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Case of the Month




Uterine Leiomyosarcoma

December, 2020

This is a 52 year old female presented for TAHBSO due to uterine mass. On gross exam the uterus contained a submucosal mass which measured 8.7 cm and had areas of hemorrhage and necrosis. Histologic sections demonstrated a spindle cell neoplasm with areas of marked cytologic atypia, coagulative tumor necrosis and brisk mitotic activity. The diagnosis is uterine leiomyosarcoma. Uterine leiomyosarcomas are rare de novo neoplasms which show severe atypia, increased mitotic activity and tumor necrosis. The average age at the time of diagnosis is 51 years. These tumors are considered aggressive even if they are confined to the uterus. Tumor stage is the most important prognostic feature.  For postmenopausal women the treatment is TAHBSO.  Lymph nodes are rarely involve by tumor, so lymph node sampling is not necessary indicated. The three main histologic subtypes include conventional/spindle cell type, myxoid type and epitheloid type. These tumors often stain with muscle markers including SMA, Desmin and Caldesmon.  Tumor cells can sometimes stain with ER/PR and occasionally with EMA and Keratin stains.