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| CASE REPORT |
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| Year : 2014 | Volume
: 2
| Issue : 2 | Page : 206-208 |
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Case of recurrent cervical polyp-unusual presentation of leiomyosarcoma
Archana Vikram1, S Ajith2, Rajagopal1, S Vikram3
1 Departments of Obstetrics and Gynecology, Yenepoya Medical College, Mangalore, Karnataka, India
2 Departments of Obstetrics and Gynecology, ACME Pariyaram, Kerala, India
3 Department of Anatomy, Yenepoya Medical College, Mangalore, Karnataka, India
| Date of Web Publication | 11-Nov-2014 |
Correspondence Address:
Archana Vikram
Department of Obstetrics and Gynecology, Yenepoya Medical College, Deralakatte, Mangalore - 575 018, Karnataka
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/2321-4848.144340
Leiomyosarcomas are relatively rare tumors of mesodermal origin. These tumors constitute 2-6% of uterine malignancies. Lieomyosarcoma is common in age group of 43-53 yrs; only 15% is usually seen in younger than 40 yrs. Symptoms are usually non-specific include vaginal bleeding, pelvic pain or pressure, and an abdominopelvic mass. Here, we describe a rare case of recurrent cervical polyp in a 32-year-old parous woman.
Keywords: Lieomyosarcoma, mitotic figures, polyp, tumor
How to cite this article:
Vikram A, Ajith S, Rajagopal, Vikram S. Case of recurrent cervical polyp-unusual presentation of leiomyosarcoma
. Arch Med Health Sci 2014;2:206-8 |
| Introduction | |  |
Leiomyosarcomas are relatively rare tumors of mesodermal origin. These tumors constitute 2-6% of uterine malignancies [1] and 30-40% of uterine sarcomas. They grow quickly, will have early lymphatic and hematogenous spread, and overall prognosis is poor. [2] As these are rare tumors, very few risk factors are identified, which includes excess estrogen exposure for long time, use of tamoxifen, previous pelvic irradiation, and African-American race. In 1993, GOG (Gynecology Oncology Group) evaluated 447 cases of uterine sarcomas and found the incidence of leiomyosarcoma was only 16% among them. [3]
| Case Report | | |
A 32-year-old parous woman presented with foul-smelling vaginal discharge and intermenstrual bleeding for 3 months. Speculum examination showed an endocervical polyp measuring 5 × 4 cm [Figure 1], which was sent for histopathological examination. After 20 days, she came with same complaints and again found a polyp.
Histopathology of first specimen showed mitotically active smooth muscle tumor with surface ulceration i.e. mitosis in the range of 8-9/10 HPF and of second specimen was grade II-leiomyosarcoma. After the report, patient was called back for laparotomy. Intra-operative finding was normal-sized uterus with healthy tubes and ovaries. Total abdominal hysterectomy with bilateral salphingo-oophorectomy was done. Post-op period was uneventful. Gross specimen-uterus with cervix measured 8 × 5 cm. Cut section - endometrium appeared thickened, cervix showed nodular mass 2 × 1 cm invading underlying tissue [Figure 2]. Histopathology showed cells arranged in sheets and whorls with eosinophilic cytoplasm and nuclear pleomorphism. Mitotic figures at rate of 10/HPF i.e. grade II leiomyosarcoma [Figure 3] and [Figure 4], involving upper part of cervix and isthmus and extending laterally upto 3 mm clearance from parametrium. Hence, patient was referred to radiotherapy where patient received pelvic radiation of 4500 cGy of radiation for 23 fractions. Patient is on regular follow up since 2 years without any recurrence or metastasis.
| Discussion | | |
Lieomyosarcoma is common in age group of 43-53 yrs; only 15% is seen in younger than 40 yrs, and pre-menopausal patient have better chance of survival. [3] Symptoms are usually of short duration and non-specific like vaginal bleeding, pelvic pain or pressure, and abdominopelvic mass [1],[4] or recurrent lieomyomas, [5] but our patient presented with recurrent cervical polyp. Majority of the cases are in stage I (60%) at the time of diagnosis. Remainder will be stage II (10%), stage III (10%), and stage IV (20%). The diagnosis of leiomyosarcoma by histopathological criteria is controversial. But, the criteria includes the frequency of mitotic figures, presence of coagulative necrosis, and the extent of nuclear atypia. [3]
Initial step in the treatment should be exploratory laparotomy. Total abdominal hysterectomy with bilateral salphingo-oophorectomy should be done. [1] Adjuvant radiotherapy decreases local recurrences. Adjuvant chemotherapy for metastatic lesions with ifosfomide, the combination of gemsitabin and docetaxel or Temolozomide has good response. [5] In recurrences, surgery must be individualized.
| Acknowledgement | | |
Special thanks to Dr. Rajalakshmi. T.N. Prof and HOD, Department of OBG, Pariyaram medical college, Kerala, for guiding me all throughout.
| References | | |
| 1. | Lurain JR. Uterine sarcoma. In: Berek and Novak's gynaecology. 15 th ed. New Delhi: Wolters Kluwer Pvt. Ltd.; 2011. p. 1382-9. 
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| 2. | Schorge OS, Schaffer JI, Halvorson LM, Hoffman BL, Bradshaw KD, Cunningham FG. Uterine sarcoma. In: Williams Gynecology. New York: McGraw Hill Publications; 2008. p. 706-15.
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| 3. | Vellanki VS, Rao M, Sunkavalli CB, Chinamotu RN, Kaja S. A rare case of uterine leiomyosarcoma: A case report. J Med Case Rep 2010;4:222.
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| 4. | Carta G, Palermo P, Di Ranio R, De Lellis V, Carta A, Patacchiola F. Leiomyosarcoma after hyteroscopic myomectomy. Eur J Gynecol Oncol 2012;33:656-7.
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| 5. | Riddfi C, Pasini G, Drudi F, Barzotti E, Santelmo C, Polselli A, et al. Long lasting response to chemotherapy for advanced uterine Leiomyosarcoma: A case report. J Med Case Rep 2013;7:29.
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[Figure 1], [Figure 2], [Figure 3], [Figure 4]
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