Mædica - a Journal of Clinical Medicine

MAEDICA – a Journal of Clinical Medicine 2014; 9(3): 269-271

C ASE

REPORTS

A Rare Case of Uterine Myxoid Leiomyosarcoma: a Case Report Luminita Elena MITRACHEa; Vasile Adrian DUMITRUa; George SIMIONb; Monica CIRSTOIUa; Maria SAJINa a

Department of Pathology, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania b Department of Pathology, Emergency University Hospital, Bucharest, Romania

ABSTRACT We present the rare case of a 61-year-old female patient who was submitted in the hospital with metrorrhagia and pelvi-abdominal pain. Echographic examination revealed an heterogeneous uterine mass measuring 190/130/110 mm. Therefore, total hysterectomy with bilateral ooforectomy was performed. Grossly, the uterus presented a tumoral mass with areas of hemorrhage, necrosis and abundant mucoid degeneration. On light microscopic examination a malignant neoplastic proliferation with features of myxoid leiomyosarcoma was noted. In this paper, we presented this rare form of leiomyosarcoma with an emphasis on its particularities that have not been mentioned in the literature.

INTRODUCTION

M

yxoid leiomyosarcoma is a rare variant of uterine leiomyosarcoma characterized by bland cellularity, myxoid matrix and aggressive behavior (1). Leiomyosarcoma is the most common uterine sarcoma and accounts for 1% of uterine malignancies (2). Few cases of myxoid leiomyosarcoma were reported in the literature and the data was insufficient for conclusive epidemiological studies regarding the incidence and prevalence of this pathology. The preexisting leiomyomas does not represent a risk factor for this malignancy (3). The reported a five-year survival rate of 1535% with a more favorable prognosis for patients showing stage I tumors and for premenopausal females (4).

In this paper is presented a rare case of uterine myxoid leiomyosarcoma with its histological and immunohistochemical particularities.  CASE REPORT

A

61-year-old female patient accusing metrorrhage and pelviabdominal pain presented at the emergency room of the University Emergency Hospital in Bucharest. The patient was submitted in the Obstetrics-Gynecology department for further investigations. In anamnesis, the patient mentioned a cervix conization procedure which was performed at 45-year-old. Speculum examination reveals yellow fluid discharge. On vaginal palpation a long cervix is described and on bimanual examination the annexes are not palpable, but the uterus appears enlarged (200/150/100 mm)

Address for correspondence: Monica Cirstoiu, Emergency University Hospital, 169 Splaiul Independentei, 5th District, Bucharest, Romania. E-mail: [email protected] Article received on the 5th of August 2014. Article accepted on the 6th of September 2014.

Maedica

A Journal of Clinical Medicine, Volume 9 No.3 2014

269

A RARE CASE OF UTERINE MYXOID LEIOMYOSARCOMA: A CASE REPORT with tumoral transformation and a hard consistency. Serology blood tests revealed hypochromic microcytic anemia. A heterogeneous miometrium mass measuring 190/130/110 mm was seen on transvaginal echography. After the surgical evaluation, total hysterectomy with bilateral ooforectomy was performed in order to treat the uterine tumor. The surgical specimen is send to the Pathology Department of the hospital and was fixed in 10% buffered formalin for 24 hours. Following macroscopic examination, the tissue fragments were processed and embedded in paraffin. Afterwards, three-micron thick sections were stained with hematoxylin and eosin. Immunohistochemical study was made on unstained paraffin sections using an indirect tristadial Avidin-Biotin complex method. The

sections were deparaffinated in toluene, dehydrated in alcohol series, rehydrated and washed in phosphate buffered saline. Then, they were incubated with primary antibody overnight, washed with carbonate buffer and developed in 3,3’-diaminobenzidine hydrochloride/hydrogen peroxide nuclear counterstaining with Mayer’s Hematoxylin. The following markers were used: desmin, myogenin, SMA (smooth muscle actin), CK-19 (cytokeratin-19), Ki-67, CD10, protein S-100 and CD34. The immunoreactivity was evaluated as follow: diffuse positive (>75% positive cells), positive (25-75% positive cells), focal positive (

A rare case of uterine myxoid leiomyosarcoma: a case report.

We present the rare case of a 61-year-old female patient who was submitted in the hospital with metrorrhagia and pelvi-abdominal pain. Echographic exa...
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