Pérez CCA, González VC, Hidalgo PL, Marroquín TV, Arruel CLI

Language: Spanish
References: 6
Page: 376-381
PDF size: 252.47 Kb.

ABSTRACT

Introduction: Uterine leiomyosarcoma is a malignant neoplasm of the smooth muscle of the uterine wall, with low survival and high mortality. Abnormal uterine bleeding in postmenopausic women and abnormal growth of uterine mass are highly suspected data. Diagnosis is challenging as it is easily confused with benign leiomyoma and adenomyosis. Imaging studies offer useful information for diagnosis, surgical planning and prognosis. Case presentation: 38 year old female, G2, P1, C1. Cesarean section three months prior to diagnosis. She began her current condition two months and eight days after her cesarean section, referring a painful palpable pelvic mass and abnormal transvaginal bleeding. Physical examination: her vital signs are stable. A palpable tumor in pelvic region of 15 cm, solid, irregular, mobile with lateral and anterior racking towards the umbilical scar, without pain on palpation was documented. Imaging studies: pelvic ultrasound, MRI, triphasic abdominal tomography and whole body PET-CT with 18-FDG. Diagnosis: uterine leiomyosarcoma. Surgical treatment. Conclusion: The diagnostic approach must be systematic since it is a rare and aggressive tumor and not in vain can it be confused with a benign pathology. This allows for better preoperative therapeutic planning.

REFERENCES

1. Ricci S, Stone RL, Fader AN. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol Oncol. 2017; 145 (1): 208-216. doi: 10.1016/j.ygyno.2017.02.019.

2. Wu TI, Yen TC, Lai CH. Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol. 2011; 25 (6): 681-689. doi: 10.1016/j.bpobgyn.2011.07.002.

3. 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. doi: 10.1002/jmri.20207.

4. DeMulder D, Ascher SM. Uterine leiomyosarcoma: can MRI differentiate leiomyosarcoma from benign leiomyoma before treatment? AJR Am J Roentgenol. 2018; 211 (6): 1405-1415. doi: 10.2214/AJR.17.19234.

5. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM et al. Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma. Gynecol Oncol. 2008; 109 (2): 255-262. doi: 10.1016/j.ygyno.2008.01.030.

6. Silverberg SG, Kurman RJ. Tumors of the uterine corpus and gestational trophoblastic disease. Atlas of tumor pathology [electronic fascicle version 2]. Washington, DC: Armed Forces Institute of Pathology, 1992.