Which Behavior of Myomatous masses is Diagnostic for Leiomyosarcoma: How Do You Clinically Differentiate Between Leiomyoma and Leiomyosarcoma? A Case Report

Distinguishing between leiomyosarcoma and benign uterine leiomyoma, as one of the common problems in reproductive age, brings a great challenge in dealing with patients. Clinical findings, imaging report, tumor markers, endometrial biopsy, and even age of the patients will not be helpful to make this distinction. So, the important question is when we should consider leiomyosarcoma probability? In this report, an unexpected case of leiomyosarcoma with a poor prognosis is presented. A ۴۵-year-old female patient gravida ۳ with complaint of hypermenorrhea from one year ago was presented to the gynecologic department. The patient did not mention anything special in her medical history. At last, a hysterectomy was planned due to her irreversible bothering symptom. The final histologic report was leiomyosarcoma in the smallest myomatous mass of the uterus, and her post-operation CT scan with contrast of abdomen-pelvic revealed several metastatic focuses. Uterine sarcomas as one of the most important causes of mortality worldwide have a low incidence and defining the standard treatment and the exact prognosis require further study. More definitive ways to differentiate benign uterine leiomyoma from leiomyosarcoma including genetic studies, specific imaging techniques, specific tumor markers, and investigating the method of intrauterine biopsy by flexible or robotic hysteroscopy are needed.

Keywords:

Leiomyoma , Leiomyosarcoma , Abnormal uterine bleeding , Myomectomy , Hysterectomy