Leiomyosarcoma of the vulva: a case report

Chemo-surgical approach in vulvar leiomyosarcoma: A case report

INTRODUCTION

Primary sarcoma of the vulva is an extremely rare entity, representing only 1%-3% of all vulvar malignant neoplasms. Among sarcomas, leiomyosarcoma (LMS) is the most prevalent histologic variant. Due to the rarity of LMS, guidelines are lacking and phase III trials have not been carried out, so clinical management is based on local clinical practice and physician experience.

CASE PRESENTATION

Here, we described a case of primary LMS of the vulva and its successful management, with the adoption of neoadjuvant chemotherapy and surgery. We report a case of a 74-year-old woman with 12.5 cm vulvar LMS. The patient received three cycles of neoadjuvant chemotherapy with a partial response. Radical vulvectomy with vulvar reconstruction with V-F flap was carried out. Surgical margins were negative. Three additional cycles of adjuvant chemotherapy were delivered.

RESULTS

One year after treatment, the patient was disease-free.

CONCLUSION

There are no approved therapeutic protocols for this rare neoplasia. Surgery is the mainstay of treatment. However, it is not always feasible, so neoadjuvant chemotherapy was delivered for downstaging the vulvar lesion. We suppose that neoadjuvant chemotherapy has optimized the possibilities of radical surgery. Despite the anectodical nature of this case presentation, neoadjuvant chemotherapy seems a valid therapeutic option for managing patients with bulky vulvar sarcoma. Further large collaborative studies are warranted to identify the best therapeutic option for these patients.

Epithelioid leiomyosarcoma of the vulva: report of a rare case and literature review

Leiomyosarcoma of the vulva is a rare soft tissue sarcoma that accounts for approximately 1% of all primary vulvar neoplasms, but it is the most common type of vulvar sarcoma. It usually originates from the smooth muscle within erectile tissue or blood vessel walls, the round ligament, the dartos muscle or the arrector pili muscle. No treatment algorithms have been established to date. Surgical resection is preferred for vulvar leiomyosarcoma. Currently, the recommended surgical method is extensive local resection with a safe surgical margin of at least 2 cm. The use of chemoradiotherapy for vulvar sarcoma remains controversial. This case report describes a 39-year-old female that underwent resection of a vulvar mass in January 2019. Postoperative pathological examination indicated that it was an epithelioid leiomyosarcoma. She presented with tumour recurrence after 43 days. Based on the diagnosis, radical right vulvectomy with a tumour margin of 2 cm was performed. The tumour margin was negative. The patient refused to undergo auxiliary radiotherapy and chemotherapy. The follow-up findings do not indicate any signs of recurrence. In order to avoid recurrence, vulvar epithelioid leiomyosarcomas should be completely resected with a margin of 2 cm at the time of first occurrence.