Abdominal Leiomyosarcomatosis After Laparoscopic Removal of Uterine Stump
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CASE REPORT
Abdominal Leiomyosarcomatosis After Laparoscopic Removal of Uterine Stump S. Devaji Rao 1 Received: 25 July 2020 / Accepted: 30 October 2020 # Association of Surgeons of India 2020
Abstract Majority of uterine smooth muscle tumors (SMTs) are benign leiomyomas, and some are malignant leiomyosarcomas, with distinct histological features. When the features are not able to conclude about the malignant nature, they are called as stromal tumors of uncertain malignant potential (STUMP). Few such tumors are reported in the literature, with scarce information. They are known to recur and metastasize after excision with uncertain predictability. I present here a case of recurrence of a uterine STUMP transforming into multiple intraabdominal leiomyosarcomas. Keywords STUMP . Recurrence . Widespread . Intraabdominal . Leiomyosarcoma
Case Report A middle-aged healthy lady presented with a mobile painless lump in the right lower part of the abdominal wall of 6 months duration, without any other symptom. On examination, a mobile nontender ovoid lump of about 6 × 3 × 2 cm was felt in the right lower anterior abdominal wall in the muscular plane, close to a scar of laparoscopic myomectomy without morcellation done 6 years ago (from the records provided), reported as STUMP by one pathologist and benign leiomyoma by another. She remained asymptomatic for about 6 years. Now, CT of the whole abdomen showed multiple homogenously enhancing well-defined isodense peritoneal and pelvic soft tissue nodules of varying sizes in the abdomen, suggesting disseminated leiomyomatosis. Wide excision was done for the lump in the right lower abdomen (Fig. 1) which was reported as a STUMP of aggressive behavior, with clear tumor free margins. Immunohistochemistry showed ER, PR, and VEGFR positivity. She refused any further treatment, and during follow-up about a year after excisional surgery, she identified a 3-cm lump close to previous surgery scar. She developed severe intestinal colic, and the CT abdomen showed increase in the number of intraabdominal swellings,
* S. Devaji Rao [email protected] 1
Dhanwanthri Surgical Clinic and St. Isabel’s Hospital, 15, Vinayagam Street, Somu Colony, Chennai 600028, India
which made her opt for a laparotomy. During laparotomy, many lumps were seen and with one adherent and kinking the transverse colon. Excision of all tumors with total hysterectomy with bilateral salpingo-oophorectomy was performed (Fig. 2). None of the intraabdominal lymph nodes were enlarged. She had an uneventful postoperative recovery. The histopathology of these tumors revealed STUMP in one and leiomyosarcoma in other tumors in the uterus. The tumor masses on all other sites showed well-demarcated pseudo encapsulation with closely packed, spindle-shaped cells arranged in wavy bundles, interlacing patterns of storiform pattern around capillaries. The nuclei were large, mildly pleomorphic with mild hyperchomatism and increased mitosis (3– 6/10 HPF). The tumor was infiltrating the fibrofatty tissue in the periphery with a
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