Ureteric Leiomyosarcoma

Abstract

Ureteric leiomyosarcoma is a rare but aggressive tumor among other sarcomas. There is no established epidemiological data due to the scarcity of literature on this uncommon disorder. The present literature comprises about 20 case reports mostly of women above 40 years of age. The presenting complaint is mostly pain in the abdomen with only a few reporting urological symptoms like hematuria. Understandably, this tumor is diagnosed by histopathological examination with immunohistochemistry. We report one such case of a 32-year-old female who underwent an exploratory laparotomy with preoperative suspicion of adnexal neoplastic mass only to find normal ovaries and left ureteric tumor intraoperatively. She was managed with excision of the tumor with partial resection of the involved ureter and end-to-end anastomosis of the ureter followed by chemotherapy and radiation.

Keywords: adnexal mass; leiomyosarcoma; sarcoma; spindle cell tumor; ureter.

Figure 1. Contrast-enhanced MRI

Contrast-enhanced MRI showing multilobulated multicystic lesion of abdomen and pelvis in (a) sagittal view, (b) coronal view, and (c) transverse sectional view.

Figure 2. Intraoperative findings

(a) A 16 cm x 16 cm necrotic mass with areas of hemorrhage encasing the left mid ureter as seen in laparotomy. (b) Operative finding of a normal uterus, bilateral fallopian tubes, and ovaries.

Figure 3. Histopathology images

(a) Section showing ureteric lining and a tumor arising and breaching the adventitial layer of the ureter. (b) Section 100x H&E showing a tumor composed of spindle-shaped cells with nuclei being elongated with pointed edges. Nuclear pleomorphism and atypical mitoses are also seen. (c) Section 200x H&E higher magnification of tumor. (d) Section 400x H&E higher magnification of tumor with atypical mitosis seen. (e) Smooth muscle actin (200x) showing strong cytoplasmic staining. (f) Caldesmon (200x) showing strong cytoplasmic staining. H&E: Hematoxylin and eosin.