Vol 95, No 1 (2024)
Clinical vignette
Published online: 2023-06-12

open access

Page views 519
Article views/downloads 297
Get Citation

Connect on Social Media

Connect on Social Media

Uterus sarcoma in 26-year-old patient with multiple uterine fibroids

Marta Pajak1, Slawomir Wozniak1, Tomasz Paszkowski1, Piotr R. Szkodziak1
Pubmed: 37318052
Ginekol Pol 2024;95(1):77-78.

Abstract

Not available

CLINICAL VIGNETTE

Ginekologia Polska

2024, vol. 95, no. 1, 79–80

Copyright © 2024 PTGiP

ISSN 0017–0011, e-ISSN 2543–6767

DOI 10.5603/GP.a2023.0055

Uterus sarcoma in 26-year-old patient with multiple uterine fibroids

Marta PajakSlawomir WozniakTomasz PaszkowskiPiotr R. Szkodziak
3rd Chair and Department of Gynecology, Medical University of Lublin, Poland

Corresponding author:

Marta Pająk

3rd Chair and Department of Gynecology, Medical University of Lublin, Poland

e-mail: marta.pajk@gmail.com

Received: 31.01.2023 Accepted: 21.02.2023 Early publication date: 12.06.2023

This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, allowing to download articles and share them with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially.

INTRODUCTION

Uterine leiomyomas are one of the most common tumors in women. These tumors, commonly known as fibroids, affect women mainly during their reproductive years and are diagnosed in up to 70% of white women during their lifetime [1]. Other uterine tumors have similar clinical presentations and about 0.5% of resected tumors presumed to be fibroids in the preoperative diagnosis revealed as sarcomas in the final histopathological examination [2, 3].

This case presents 28-year-old-women with multiple fibroids, of whom one was diagnosed as leiomyosarcoma.

CASE STUDY

In February 2022 a nulligravid 28-years-old woman was admitted to the 3rd Chair and Department of Gynecology at Teaching Hospital No 4, Lublin, Poland due to heavy menstrual bleeding. Clinical examination showed stable vital signs and normal laboratory results. Pelvic ultrasound (Fig. 1A) showed anteflexed uterus with heterogeneous echostructure, thin endometrium, and multiple uterine fibroids: 4 International Federation of Gynecology and Obstetrics (FIGO) 4, and 1 FIGO 7 type with a diameter of 5 cm. There was no free fluid in the Douglas’ pouch. A magnetic resonance was performed (Fig. 1B) which showed enlarged uterus with focal intramural lesions of the echostructure typical for fibroids: two within anterior wall with a diameter of 30 mm and 13 mm, two within posterior wall with a diameter of 21 mm and 8 mm, and one lesion (20 × 18 mm) on the left side. Furthermore, in front of the uterus, above the bladder, pedunculated fibroid was shown with measurements of 57 × 42 × 51 mm. The patient was offered scheduled fertility-preserving surgical treatment.

Figure 1. A. Ultrasound image of the uterus with fibroid; B. The magnetic resonance image of pelivis; C. Intraoperative view of uterus with fibroid

In June 2022, the patient was readmitted to the hospital to perform the operation. Pelvic ultrasound was performed, with results similar to the one performed in February. Patient was qualified for surgery. Laparotomy, with removal of uterine fibroids was chosen by the patient from the treatment options offered. The patient’s postoperative course was complicated with mild postoperative wound infection. She was discharged twelve days after admission without further complications. The definitive histological diagnosis was leiomyosarcoma with bizarre nuclei within the pedunculated tumor, and leiomyoma for the remaining five tumors. Six weeks after the surgery, an ultrasound re-evaluation showed the normal sonographic appearance of uterus.

COMMENT

This is a rare case of single malignant tumor among multiple fibroids in young patient. It serves a reminder to maintain oncological vigilance in all patients with uterine tumors.

Article information and declarations
Conflicts of interest

The authors declare no conflict of interest.

REFERENCES

  1. Krzyzanowski J, Wozniak S, Szkodziak P, et al. Minimally invasive treatment options for uterine fibroids - state-of-the art 2021. Ginekol Pol. 2022; 93(3): 242247, doi: 10.5603/GP.a2021.0202, indexed in Pubmed: 35106750.
  2. Giuliani E, As-Sanie S, Marsh EE. Epidemiology and management of uterine fibroids. Int J Gynaecol Obstet. 2020; 149(1): 39, doi: 10.1002/ijgo.13102, indexed in Pubmed: 31960950.
  3. Lin Y, Wu RC, Huang YL, et al. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom Radiol (NY). 2022; 47(6): 21972208, doi: 10.1007/s00261-022-03431-6, indexed in Pubmed: 35347386.
  4. Zhang J, Zhang J, Dai Yi, et al. Clinical characteristics and management experience of unexpected uterine sarcoma after myomectomy. Int J Gynaecol Obstet. 2015; 130(2): 195199, doi: 10.1016/j.ijgo.2015.01.009, indexed in Pubmed: 26117552.