Primary leiomyosarcoma of the ovary: a report of three cases and a systematic review of literature

Ovarian Leiomyosarcoma as Incidentaloma during Postbariatric Abdominoplasty Surgical Procedure

This case report addresses the discovery, surgical management, histology, and postoperative outcomes of an incidentaloma during the preoperative evaluation of a 58-year-old woman planning to undergo abdominoplasty and hernia correction after bariatric surgery. The patient's computed tomography scan revealed a large pelvic mass in addition to an enlarged uterus and an umbilical hernia. Subsequent surgical intervention included umbilical hernia repair, subtotal omental excision, and en-bloc removal of the uterine and ovarian structures. Histological analysis confirmed the mass as a high-grade utero-ovarian leiomyosarcoma. The patient received adjuvant chemotherapy and demonstrated a positive response in follow-up imaging at 6 months, with reduced mass size and no significant lymphadenopathy. Both aesthetic and morpho-functional outcomes were satisfactory. The report highlights the challenges of diagnosing and treating incidentalomas, emphasizing the need for individualized management. It discusses the rarity of primary ovarian leiomyosarcoma and the surgical approach used. The case ultimately emphasizes the importance of multidisciplinary clinical evaluations in ensuring comprehensive care for patients with unexpected radiological findings, such as utero-ovarian leiomyosarcoma.

Primary Ovarian Leiomyosarcoma Is a Very Rare Entity: A Narrative Review of the Literature

BACKGROUND

Primary ovarian leiomyosarcoma is a very rare malignancy characterized by unclear management and poor survival. We reviewed all the cases of primary ovarian leiomyosarcoma to identify prognostic factors and the best treatment.

METHODS

We collected and analyzed the articles published in the English literature regarding primary ovarian leiomyosarcoma from January 1951 to September 2022, using PubMed research. Clinical and pathological characteristics, different treatments and outcomes were analyzed.

RESULTS

113 cases of primary ovarian leiomyosarcoma were included. Most patients received surgical resection, associated with lymphadenectomy in 12.5% of cases. About 40% of patients received chemotherapy. Follow-up information was available for 100/113 (88.5%) patients. Stage and mitotic count were confirmed to affect survival, and lymphadenectomy and chemotherapy were associated with a better survival rate. A total of 43.4% of patients relapsed, and their mean disease-free survival was 12.5 months.

CONCLUSIONS

Primary ovarian leiomyosarcomas are more common in women in their 50s (mean age 53 years). Most of them are at an early stage at presentation. Advanced stage and mitotic count showed a detrimental effect on survival. Surgical excision associated with lymphadenectomy and chemotherapy are associated with increased survival. An international registry could help collect clear and reliable data to standardize the diagnosis and treatment.

Leiomyosarcoma arising from the ovarian vein as a gynecologic malignancy: Two case reports and a review of the literature

Leiomyosarcoma arising from the ovarian vein has rarely been reported. Herein, we report two cases from a single institute. Given their direct connections to ovarian vessels, both leiomyosarcomas were initially suspected to be gynecological malignancies. In one case, leiomyosarcoma was discovered incidentally without any clinical symptoms; it had a close connection with the ovarian vein, was removed surgically, and the patient has survived for over 12 years. In another case, bowel obstruction caused by the tumor helped to identify metastatic leiomyosarcoma. Blood flow was supplied by the ovarian artery and grew into the lumen of the ovarian vein without invading adjacent organs. After surgical resection, the patient underwent 18 months of chemotherapy prior to palliative care. We propose that leiomyosarcoma arising from the ovarian vein should be treated as a gynecologic malignancy, especially if it develops in the lower abdomen.

Recurrent primary ovarian leiomyosarcoma preconception, pregnancy, delivery, and puerperal management: A case report and literature review

A primary ovarian leiomyosarcoma (POLMS) is a rare malignant tumor of the ovary. Herein, we report a patient with an early-stage POLMS who underwent unilateral adnexectomy in our department with a subsequent pregnancy, delivery, and tumor recurrence. In this case, the patient was a 29-year-old female with a complaint of abdominal distention who underwent a right adnexectomy for a solid tumor in the right ovary. The pathological diagnosis was a stage IA leiomyosarcoma of the right ovary. One month later, a recurrence in the left ovary tumor was diagnosed. The patient did not agree to further treatment. She subsequently achieved a spontaneous pregnancy and had an uneventful pregnancy and delivery at term. During the puerperium, she underwent radical surgery and chemotherapy with the recommended follow-up evaluation. The literature review shows the pathogenesis of POLMS has not been established. There are no specific tumor markers, and it is difficult to distinguish the nature and origin of the tumor with imaging modalities, thus, early diagnosis is difficult. The malignancy rate is high, and the prognosis of advanced tumors is poor. To properly counsel patients to optimize treatment, more reports of cases, the disease course, treatments, and outcomes are needed.