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Uterine leiomyosarcoma

Case contributed by Dr Pranav Sharma

Presentation

Abnormal uterine bleeding.

Patient Data

Age: 50 years
Gender: Female
CT

Large mass of the myometrium and endometrium involving >50% depth but no serosal breach or localized metastatic disease. No distal metastasis or pathological lymph node. Distended gallbladder with gallstones.

4 months later

CT

Impressive disease progression with diffuse pulmonary metastatic disease and diffuse abdominal involvement.

Case Discussion

This is a case of a 50-year old lady that presented with abnormal uterine bleeding to the gynecology outpatients department. Unfortunately, there was a delay to theater given patient non-compliance. A repeat CT was performed 4 months after the first CT and showed impressive progressive disease.

The patient eventually underwent a total abdominal hysterectomy and bilateral salpingo-oophorectomy with omental biopsies. Intra-op findings:

  • disease eroding through serosa with disease on the omentum
  • normal ovaries and peritoneal surfaces

Histopathology results: Uterine leiomyosarcoma, high grade, no lymphovascular invasion, metastatic disease to omentum, surgical margins adequate.

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