Uterine leiomyosarcoma in a premenopausal woman. Clinical case

Research Article

Abstract

INTRODUCTION. Leiomyosarcoma  (LMS) of the uterus is a rare soft‑tissue tumor of the female pelvis with <1% of uterine tumor. It usually arises from the uterine myometrium de novo or is very rarely transformed from a preexisting benign leiomyoma. These tumors are found mainly in females 40–60 years of age. Leiomyomas seen in the reproductive age group and a strong suspicion of LMS should be in mind in cases of fibroid with postmenopausal bleeding.

CLINICAL CASE. A 39-year-old female came to the emergency room complaining of pelvic pain of 8 days duration, treated symptomatically with NSAIDs. It has the following background: hereditary family history, which is unimportant to the case. Gynecobstetric history: menarche 11 years old, regular cycles five to seven days, reports two months with uncontrolled cycle with heavy menstrual bleeding, start active sexual life 24 years old. Papanicolaou: last year reported normal; colposcopy last one and a half ago reported normal.

DISCUSSION. Approximately 40-80% of women may develop leiomyomas, the most common benign gynecological disease, during their lifetime. Uterine sarcoma, on the other hand, is a rare disease with an incidence ranging from 1.55 to 1.95 per 100,000 women per year. According to the WHO, in 2011, a LMS is a specific type of rare sarcoma that accounts for over 60% of all cases of uterine sarcoma. It is essential to correctly evaluate myometrial tumors before surgery to ensure proper patient management and avoid delayed treatment. However, distinguishing an LMS from fibroids can be difficult due to similar clinical, laboratory, and ultrasound features. Ultrasound is a cost-effective, non-invasive, and widely accepted imaging method for evaluating the myometrium. The reporting of ultrasound characteristics of the myometrium and myometrial lesions was standardized by developing a consensus statement by the Morphological Uterus Sonographic Assessment group.