Leiomyosarcoma In A Young Adult

摘要

A 35 years old woman of infertility with multiple myomas underwent myomectomy with tubal reconstructive surgery . There was difficulty in enucleating one of the myoma which was diagnosed on histopathology as leiomyosarcoma. Introuction The incidence of leiomyosarcoma in patients with leiomyomas is reported to be 0.2 percent 1. Leiomyomas can cause infertility either by mechanical obstruction or interference with implantation. But leiomyosarcoma presenting with infertility is unique. Management of such a rare case is discussed here. Case Report A 35 year old female was admitted in the Department of Obstetrics and Gynecology for investigation and management of infertility. She was married for four years. Her menstrual cycles were regular with average flow and there was no history of dysmenorrhoea. Her general and systemic examination were clinically within normal limits. On per abdomen examination there was a suprapubic pelvic mass of 14 weeks pregnant uterus size. Per speculum showed healthy vagina and cervix. Bimanual examination also revealed irregularly enlarged uterus corresponding to the size of 14 weeks pregnant uterus. On investigation the haematological study, liver and kidney function tests were within normal limits. Endometrial histopathology showed secretary pattern. On ultrasonography the uterus showed multiple fibroids, the largest being seven × six cm size on right cornual part and ovaries were normal with normal follicles. Considering her infertility hysterosalphingography was done after the exclusion of tuberculosis following endometrial acid fast bacilli culture study. The hysterosalphingography and laparoscopic chromopertubation showed left fimbrial and right cornual block of fallopian tubes. A course of Danazol theray was administered for three months with the view to reduce the vascularity and size of myoma prior to surgery. Exploratory laparatomy with myomectomy and tuboplasty was planned. On laparotomy a total of five myomas could be seen. Two myomas, one of the size four × three cm and the other of three × three cm were present on the anterolateral wall of uterus at the cornu and two subserous sessile fibroid of size two × three cm on lateral wall of uterus were seen. There was difficulty in enucleation of the right cornual fibroid which was largest of all and had poorly circumscribed capsule. The myomectomy was completed carefully with minimum blood loss. Left side fimbriolysis was done and patency of the tube was restored .The right side tuboplasty was not attempted. On gross examination the largest myoma looked hyalanized and had no whorled appearance. On histopathology (Fig.1) of the larger fibroid borderline leiomyosarcoma and the other fibroids as benign leiomyoma were diagnosed.