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Uterine leiomyosarcomaFrom: ainsron@msn.comThu May 3 01:50:29 2001
I had an interesting case last week that I have never seen before. 39 yo who was referred from Planned Parenthood because of 45 days of heavy irregular bleeding. Always regular before, they could not control it with Lo-Ovral or Alesse. She had a 12-13 week size fibroid uterus, confirmed on sonogram, looked like a normal fibroid to me. Options discussed, including hysteroscopic resection, but I told her I didn't think she was a good candidate because it appeared to occupy the entire posterior aspect of uterus - from endometrial cavity to serosa, 8-9 cm in diameter. She agreed to hysterectomy, and I did a vaginal hysterectomy with morcellation, left the ovaries. The opened fibroid was an unusual yellow appearance. The final path showed a leiomyosarcoma with immature, blastic cells. Discussed it with one of the gyn oncs I refer to. He suggested CT of abdomen, pelvis and chest, doesn't think that further surgical staging is indicated, due to higher incidence of hematogenous spread, as opposed to lymphatic spread. Probably will recommend radiation for the pelvic nodes and chemotherapy. Any of you have experience with similar situations? Sure bothers you to see this kind of a tumor, ruins your faith in hoofbeats, this was certainly a zebra. When patients ask if their fibroids could be malignant, I usually say the odds are 99.9% that they will be benign, especially in this age group, unless they are growing rapidly. In this patient, we didn't have a benchmark to compare with. Fortunately I didn't sit around watching it for awhile!
-- Ronald E. Ainsworth, MD
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