Primary Broad Ligament Leiomyosarcoma: a Rare Case Report with Review of Literature
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CASE REPORT
Primary Broad Ligament Leiomyosarcoma: a Rare Case Report with Review of Literature Sumit Kumar 1 & Prashanth Giridhar 2 & Shalini Verma 1 & Ravi Hari Phulware 3 & Neena Malhotra 4 & Ritesh Kumar 1 Received: 3 November 2019 / Accepted: 6 February 2020 # Indian Association of Surgical Oncology 2020
Introduction Leiomyosarcoma (LMS) constitutes approximately 10% of all soft tissue sarcoma [1]. In the gynecological tract, LMS most commonly occurs in the uterus [2]. Broad ligament LMS is very rare with less than 30 cases reported in English literature. Gardner et al. proposed the definition of tumor of broad ligament as “Tumors occurring on or in the broad ligament and completely separated from and in no way connected with either the uterus or the ovary” [3]. LMS has a varied prognosis but in general is aggressive with 5-year survival of 25–76% [4]. We hereby report a rare case of this malignant tumor in a premenopausal female.
Case Report A 40-year old premenopausal female with 2 living children presented with symptoms of dull abdominal pain and abdominal distension of 7 months duration. There was no significant gynecological or past medical history. There were no complaints of menorrhagia, metrorrhagia, or dysmenorrhoea. General physical examination revealed a vague ill-defined, non-tender lump palpable in the left side of the lower abdomen. All her hematological and biochemical parameters were
within normal limits. An ultrasound examination of the abdomen and pelvis showed a heterogeneous hypoechoic mass 11.59*8.77*8.03 cm in the left adnexa and pouch of Douglas. The uterus was normoechoic with normal thickness of endometrium and displayed anteriorly. MRI pelvis revealed an abdomino-pelvic mass with lobulated margins and prominent central necrosis/cystic areas (20*15 cm) arising from the left adnexa and extending upwards into the abdominal cavity (Fig. 1). The serum CA-125, CEA, CA19.9, and LDH were within normal limits. She underwent exploratory laparotomy. Intraoperatively, there was a 20*20 cm multilobulated mass arising from the left broad ligament. The mass was separate from the uterus and left ovary. Bilateral ovaries, fallopian tubes, uterus, and urinary bladder were normal. She underwent left broad ligament mass excision, total abdominal hysterectomy (TAH), bilateral salpingo-oophorectomy (BSO), and peritoneal wash cytology. The cut section of the mass showed areas of hemorrhage and whirling. The cut surface of the uterus and both ovaries were unremarkable. Microscopic examination of the mass showed a malignant spindle cell tumor with nuclear and cellular pleomorphism along with the areas of coagulative necrosis. The tumor cells had pleomorphic, vesicular coarse chromatin with conspicuous nucleoli. Mitosis was brisk at about 12–15/10 HPFs. There were interspersed areas of necrosis (Fig. 2). Sections
* Ritesh Kumar [email protected] Sumit Kumar [email protected]
Neena Malhotra [email protected] 1
Department of Radiation Oncology, All India Institute of Medical Sciences, New D
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