Primary vaginal leiomyosarcoma: A case report with complete morphological, immunohistochemical and ultrastructural study

Primary vaginal sarcoma in a single center

Objectives

To investigate the clinical characteristics and prognosis of primary vaginal sarcoma.

Methods

A retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted.

Results

Fifteen patients were identified, among which 9 (60.0 %) patients had leiomyosarcoma, 2 (13.3 %) patients had Ewing's sarcoma, 2 (13.3 %) patients had rhabdomyosarcoma, 1 (6.7 %) patient had undifferentiated sarcoma, and 1 (6.7 %) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7 months (10.1-137.5 months). Thirteen patients (86.7 %) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6 %) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7 %) developed liver metastases, and the remaining 1 patient (1/13, 7.7 %) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9 %) patients relapsed within 2 years after diagnosis. Eight patients (8/11, 72.7 %) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0 % and 66.7 %, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1 % vs 66.7 %, P = 0.307).

Conclusions

Primary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.

Primary vaginal sarcoma in a single center

Objectives

To investigate the clinical characteristics and prognosis of primary vaginal sarcoma.

Methods

A retrospective analysis of patients with primary vaginal sarcoma treated at our center from 2000 to 2020 was conducted.

Results

Fifteen patients were identified, among which 9 (60.0 %) patients had leiomyosarcoma, 2 (13.3 %) patients had Ewing's sarcoma, 2 (13.3 %) patients had rhabdomyosarcoma, 1 (6.7 %) patient had undifferentiated sarcoma, and 1 (6.7 %) patient had malignant peripheral schwannoma. Nine patients presented with vaginal mass that was the most common primary symptoms. Eleven patients received their primary surgery, and 7 of them received postoperative adjuvant chemotherapy or radiation therapy. The remaining 4 patients received initial chemotherapy and/or radiotherapy because of advanced stage. The distribution by stage was as follows: stage I in 10 patients, stage II in 1 patient, stage III in 2 patients and stage IV in 2 patients. The median follow-up was 43.7 months (10.1-137.5 months). Thirteen patients (86.7 %) had disease extent during follow-up, and among them, 11 patients (11/13, 84.6 %) developed local relapse or adjacent organ metastases, 1 patient (1/13, 7.7 %) developed liver metastases, and the remaining 1 patient (1/13, 7.7 %) developed lung metastases and local relapse during follow-up. Ten (10/13, 76.9 %) patients relapsed within 2 years after diagnosis. Eight patients (8/11, 72.7 %) with local recurrence or adjacent organ metastases received a secondary surgery treatment, and only 2 of them relapsed again. Two-year overall survival (OS) and 5-year OS were 80.0 % and 66.7 %, respectively. Patients with leiomyosarcoma had a tendency toward a better 5-year OS than those with other sarcomas (74.1 % vs 66.7 %, P = 0.307).

Conclusions

Primary vaginal sarcomas are aggressive neoplasms with different presenting characteristics. Surgery is the main treatment for primary vaginal sarcoma and for local relapse vaginal sarcoma.

GnRH analogue followed by surgery in treatment of vaginal leiomyoma-a case report

RATIONALE

Vaginal leiomyoma is a rare type of leiomyoma that occurs on the wall of vagina. Treatment for vaginal leiomyoma is varied and is based on the location and size of the leiomyoma.

PATIENT CONCERNS

In this case, a 24-year-old newly married Chinese woman complained of dyspareunia. The physical examination revealed a solid mass on the anterior wall of vagina. It almost filled up the whole vagina cavity.

DIAGNOSIS

Transvaginal ultrasound showed a tumor on the anterior wall of vagina. Pelvic computed tomography (CT) and magnetic resonance imaging (MRI) also confirmed the tumor on vaginal wall. Fine needle aspiration biopsy confirmed fibrous and smooth muscle tissue in the tumor, and immunohistochemical examination found the estrogen receptor (ER) and progesterone receptor (PR) were positive.

INTERVENTIONS

6 courses of gonadotropin-releasing hormone (GnRH) analogue were given before the patient underwent complete surgical resection through vagina.

OUTCOME

No postoperative complications occurred, and the patient was discharged from the hospital 3 days after surgery. Follow-up after 3 months revealed negative symptoms of genitourinary system. No sign of recurrence was found.

CONCLUSION

In this case, vaginal leiomyoma was diagnosed with help of imagological examinations like ultrasound, CT, and MRI, as well as pathological examination like fine needle aspiration biopsy. Preoperative GnRH analogue treatment can ensure smooth surgical procedure, and reduce blood loss during surgery.