|Year : 2014 | Volume
| Issue : 2 | Page : 206-208
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|
Department of Obstetrics and Gynecology, Yenepoya Medical College, Deralakatte, Mangalore - 575 018, Karnataka
Source of Support: None, Conflict of Interest: None
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  and 30-40% of uterine sarcomas. They grow quickly, will have early lymphatic and hematogenous spread, and overall prognosis is poor.  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. 
| 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.  Symptoms are usually of short duration and non-specific like vaginal bleeding, pelvic pain or pressure, and abdominopelvic mass , or recurrent lieomyomas,  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. 
Initial step in the treatment should be exploratory laparotomy. Total abdominal hysterectomy with bilateral salphingo-oophorectomy should be done.  Adjuvant radiotherapy decreases local recurrences. Adjuvant chemotherapy for metastatic lesions with ifosfomide, the combination of gemsitabin and docetaxel or Temolozomide has good response.  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. |
|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. |
|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. |
|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. |
|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. |
[Figure 1], [Figure 2], [Figure 3], [Figure 4]