Myxoid leiomyosarcoma of the uterus in a woman of childbearing age: A case report

Abstract

Myxoid leiomyosarcoma of the uterus (MLMS) is an extremely rare malignancy characterized by a poor prognosis. The present report describes a rare case of MLMS in a woman of childbearing age. The patient was a 33-year-old woman who presented with lower abdominal pain and was initially diagnosed with uterine myoma by preoperative B-mode ultrasound and magnetic resonance imaging. However, intraoperative pathological biopsy indicated the presence of a malignant tumor. The patient underwent total uterine and bilateral salpingectomy, along with pelvic lymph node biopsy, which confirmed the diagnosis of MLMS postoperatively. In a subsequent surgical procedure, the bilateral ovaries, omentum and appendix were also resected. The patient then received chemotherapy with gemcitabine and docetaxel and remains in good health, with no signs of recurrence. The present case report underscores the importance of early diagnosis and personalized treatment strategies for MLMS, particularly regarding their implications for fertility and survival outcomes in young women.

Keywords: case report; myxoid leiomyosarcoma; uterine myoma; women of childbearing age.

Figure 1.

Three-dimensional ultrasound examination reveals an unevenly echogenic region in the posterior wall of the uterus, measuring 120×62×109 mm, with unclear boundaries and cystic interiors. Color Doppler flow imaging indicates abundant blood flow signals.

Figure 2.

Magnetic resonance imaging findings prior to surgery. (A) Lateral view showing enlargement of the posterior portion of the uterus. The red arrow indicates multiple circular cystic lesions behind the uterus. The posterior portion of the uterus is not clearly demarcated from the posterior uterine wall. (B) Anteroposterior view. Red arrow indicates a mass shadow behind the uterus, containing multiple cysts. (C) The posterior uterine mass is surrounded by multiple thick, empty vascular shadows, as indicated by the red arrow.

Figure 3.

Postoperative specimen showing the excised uterus, bilateral fallopian tubes and uterine tumors. The tumor tissue on the front and left sides of the specimen was soft, gel-like, brittle and easily separable.

Figure 4.

Histopathological analysis of the excised tumor. (A) Abundant mucous stroma and (B) mitotic cells are visible; hematoxylin and eosin staining (magnification, ×20; scale bar, 100 µm).

Figure 5.

Immunohistochemical analysis of the excised tumor. Neoplastic cells exhibit the expression of (A) Ki-67 with ~50% positive nuclei (magnification, ×10; scale bar, 200 µm), and the positive expression of (B) desmin (magnification, ×20; scale bar, 100 µm), (C) estrogen receptor (magnification, ×10; scale bar, 200 µm) and (D) progesterone receptor (magnification, ×20; scale bar, 100 µm).