Primary leiomyosarcoma of the vagina. A case report and literature review

Thinking Twice about the Cervical Mass: A Case Report of Primary Vaginal Leiomyosarcoma and Review of the Literature

Primary vaginal leiomyosarcoma (LMS) is an unusual cause of aggressive gynecologic cancer which requires prompt surgical treatment for favorable outcomes. Definitive diagnosis and treatment render unique challenges to clinicians based on vague presentation and limited evidence for management. Here, we describe a case of vaginal LMS in a middle-aged woman with a history of cervical dysplasia found to have a proximal vaginal mass after presenting with vaginal discharge and cramping pain. The patient was diagnosed on pathologic surgical specimen and subsequently underwent definitive surgical treatment. She remains with no evidence of disease 20 months later. In our report, we emphasize the nuances of surgical management including localized source control in those desiring future fertility. Ultimately, we make recommendations for surgical treatment and surveillance based on the available published literature.

A giant primary vaginal sarcoma: A report case and literature review

Primary vaginal sarcoma is a rare disease entity, reported in less than 3% of cases of vaginal cancers. We report the observation of a patient treated at the regional oncology center of Oujda in Morocco who is presented with a non-metastatic primary vaginal leiomyosarcoma of 20 cm. The treatment consisted of neoadjuvant chemotherapy, followed by hemostatic surgery with tumor resection limits, reinforced by radiotherapy and then a surgical resection with a tumor resection taking away the infiltrated part of the anterior face of the lower rectum and the realization of a left iliac colostomy whose resected tumor part limits were healthy. At present, the patient is 4 years of follow-up without locoregional or distant recurrence.

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.

Vulvar Leiomyosarcoma Masquerading as a Bartholin’s Gland Cyst in an Adolescent

Sarcomas, tumors of mesenchymal origin, comprise a small percentage of all malignant tumors and are often challenging to diagnose. Leiomyosarcoma (LMS) is a rare form of cancer arising from smooth muscle cells. While a soft tissue sarcoma diagnosis is rare in and of itself, LMS diagnosis at an adolescent age is even more unique. Vulvar LMS can easily be misdiagnosed as a benign vaginal lesion, leading to a delay in proper treatment and poorer outcomes. In this case, we present a 14-year-old female who was diagnosed with a grade 2 vulvar LMS that clinically mimicked a Bartholin’s gland cyst.

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.

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

OBJECTIVE

Primary vaginal leiomyosarcomas (LMS) are rare, easily recurrent tumours with an unknown etiology; the prognosis is poor and there is no consensus guideline on their management.

CASE REPORT

A nodular, 25 × 23 x 28 mm-mass, infiltrating the urethra, was found in a 58-year-old woman. A biopsy showed a LMS of the vagina that was positive for vimentin, alpha-smooth muscle actin, caldesmon, desmin, p16 and p53. An anterior pelvic exenteration was performed. The sample was fixed and prepared for light microscopy, transmission and scanning electron microscopy, confirming the diagnosis of LMS.

CONCLUSIONS

Best outcomes occur when the tumour is small, localized, and can be removed surgically with wide, clear margins, as in this case. As there are different kinds of malignant mesenchymal tumours, biopsy followed by immunohistochemistry and electron microscopy still represents a good diagnostic choice and surgical resection is generally the gold standard in these cases.

Successful robotic surgery for primary resection of a vaginal leiomyosarcoma: A case report

Primary vaginal leiomyosarcoma (LMS) is a rare entity with limited data on optimal treatment approach. Most previously reported cases utilize an open or transvaginal surgical approach for primary tumor resection. Minimally invasive surgery is an important tool in complex pelvic surgery and the limits of its utility continue to expand. Here, we report a rare case of an 11.7 cm primary vaginal LMS in a 45-year-old female that was successfully resected with a robotic approach. Our case demonstrates an innovative use of the robot and the feasibility and efficacy of this approach for primary resection of large vaginal tumors.

Sonovaginography: A Useful Technique in the Assessment of the Lower Genital Tract

Conventional sonographic evaluation of the cervix and vagina is compromised by inattention, poor subject contrast, and obscuring artifacts. We describe a technique involving distention of the vaginal canal and fornices with ultrasound gel, providing an acoustic window for improved definition of the cervix and vagina. This exam is usually performed in concert with transvaginal sonography, but a transabdominal or transperineal approach may be more useful in selected scenarios. A wide variety of formerly sonographically inconspicuous conditions are demonstrable with this technique, many of which were undetected or inadequately characterized on the physical exam. Cervical polyps were the most commonly seen abnormality.

Unusual indolent behavior of leiomyosarcoma of the vagina: Is observation a viable option?

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Primary leiomyosarcoma of the vagina is a rare disease.

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We identified a case of unanticipated indolent behavior of vaginal leiomyosarcoma.

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Observation or hormonal therapy may be viable option for select patients.

Leiomyosarcoma of the Vagina: An Exceedingly Rare Diagnosis

Background. Primary leiomyosarcoma of the vagina is an exceedingly rare diagnosis. Current estimates are that this tumor could at most represent a mere 0.062% of malignant neoplasms in the female genital tract, although in actuality it is likely far less common. Case Presentation. A 70-year-old female gravida 3 para 2 with new onset palpable vaginal mass and pink vaginal discharge is diagnosed with primary leiomyosarcoma of the vagina. Chemotherapy is complicated by acute Lyme disease, and the patient requires a robotic-assisted total hysterectomy with bilateral salpingo-oophorectomy and partial vaginectomy. The patient remains without recurrence 18 months after surgery. Conclusion. Vaginal leiomyosarcoma is exceedingly rare with an aggressive course, high recurrence, and undetermined ideal treatment regimen. Its diagnosis can be delayed and its presentation varied. Information on this rare tumor type is predominantly through rare case reports with collective consensus on management lacking. The gynecologic oncologist must exercise prudence in individualizing treatment regimens for this rare yet aggressive malignancy.

A large primary retroperitoneal vaginal leiomyosarcoma: a case report

INTRODUCTION

Primary vaginal leiomyosarcomas are uncommon, especially those growing outside the vagina.Out of all malignant vaginal neoplasms, leiomyosarcomas account for about 2%. Reports in the literature mostly concern the pathology of these tumors; few reports have been published that discuss how to surgically remove them.

CASE PRESENTATION

A 69-year-old Chinese woman presented with a mass in her buttocks that had been present for more than four months. Computed tomography demonstrated a mass of approximately 12.0×9.5×8.0cm in her retroperitoneal space. We resected the tumor via a posterior incision, and resected part of her sacrum and coccyx. The resected tumor was diagnosed by its pathological features as a leiomyosarcoma. Our patient received adjuvant chemotherapy after surgery. She was free of disease at a one-year follow-up and her general condition is good.

CONCLUSIONS

We report a rare case of a primary vaginal leiomyosarcoma that was resected through an approach that has not, to the best of our knowledge, been previously reported. This case report adds valuable knowledge to the sparse available literature on the surgical treatment of vaginal leiomyosarcomas.

Leiomyosarcoma of the vagina: A rare entity with comprehensive review of the literature

Primary malignant lesions of the vagina are uncommon, and vaginal sarcomas are even rarer. We describe a rare case of stage I, high-grade leiomyosarcoma of the vagina treated with combined modality treatment. A 39-year-old female presented with vaginal mass and underwent resection. Histopathological examination revealed atypical leiomyoma of the vagina with definite risk of recurrence. Eleven months later, she presented with a recurrent vaginal mass and underwent exploratory laparotomy with total abdominal hysterectomy and bilateral salpingo-oophorectomy plus resection of recurrent tumor and partial vaginectomy. The detailed histopathological examination was suggestive of leiomyosarcoma of the vagina. The patient received adjuvant radiotherapy and chemotherapy. The patient is alive and disease-free 29 months postsurgery. Experience with vaginal leiomyosarcomas is limited. The optimal treatment methods have not yet been established because of the rarity of the tumor. We add another case of leiomyosarcoma of the vagina to the limited existing literature.

Leiomyosarcoma of the vagina: MR findings

We report the magnetic resonance imaging findings of a case of vaginal leiomyosarcoma. The lesion was demonstrated as a well-defined heterogeneously hyperintense mass within the vagina on T2-weighted images and was demonstrated as a hypointense mass on T1-weighted images. The mass showed irregular enhancement on fat-suppressed T1-weighted images after administration of gadopentate dimeglumine. On pathological specimen, the nonenhancing foci of the mass were seen as the necrotic portion of the lesion.

Smooth Muscle Tumors of the Female Genital Tract

Smooth muscle tumors are the most common among mesenchymal tumors in the female genital tract. The vast majority of these neoplasms are clinically benign and easy to diagnose. In contrast, leiomyosarcomas are highly aggressive tumors that may pose considerable diagnostic problems when they display unusual (myxoid or epithelioid) morphology, ambiguous histologic features for malignancy, or an unusual anatomic distribution. Diagnostic criteria for these problematic tumors vary depending on the site and type of histologic differentiation, and are based on a combination of 3 major criteria: (1) moderate to severe cytologic atypia; (2) increased mitotic index; and (3) tumor cell necrosis. Certain benign smooth muscle proliferations may show worrisome histologic features or unusual growth patterns, causing concern for leiomyosarcoma. Furthermore, other tumors, including perivascular epithelioid tumors, may mimic leiomyosarcoma. Careful attention to the clinical and anatomic setting, cytologic and architectural features, and immunohistochemical characteristics are helpful in distinguishing these entities. This article discusses conventional smooth muscle tumors as well as unusual subtypes, with emphasis on the diagnostic criteria and problems in differential diagnosis that arise at each site within the female genital tract.

Combined laparoscopic and radical vaginal treatment of primary vaginal leiomyosarcoma in a patient with unicornuate uterus and pelvic kidney

We report a case of primary vaginal leiomyosarcoma occurring in a patient with a unicornuate uterus and pelvic kidney. The patient was treated with radical partial vaginectomy, unilateral groin dissection, total laparoscopic hysterectomy, and left pelvic laparoscopic lymphadenectomy, followed by adjuvant chemotherapy. Twenty-five months after her original procedure, the patient is alive and free of disease. The exact association between müllerian anomalies and primary malignancies of the genitourinary tract is unclear. It is nonetheless important to be aware of the close embryonic association between the genital and urinary tracts when evaluating such patients and choosing the appropriate surgical and therapeutic approach.

Thoracotomy for the management of recurrent vaginal leiomyosarcoma

Vaginal leiomyosarcoma is a rare malignancy for which little data exists to guide treatment decisions. We describe a patient diagnosed with primary vaginal leiomyosarcoma who underwent hysterectomy and upper vaginectomy followed by whole pelvic radiation. Approximately 3 months after her initial treatment, she presented with an isolated pulmonary recurrence, which resolved after 12 cycles of chemotherapy. Nineteen months later, a second recurrence was found at the same site. This metastasis was resected and she has remained without evidence of further disease for more than 24 months. Similar to patients diagnosed with uterine sarcomas, resection of pulmonary metastases may offer women with recurrent vaginal leiomyosarcoma improved survival with good quality of life. Thoracotomy should be considered for women diagnosed with pulmonary recurrences of this disease.

Primary spindle cell sarcoma of the vagina treated with neoadjuvant radiation and pelvic exenteration

OBJECTIVE

Malignant neoplasms of the vagina are rare gynecologic tumors. Primary vaginal sarcomas are even more unusual lesions, representing fewer than 2% of malignant vaginal lesions.

CASE

We present a case of a primary vaginal spindle cell sarcoma, treated with neoadjuvant radiation followed by total pelvic exenteration. The patient remains without evidence of disease 2 years after surgery.

CONCLUSIONS

The mainstay of treatment of vaginal sarcomas is surgical. Neoadjuvant radiation treatment may decrease surgical morbidity and lead to long-term cure.

Leiomyosarcoma of the vagina: case report and literature review

Leiomyosarcoma of the vagina is quite rare. Extensive search of the literature discloses 137 case reports published over the past 40 years. Collectively, these reports give only cursory guidelines for diagnosis, management, and prognosis. We add another case to the sparse literature on leiomyosarcoma of the vagina. Treatment consisted of surgical excision. Tumor was found to extend to the margin of the excised specimen. The malignancy quickly recurred with lung metastases and the patient died. The very poor prognosis associated with this lesion emphasizes the critical need for early diagnosis and expeditious therapy. In the interest of improving salvage by prompt recognition and intervention, it is important for health-care professionals to be knowledgeable about and alert to this condition.

Extragastrointestinal stromal tumors presenting as vulvovaginal/rectovaginal septal masses: a diagnostic pitfall

Gastrointestinal stromal tumor (GIST) are the most common mesenchymal tumors of the gastrointestinal (GI) tract. Most GISTs arise in the stomach and small bowel, whereas a small number occur elsewhere in the GI tract. Rare cases are identified outside the GI tract and are collectively known as extragastrointestinal stromal tumors (EGISTs). Because of their malignant potential and recent advances in the management of GISTs with imatinib mesylate (Gleevec, Glivec), it is imperative that these tumors are correctly diagnosed. In this study, we reviewed the clinical and pathologic characteristics of 3 cases of EGIST presenting as vulvovaginal/rectovaginal septal masses that were originally misdiagnosed, presumably due to their unusual anatomic locations. The original diagnoses were leiomyoma in one case and leiomyosarcoma in 2 cases. The lesions were localized to the rectovaginal septum () or vagina () and ranged from 4 to 8 cm in diameter. All 3 lesions had a spindle cell morphology that mimicked a smooth muscle tumor. Mitotic figures numbered from 12/50 to 16/50 high power fields (HPFs; median 15). Immunohistochemistry revealed that all 3 cases were strongly positive for KIT (CD117) and CD34 and negative for smooth muscle actin, desmin, pan-cytokeratin, and estrogen receptor. KIT sequence analysis revealed oncogenic mutations in all 3 cases. The first tumor recurred at 2 years and the second tumor recurred at 10 years; the third case is too recent for meaningful follow-up. EGISTs that present as gynecologic masses are rare but may be more common than is currently recognized. Misdiagnosis may lead to inappropriate therapy because conventional chemotherapy and radiotherapy are not effective in the treatment of GISTs, whereas imatinib mesylate (Gleevec, Glivec) has a proven role in managing these tumors. Thus, it is imperative to consider EGISTs in the differential diagnosis of mesenchymal neoplasms in the vulvovaginal/rectovaginal septum.

Primary leiomyosarcoma of the vagina: a case report involving a TVT allograft

INTRODUCTION

Primary malignant lesions of the vagina represent less than 2% of all gynecologic malignancies. Primary vaginal sarcomas account for about 2% of all malignant vaginal lesions, with leiomyosarcoma being the most common vaginal sarcoma found in adult women.

CASE

We report a case of primary vaginal leiomyosarcoma occurring in the field of a prior tension-free vaginal tape (TVT) procedure using a Bard Duraderm allograft.

CONCLUSION

This report represents the first report, to our knowledge, of a vaginal sarcoma arising in the field of a Bard Duraderm TVT allograft. Although the product is no longer available for this use, the ongoing studies of the TVT procedure and outcomes should include this potential complication in their review.

Primary vaginal leiomyosarcoma in pregnancy☆

BACKGROUND

Primary vaginal sarcoma constitutes about 2% of all malignant vaginal lesions, with leiomyosarcoma being the most common in adult women. To our knowledge, this is the first case of vaginal leiomyosarcoma occurring during pregnancy.

CASE

A 21-year-old woman, at 39 weeks of gestation, presented with a pedunculated vaginal mass. Local excision of the mass was performed immediately. Histopathologic evaluation revealed a grade 2 leiomyosarcoma. The patient delivered a healthy infant 2 weeks after resection. She has had no evidence of recurrence in 28 months of follow-up.

CONCLUSION

Previous cases of vaginal leiomyosarcoma and sarcomas of the female genital tract occurring during pregnancy are reviewed. The histopathologic criteria for vaginal smooth muscle tumors are well established. Primary management of vaginal leiomyosarcoma is surgical.

[Vaginal leiomyosarcoma. Apropos of 2 cases and review of the literature]

The leiomyosarcoma of the vagina is extremely rare. This paper reports two observations treated at the Ibn Rochd oncology center of Casablanca. The first patient was 32 years old, and presented a tumor of 15 cm to the detriment of the posterior wall of the vagina. The treatment consisted of a large exeresis of the tumor followed by postoperative radiotherapy. After 50 months, she is still alive. The second patient who was 42 years old, had a 10 cm tumor of the posterior wall of the vagina. A tumorectomy was realized and then the patient was not heard of. The evolution was marked by the appearance of pulmonary metastasis and a palliative chemotherapy was prescribed. This patient is deceased after 31 months. Seventy-five cases only are described in the literature. The surgery is the basic treatment whereas radiotherapy is still discussed. The prognosis of these tumors remains linked especially to the histological rank.

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.