Nasreen Jatoi.
Leiomyosarcoma: A rare malignant change in a Leiomyoma.
J Coll Physicians Surg Pak Jan ;13(2):106-7.

A 62 years old post-menopausal lady para l+1 presented with irregular vaginal bleeding and foul smelling vaginal discharge for 3 months. Her past medical and surgical history was unremarkable. Premenopausal menstrual history as well as obstetrical performance was normal. Physical examination revealed a lady of weak built and pale looks. Her abdomen, chest and cardiovascular system were unremarkable. On speculum examination, there was a soft friable necrotic mass of about 6 x 4 cm, with foul smelling discharge, protruding through external cervical os and filling whole of upper vagina. Cervix was normal. Uterine size could not be assessed due to mass filling upper vagina. Both adnaxae were clear. Provisional diagnosis of endometrial polyp with inflammatory or malignant change was made. On blood analysis heamoglobin was 9.5 grams / dl , ESR was 30 m.m. and TLC was 12000. Liver function test, blood urea, blood glucose, ECG and x-ray chest were normal. Ultrasound of abdomen and pelvis showed enlarged uterus with hyper-echoic irregular mass arising from fundus of uterus and occupying whole uterine cavity measuring 8 x 33 cm in size, suggestive of fibroid, polyp or leiomyosarcoma. Considering her age, symptoms and ultrasound report, laparotomy was decided. At laparotomy, in inspection, uterus was enlarged, 12 weeks size with outer smooth surface and partial inversion of uterine fundus. Adnexae and rest of peritoneal cavity was normal. There was no ascites or enlarged pelvic lymph nodes or any evidence of malignancy in peritoneal cavity and liver. Total hysterectomy with bilateral salpingo-ophrectomy was done. Both tubes and ovaries looked normal. On incising uterine cavity, a large polypiodal growth, arising from the left corner of uterus and extending down to the cervix was found. Histopathology report confirmed the diagnosis of leiomyosarcoma.

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