A rare case of leiomyosarcoma of cervix and challenges in its management: a case report and brief review of literature
Keywords:Leiomyosarcoma, Retrograde approach, Retrograde hysterectomy
Leiomyosarcoma of cervix is an aggressive and rare tumour of the cervix with poor prognosis. Management plan differs greatly from other common cervical malignancies. A 38 year old multiparous lady presented with a large circumferential cervical tumour which was diagnosed as leiomyosarcoma of cervix on cervical biopsy. It was a surgical challenge. Patient underwent pre-operative ureteric stenting followed by exploratory laparotomy with hysterectomy with bilateral salphingo-oophorectomy. Surgical difficulties were encountered due to deep impaction of tumour in pelvis and altered anatomy due to the bulk of tumour. Retrograde approach was taken and pouch of Douglas was opened before clamping the mackenrodts and the uterus was bisected and debulking of tumour done simultaneously to facilitate the surgery. Post operatively patient received chemotherapy (Vincristine, adriamycin and
cyclophosphamide) followed by radiotherapy. Patient developed vesicovaginal fistula and liver metastasis nine months post- surgery. She received second line of chemotherapy (gemcitabine and docetaxel) after which she was lost to follow up.
Fadare O. Uncommon sarcomas of uterine cervix: a review of selected entities. Diagn Pathol. 2006;1:30.
Larson, Silfversward C, Nilsson B, Pettersson F. Prognostic factors in uterine leiomyosarcoma: a clinical and histopathological study of 143 cases. Acta Oncol. 1990;29:185-91.
Giuntolli RL, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, et al. Retrospective review of 208 patients with leiomyosarcoma of uterus: prognostic indicators, surgical management and adjuvant therapy. Gynaecol Oncol. 2003;89:460-9.
Grover S, Abraham M, Mahajan MK. Leiomyosarcoma of cervix. J Obstet Gynaecol India. 2009;59:364-6.
Dhull AK, Adarsh C, Kaushal V, Marwah N. The uncovered story of leiomyosarcoma of the cervix: a rare case report and review of literature. BMJ Case Rep. 2013. Mar;2013. pii: bcr2013008616.
Abell MR, Ramirez JA. Sarcomas and carcinosarcomas of uterine cervix. Cancer. 1973;31:1176-92.
Toyoshima M, Okamura C, Niikura H, Ito K, Yaegashi N. Epithelioid leiomyosarcoma of the uterine cervix: a case report and review of literature. Gynaecol Oncol. 2005;97:957-60.
Irwin W, Presley A, Anderson W, Taylor P, Rice L. Leiomyosarcoma of cervix. Gynaecol Oncol. 2003;91:636-42.
Masbah O, Mellas N, Bekkouch I, Mellas S, Ismaili N, Kamouni M, et al. Epithelioid leiomyosarcoma of uterine cervix: a case report and review of literature. J Afr Cancer. 2012;4:53-6.
Reed N. A review of treatment of uterine leiomyosarcomas. Curr Oncol Rep. 2013;15:581.
Hensley ML, Wathen JK, Maki RG, Araujo DM, Sutton G, Priebat DA, et al. Adjuvant therapy for high-grade, uterus-limited leiomyosarcoma: results of a phase 2 trial (SARC 005). Cancer. 2013;119:1555-61.