Leila Mousavi - assistant profesor, fellowship of gynecology oncology, obstetric and gynecology department, isfahan medical scienceof school, isfahan, iran
Azar Danesh Shahraki - professor, obstetric and gynecology department, isfahan medical science of school, isfahan, iran

Background and Aim : Differentiating between Leiomyosarcoma as one of the rarest uterine malignanciesversus benign uterine leiomyoma as a common problem in childbearing age has always been a challengingissue in dealing with patients. The clinical finding, the imaging report, the tumor markers, the endometrialbiopsy, and even the age of the patient is not helpful to make this distinction. Although, theLeiomyosarcoma incidence in menopausal women has been reported in about one in 400 patients and morelikely in people over 60 years. In regard of the poor prognosis of this malignancy, many patient especiallyin reproductive age prefer medical therapy such as uterine artery embolization or gonadotropin agonistadministration for controlling of their symptom. So the important question is when we should considerLeiomyosarcoma probability Here with reporting a case of unexpected Leiomyosarcoma with poorprognosis to aware its possibility.Methods : A 46-year-old female patient gravid 3 with complains of hyper menorrhea since one year agowhich refer to her myomatosis uterine was presented to gynecologic department of Isfahan medical school,Iran. The patient does not mention anything special in her medical history. At last hysterectomy plannedfor her due to her irreversible bothering symptomResults : . The final histologic report was surprising; In the smallest myoma of uterus the Leiomyosarcomawas reported and the worse finding was her post operation CT scan with contrast of abdomen-pelvic whichrevealed several metastatic focuses.Conclusion : Uterine sarcomas as one of the most important causes of mortality worldwide have lowincidence and so defining the standard treatment and the exact prognosis require further. More definitiveways to differentiate benign uterine myoma from Leiomyosarcoma in regard of genetic studies, specificimaging techniques, and specific tumor markers is needed.

Key words: Myoma, Leiomyosarcoma, Abnormal uterine bleeding, Myomectomy,Hysterectomy