What is it about?
Uterine leiomyosarcomas are very rare and highly aggressive tumors that have a high rate of recurrence and poor prognosis, even when early diagnosed. Due to their relative rarity, there is limited research on optimal management strategies.
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Why is it important?
Differentiating leiomyosarcoma from leiomyoma is challenging and few tools other than microscopic evaluation are available. Vaginal compromise in leiomyosarcoma usually results from tumor extension, not hematogenous metastasis. A vaginal metastasis is a very rare initial presentation. We have found only two cases like this described on published literature. The atypical clinical and histological presentation in our case complicated diagnosis and delayed treatment. An early diagnosis and complete surgical clearance gives the best chance of survival, and imaging tools should be applied early in instances of new suspicious malignant lesions.
Perspectives
We believe that this case is relevant because of its extremely rare presentation and its unique histopathological staining. As previously stated, this staining is most probably associated to non-coding RNAs posttranscriptionally regulating gene expression in leiomyosarcomas and endometrial stromal sarcomas. Imaging for diagnosis and staging, and a second biopsy were key to reaching an initial diagnostic approach in our case. The final pathology report indicated an hematogenous spread of a uterine leiomyosarcoma, which had changed its immunophenotype through metastasis. When faced with new suspicious malignant vaginal lesions, diagnostic techniques should not be delayed. Although unlikely, metastasis of an aggressive, fast growing tumor with a poor prognosis, like a leiomyosarcoma, is possible.
Professor Jesus S. Jimenez-Lopez
Hospital Universitario 12 de Octubre
Read the Original
This page is a summary of: Vaginal metastasis as the initial presentation of leiomyosarcoma: a case report, BMC Cancer, July 2017, Springer Science + Business Media,
DOI: 10.1186/s12885-017-3484-1.
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