Uterine Leiomyosarcoma: A Diagnostic Dilemma

Year : 2024 | Volume :01 | Issue : 01 | Page : –

Murad Ahmed

  1. Assistant professor, department of pathology, JNMCH,Aligarh Uttar Pradesh India


Tumours that fall under the category of uterine malignancies include carcinosarcomas, leiomyosarcomas, endometrial stromal sarcomas, and undifferentiated sarcomas. Of them, leiomyosarcoma is the most common subtype, while still quite uncommon—it accounts for 1% to 2% of uterine cancers. Since postmenopausal bleeding is typically present in leiomyosarcomas, prompt detection is essential for successful treatment.
This case study features a 50-year-old female patient who had postmenopausal bleeding, which is a common sign of uterine cancers. Based on preliminary microscopic analysis, leiomyoma of the symplastic variety—a benign smooth muscle tumour frequently seen in clinical practice—was diagnosed. But a more concerning discovery was made upon closer inspection of the entire hysterectomy specimen: leiomyosarcoma.
Considering postmenopausal haemorrhage in particular, this case highlights the diagnostic difficulties in distinguishing benign from malignant uterine tumours. Though up to 40% of women over 40 have leiomyomas, which are incredibly frequent, the possibility of malignant transformation, while rare, makes careful clinical and histological diagnosis necessary.
The shift in diagnosis from benign leiomyoma to malignant leiomyosarcoma highlights the significance of thorough tissue specimen evaluation and comprehensive diagnostic methods. This example also emphasises the need of ongoing monitoring and scepticism on the side of the practitioner, especially when patients present with unusual symptoms like postmenopausal haemorrhage.
The best possible outcomes for patients depend on early discovery and proper diagnosis, since uterine leiomyosarcoma has a worse prognosis than its benign equivalent. Surgical intervention, adjuvant therapy, and vigilant observation to check for metastasis or recurrence are possible treatment approaches.
Considering postmenopausal bleeding, this case report underscores the significance of taking leiomyosarcoma into account when making a differential diagnosis of uterine tumours. To diagnose uterine cancers promptly and treat them appropriately, raising clinical suspicion and doing a comprehensive pathological assessment are crucial for improving patient outcomes.

Keywords: uterine tumours, postmenopausal bleeding,leiomyosarcoma, symplastic leiomyoma, smooth muscle neoplasm.

[This article belongs to International Journal of Pathogens(ijpg)]

How to cite this article: Murad Ahmed. Uterine Leiomyosarcoma: A Diagnostic Dilemma. International Journal of Pathogens. 2024; 01(01):-.
How to cite this URL: Murad Ahmed. Uterine Leiomyosarcoma: A Diagnostic Dilemma. International Journal of Pathogens. 2024; 01(01):-. Available from: https://journals.stmjournals.com/ijpg/article=2024/view=146953


  1. Corcoran S, Hogan AM, Nemeth T, Bennani F, Sullivan FJ, Khan W, Barry K. Isolated cutaneous metastasis of uterine leiomyosarcoma: case report and review of literature. Diagnostic Pathology. 2012 Dec;7:1-5.
  2. Forney JP. Classifying, staging, and treating uterine sarcomas. Contempt. Ob. Gyn.. 1981;18(3):47.
  3. Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, Yordan E, Brady MF. Prognostic factors in early‐stage uterine sarcoma: a Gynecologic Oncology Group Study. Cancer. 1993 Feb 15;71(S4):1702-9.
  4. Tsuzaka S, Asahi Y, Kamiyama T, Kakisaka T, Orimo T, Nagatsu A, Aiyama T, Uebayashi T, Kamachi H, Matsuoka M, Wakabayashi K. Laparoscopic liver resection for liver metastasis of leiomyosarcoma of the thigh: a case report. Surgical case reports. 2022 Mar 21;8(1):47.
  5. Harry VN, Narayansingh GV, Parkin DE. Uterine leiomyosarcomas: a review of the diagnostic and therapeutic pitfalls. The Obstetrician & Gynaecologist. 2007 Apr;9(2):88-94.
  6. Lin Y, Wu RC, Huang YL, Chen K, Tseng SC, Wang CJ, Chao A, Lai CH, Lin G. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdominal Radiology. 2022 Jun;47(6):2197-208.
  7. WHO Classification of Tumours Editorial Board. Female genital tumours. International Agency for Research on Cancer, World Health Organization; 2020.
  8. Mira JL, Fenoglio-Preiser CM, Husseinzadeh N. Malignant mixed müllerian tumor of the extraovarian secondary müllerian system. Report of two cases and review of the English literature. Archives of pathology & laboratory medicine. 1995 Nov 1;119(11):1044-9.
  9. Skorstad M, Kent A, Lieng M. Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study. Acta obstetricia et gynecologica Scandinavica. 2016 Nov;95(11):1228-34.
  10. Mittal KR, Chen F, Wei JJ, Rijhvani K, Kurvathi R, Streck D, Dermody J, Toruner GA. Molecular and immunohistochemical evidence for the origin of uterine leiomyosarcomas from associated leiomyoma and symplastic leiomyoma-like areas. Modern pathology. 2009 Oct 1;22(10):1303-11.

Regular Issue Subscription Case Study
Volume 01
Issue 01
Received March 8, 2024
Accepted May 10, 2024
Published May 20, 2024