Uterine leiomyosarcoma

Uterine leiomyosarcomas are malignant uterine tumours that arises from the myometrium. The uterus is the commonest location for a leiomyosarcoma.

Typically present in women in the 6th decade. They account for up to one-third of uterine sarcomas but only ~8% of all uterine cancers 10.

Most commonly patients present with abnormal PV bleeding, pelvic mass, and/or pelvic pain. Uncommonly, patients present with symptoms from local extension or metastases 10.

Leiomyosarcomas may arise either de novo 5 from uterine musculature or the connective tissue of uterine blood vessels, or in a pre-existing leiomyoma. The incidence of sarcomatous transformation in benign uterine leiomyomas is reported to be 0.1-0.8% 2

The pattern of tumour spread is to the myometrium, pelvic blood vessels and lymphatics, contiguous pelvic structures, abdomen, and then distantly, most often to the lungs.

Histology can be similar to leiyomyosarcomas at other sites. A leiomyosarcoma is differentiated histologically from a leiyomyoma by noting the presence of infiltrative margins, nuclear atypia and increased mitotic figures.

General

The uterus is often massively enlarged.

CT
  • may show irregular central zones of low attenuation, suggesting extensive necrosis 8 and haemorrhage
  • foci of calcification may be present but rare
MRI

Although it has been suggested that an irregular margin of a uterine leiomyoma on MRI is suggestive of sarcomatous transformation, this is not considered that specific.

They generally carry a poor prognosis 6.

Consider other uterine masses such as:

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Article Information

rID: 13012
System: Gynaecology
Section: Pathology
Tags: uterus, cases
Synonyms or Alternate Spellings:
  • Leiomyosarcoma of the uterus
  • Leiomyosarcoma of uterus
  • Uterine leiomyosarcomas
  • Leiomyosarcomas of uterus
  • Leiomyosarcomas of the uterus

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