Diagnosis challenges in a uterine leiomyosarcoma

Raluca Balan, Corina Andriescu, Diana Popovici, Ioana Păvăleanu, Cornelia Amălinei


Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. Therefore, we present a case of LMS in a 48 year-old patient, complaining of a 3-months metrorrhagia. The tumor presented as a poorly defined submucosal nodule, with a soft consistence and measuring 6 cm in diameter. The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. At least 5 atypical mitoses/ 10 HPF were also found. Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. The final histopathological diagnosis was that of uterine LMS. Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.


uterine leiomyosarcoma, ER, PR, PCNA, SMA, p53, bcl-2

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Zaloudek CJ, Hendrickson MR, Soslow RA. Mesenchymal tumors of the uterus. In Kurman RJ, Ellenson LH, Ronnett BM (Eds.). Blaustein’s Pathology of the female genital tract. Springer; 2011:453-528.

Oliva E, Loening T, Carcangiu ML, Longacre TA, Carinelli SG, et al. Tumours of the uterine corpus. Mesenchymal tumours. In Kurman RJ, Carcangiu ML, Herrington CS, Young RH (Eds.) WHO Classification of tumours of female reproductive organs. IARC Press 2014:135-147.

Setia A, Kanotra S, Aggarwal R, Bhavthankar DP. Epithelioid leiomyosarcoma of uterus. BMJ Case Rep 2012; doi:10.1136/bcr.11.2011.5144.

Adesiyun AG, Samaila MOA. Leiomyosarcoma uteri in a white woman. Ann Afr Med 2010; 9:35-38.

Oliva E. Pure mesenchymal and mixed Müllerian tumors of the uterus. In Nucci MR, Oliva E (Eds.). Gynecologic Pathology. Elsevier Churchill Livingstone; 2011:261-330.

D'Angelo E, Prat J. Uterine sarcomas: a review. Gynecol Oncol 2010; 116:131–139.

Yoshida H, Watanabe M, Shomori K, Ito H, Minamizaki T. Apoptotic cell death and p53 expression in leiomyosarcoma of soft-tissue origin. Yonago Acta Med 2001; 44:115-123.

Senol T, Kahramanoglu I, Muezzinoglu B, Yucesoy I. Giant leiomyosarcoma: a case report. Int J Surg Case Rep 2016; 19:109-111.

Danielson LS, Menendez S, Attolini CS, Guijarro MV, Bisogna M, et al. A differentiation-based microRNA signature identifies leiomyosarcoma as a mesenchymal stem cell-related malignancy. Am J Pathol 2010; 177:908-917.

Shah SH, Jagannathan JP, Krajewski K, O’Regan KN, George S, Ramaiya NH. Uterine sarcomas: then and now. AJR Am J Roentgenol 2012; 199(1):213-223.

Tanaka YO, Nishida M, Tsunoda H, Okamoto Y, Yoshikawa H. Smooth muscle tumors of uncertain malignant potential and leiomyosarcomas of the uterus: MR findings. J Magn Reson Imaging 2004; 20(6):998–1007.

Cornfeld D, Israel G, Martel M, Weinreb J, Schwartz P, McCarthy S. MRI appearance of mesenchymal tumors of the uterus. Eur J Radiol 2010; 74(1):241–249.

Kurjak A, Kupesic S, Shalan H, Jukic S, Kosuta D, Ilijas M. Uterine sarcoma: a report of 10 cases studied by transvaginal color and pulsed Doppler sonography. Gynecol Oncol 1995; 59(3):342–346.

Umesaki N, Tanaka T, Miyama M, et al. Positron emission tomography with (18)F-fluorodeoxyglucose of uterine sarcoma: a comparison with magnetic resonance imaging and power Doppler imaging. Gynecol Oncol 2001; 80(3):372–377.

Murase E, Siegelman ES, Outwater EK, Perez-Jaffe LA, Tureck RW. Uterine leiomyomas: histopathologic features, MR imaging findings, differential diagnosis, and treatment. Radiographics 1999; 19(5):1179–1197.

Kelley TW, Borden EC, Goldblum JR. Estrogen and progesterone receptor expression in uterine and extrauterine leiomyosarcomas: an immunohistochemical study. Appl Immunohistochem Mol Morphol 2004; 12(4):338-341.

Tinelli A. Uterine leiomyosarcomas and leiomyomas: Two similar uterine solid tumors, totally different for prognosis. JST 2011; 1(2):29-33.

Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 2008; 65(2):129-142.

Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Leodolter S et al. Estrogen and progesterone receptor expression in patients with uterine leiomyosarcoma and correlation with different clinicopathological parameters. Anticancer Res 2003; 23(1B):729-732.

Bodner K, Bodner-Adler B, Kimberger O, Czerwenka K, Mayerhofer K. Bcl-2 receptor expression in patients with uterine smooth muscle tumors: an immunohistochemical analysis comparing leiomyoma, uterine smooth muscle tumor of uncertain malignant potential, and leiomyosarcoma. J Soc Gynecol Investig 2004; 11(3):187-191.

DOI: http://dx.doi.org/10.22551/2017.16.0403.10109

Copyright (c) 2017 Raluca Balan, Corina Andriescu, Diana Popovici, Ioana Păvăleanu, Cornelia Amălinei

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ISSN: 2360-6975