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.
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.
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Conflicts of interest
The authors declare no conflict of interest.
