p53, and Ki 67 expression in uterine smooth muscle tumors. Int J Gynecol Pathol. 2008;27(3):326–332. doi:10.1097/PGP.0b013e31815ea7f5
12. Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009;104(3):177–178. doi:10.1016/j.ijgo.2008.12.008
13. Zivanovic O, Leitao MM, Iasonos A, et al. Stage specific outcomes of patients with uterine leiomyosarcoma: a comparison of FIGO and AJCC staging systems. J Clin Oncol. 2009;27(12):2066–2072. doi:10.1200/JCO.2008.19.8366
14. Miettinen M, Fetsch JF. Evaluation of biological potential of smooth muscle tumours. Histopathology. 2006;48(1):97–105. doi:10.1111/j.1365-2559.2005.02225.x
15. Bell SW, Kempson RL, Hendrickson MR. Problematic uterine smooth muscle neoplasms: a clinicopathologic study of 213 cases. Am J Surg Pathol. 1994;18(6):535–558.
16. Ip PP, Cheung AN, Clement PB. Uterine smooth muscle tumors of uncertain malignant potential: a clinicopathologic analysis of 16 cases. Am J Surg Pathol. 2009;33(7):992–1005.
17. Travaglino A, Raffone A, Gencarelli A, et al. p53, p16 and Ki 67 as immunohistochemical prognostic markers in uterine smooth muscle tumors of uncertain malignant potential. Pathol Res Pract. 2021;226:153592.
18. Mäkinen N, Aavikko M, Heikkinen T, et al. Exome sequencing of uterine leiomyosarcomas identifies frequent mutations in TP53, ATRX, and MED12. PLoS Genet. 2016;12(2):e1005850. doi:10.1371/journal.pgen.1005850
19. Cui RR, Wright JD, Hou JY. Uterine leiomyosarcoma: a review of recent advances in molecular biology, clinical management and outcome. BJOG. 2017;124(7):1028–1037. doi:10.1111/1471-0528.14579
20. Amant F, Coosemans A, Debiec Rychter M, Timmerman D, Vergote I. Clinical management of uterine sarcomas. Lancet Oncol. 2009;10(12):1188–1198. doi:10.1016/S1470-2045(09)70226-8
21. Maulana A, Masadah R, Nelwan BJ, Ghaznawie M, Miskad UA, Tawali S. Stratifikasi risiko hiperplasia endometrium dan kanker endometrium tipe endometrioid berdasarkan faktor demografi, gejala ginekologi dan ekspresi beta catenin. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako). 2024;10(2):282–292. doi:10.22487/htj.v10i2.1150
22. Fardillah N, Cangara MH, Kaelan C, et al. Pola ekspresi protein p53 pada astrositoma berdasarkan grading histopatologi. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako). 2023;9(2):148–156. doi:10.22487/htj.v9i2.731
23. Hutasoit GA, Sari P, Rupawan IK, Salman M. Tumor phyllodes dan prognosisnya. Healthy Tadulako Journal (Jurnal Kesehatan Tadulako). 2022;8(3):204–213. doi:10.22487/htj.v8i3.476
24. D’Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol. 2010;116(1):131–139. doi:10.1016/j.ygyno.2009.09.023
25. Kapp DS, Shin JY, Chan JK. Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy. Cancer. 2008;112(4):820–830. doi:10.1002/cncr.23245
26. 26. George S, Serrano C, Hensley ML, Ray Coquard I. Soft tissue and uterine leiomyosarcoma. J Clin Oncol. 2018;36(2):144–150. doi:10.1200/JCO.2017.75.9845
Downloads
Published
Issue
Section
License
Copyright (c) 2026 Muh Lingga Primananda, Aries Maulana, Jasa Nita Listiana, Muh Arfan, Ivy Tania
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
