Leiomyosarcoma of the broad ligament: a case report and literature review

Primary leiomyosarcoma of broad ligament: case report and review of literature

INTRODUCTION

Primary leiomyosarcoma of the broad ligament (LBL) is a very rare and highly malignant gynecological tumor.

MATERIALS AND METHODS

A 45 year old hysterectomized woman with this rare tumor is presented. Treatment consisted of resection of the tumor along with omental and peritoneal sampling and adjuvant chemotherapy. No evidence of metastasis was present after 15 months of follow up.

CONCLUSION

Complete surgery along with adjuvant chemotherapy or radiation and a close follow up for recurrence are advocated to optimize disease free survival.

Leiomyosarcoma of the broad ligament: a case report and review of literature

Leiomyosarcoma of the broad ligament is a rare tumor, since only 12 cases have been reported so far in the literature. A 53-year-old patient was diagnosed with leiomyosarcoma of the broad ligament at the Department of Gynecology Oncology of the National Cancer Research Institute in Genoa. The tumor had low mitotic activity and less than ten mitotic figures were found for ten high-power fields. The treatment consisted of total abdominal hysterectomy and bilateral salpingo-oophorectomy with bilateral ureteral neoanastomosis and omentectomy. The patient has not received either radiotherapy or chemotherapy, considering the low grade of malignancy, but she is only followed up on an outpatient basis. No evidence of metastasis has been noted after a follow-up of 13 months. It is concluded that low-grade leiomyosarcoma of the broad ligament should be treated only with surgery.

Léiomyosarcome du ligament large

INTRODUCTION

Leiomyosarcoma of the broad ligament is an extremely rare malignant tumor, with only 13 cases reported.

OBSERVATION

A 52 year-old woman consulted for pelvic pain and metrorrhagia. Clinical examination revealed a multinodular mass on the right side of the uterus. Pelvic ultrasound revealed a heterogeneous mass. Laparotomy found a malignant tumor arising from the right broad ligament. It was independent from the proximity organs. Treatment consisted in resection and total hysterectomy with bilateral salpingo-oophorectomy. The histologic examination led to the diagnosis of leiomyosarcoma. The patient died three months later.

COMMENT

This is an exceptional case. Most authors underline the poor prognosis when tumoral relapse occurs early, as was the case in our patient.

Leiomyosarcoma of the broad ligament: a case report and literature review

Primary leiomyosarcoma of the broad ligament is a very rare, rapidly progressive and highly malignant gynaecological tumor. There are only 11 cases reported so far in the literature. An 87-year-old Caucasian lady with leiomyosarcoma of the broad ligament is presented. Treatment consisted of resection and total abdominal hysterectomy with bilateral salpingo-oopphorectomy. Unusually, she developed large recurrent pelvic disease in the absence of disseminated metastasis following surgery. She died within 8 weeks of primary surgery. This highlights the unknown behavior of this tumor and the need for more research into management.

Mesenchymal tumors and tumor-like lesions of the female genital tract: a selective review with emphasis on recently described entities

The diverse mesenchymal tumors and tumor-like lesions that occur within the female genital tract include a number of lesions that have only been recently characterized and others about which there is new information. In this group are the aggressive angiomyxoma, angiomyofibroblastoma, and cellular angiofibroma. Criteria for the distinction of these lesions are reviewed, as are the pathologic features of prognostic significance in assessing smooth muscle tumors of the vulva. The diagnostic problems that the epithelioid variant of smooth muscle tumors, both benign and malignant, may pose when they occur in various areas of the genital tract are discussed, particularly with regard to problems encountered in the ovary, a site where the diagnosis often is not considered. Recent information expanding the morphologic spectrum of fibroepithelial polyps of the genital tract is presented, and important non-neoplastic entities, including nodular fasciitis and the postoperative spindle cell nodule, are reviewed. Mesenchymal tumors of the various types seen in the soft tissues may be encountered anywhere in the female genital tract and have been the subject of particular recent interest in the ovary; issues relevant to differential diagnosis are reviewed.