Unexpected leiomyosarcoma after total abdominal hysterectomy with indication uterine myoma in nullipara: a case report

Cut Meurah Yeni , Cut Rika Maharani, Herman Supriadi

Cut Meurah Yeni
Staff Departement of Obstetrics and Gynecology Faculty of Medicine, Universitas Syiah Kuala, Dr Zainoel Abidin Hospital, Banda Aceh. Email:

Cut Rika Maharani
Staff Departement of Obstetrics and Gynecology Faculty of Medicine, Universitas Syiah Kuala, Dr Zainoel Abidin Hospital, Banda Aceh

Herman Supriadi
Resident of Obstetrics and Gynecology, Faculty of Medicine, Universitas Syiah Kuala, Dr Zainoel Abidin Hospital, Banda Aceh
Online First: August 21, 2021 | Cite this Article
Yeni, C., Maharani, C., Supriadi, H. 2021. Unexpected leiomyosarcoma after total abdominal hysterectomy with indication uterine myoma in nullipara: a case report. Bali Medical Journal 10(2): 775-779. DOI:10.15562/bmj.v10i2.2395

Introduction: Uterine sarcomas are rare tumors, with 3-7% incidence. Abnormal uterine bleeding, abdominal or pelvic masses, and pain are the most common symptoms in the patient. Non-specific clinical symptoms or preoperative diagnostic techniques to differentiate uterine myoma and uterine sarcoma lead to the general diagnosis after surgery. The incidence of uterine sarcoma established from the literature was 0.09% -0.49% in women undergoing benign hysterectomy or myomectomy. The difficulty of diagnosing preoperative leiomyosarcoma is a challenge in itself. This case report aims to provide knowledge information with characteristics of a sonographic image with a non-hypervascularity encapsulated image and intraoperative findings with a regular smooth uterine surface, which is thought to be a uterine myoma is different from the anatomical pathology results, which indicate a leiomyosarcoma malignancy.

Case description: Miss A, 47 years old with complaints of an enlarged stomach for two years, felt abdominal pain and complained about prolonged menstruation for four years. The patient was unmarried and had no previous history of surgery. Intraoperatively, there was posterior corpus adhesion with ascending colon and adhesion was performed. Large, fragile blood vessels appeared. Then it was decided to do a total abdominal hysterectomy—intraoperative hemorrhage 1200 cc. The results of the anatomic pathology showed a leiomyosarcoma. Furthermore, the patient was consulted to the oncology subdivision for a bilateral Salpingo-Oophorectomy procedure followed by chemotherapy. MRI, 3D Doppler sonography were required to increase the preoperative diagnosis of uterine sarcoma.

Conclusion: Our case reported that a patient was diagnosed with uterine myoma and stage II hypertension. The patient showed common signs and symptoms. There was posterior corpus adhesion with ascending colon, and adhesion was performed. Theoretically, pelvic sonography is a first-line imaging study. MRI can be used to help differentiate uterine sarcomas from uterine myomas.


Zappacosta R, Fanfani F, Zappacosta B, Sablone F, Pansa L, Liberati M, et al. Uterine Sarcomas: An Updated Overview. Part 1: Smooth Muscle Tumors. Neoplasm. 2018;

Wen KC, Horng HC, Wang PH, Chen YJ, Yen MS, Ng HT, et al. Uterine sarcoma Part I—Uterine leiomyosarcoma: The Topic Advisory Group systematic review. Taiwan J Obstet Gynecol. 2016;55(4):463–71.

Cantrell LA, Blank S V., Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol. 2015;137(3):581–8.

Blythe JG, Bari WA. Uterine Sarcoma: Histology, Classification, and Prognosis. Glob Libr Women's Med. 2009;

D’Angelo E, Prat J. Uterine sarcomas: A review. Gynecol Oncol. 2010;116(1):131–9.

Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA. Treatment of early uterine sarcomas: Disentangling adjuvant modalities. World J Surg Oncol. 2009;7:38.

Terek MC, Akman L, Hursitoglu BS, Sanli UA, Ozsaran Z, Tekindal MA, et al. The retrospective analysis of patients with uterine sarcomas: A single-center experience. J Cancer Res Ther. 2016;12(1):309–13.

Kyriazoglou A, Liontos M, C Ziogas D, Zagouri F, Koutsoukos K, Tsironis G, et al. management of uterine sarcomas and prognostic indicators: Real world data from a single-institution. BMC Cancer. 2018;18(1):1–8.

Harlow BL, Weiss NS, Lofton S. The epidemiology of sarcomas of the uterus. J Natl Cancer Inst. 1986;76(3):399–402.

Schwartz SM, Weiss NS, Daling JR, Gammon MD, Liff JM, Watt J, et al. Exogenous sex hormone use, correlates of endogenous hormone levels, and the incidence of histologic types of sarcoma of the uterus. Cancer. 1996;77(4):717–24.

Brooks SE, Zhan M, Cote T, Baquet CR. Surveillance, epidemiology, and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol. 2004;93(1):204–8.

Felix AS, Cook LS, Gaudet MM, Rohan TE, Schouten LJ, Setiawan VW, et al. The etiology of uterine sarcomas: A pooled analysis of the epidemiology of endometrial cancer consortium. Br J Cancer. 2013;108(3):727–34.

KOBAYASHI H, UEKURI C, AKASAKA J, ITO F, SHIGEMITSU A, KOIKE N, et al. The biology of uterine sarcomas: A review and update. Mol Clin Oncol. 2013;1(4):599–609.

Wang F, Lei R, Yang H, Guo M, Tan G. Endometrial stromal sarcoma: a clinicopathological analysis of 14 cases. Int J Clin Exp Pathol. 2018;11(5):2799–804.

Meseci E, Naki MM. Prognostic factors, survival outcomes, and surgical practices when dealing with uterine sarcomas: 8 years' clinical experience. J Turkish Ger Gynecol Assoc. 2019;20(3):154–64.

Lim MC, Lee M, Shim SH, Nam EJ, Lee JY, Kim HJ, et al. Practice guidelines for management of cervical cancer in Korea: A Korean society of gynecologic oncology consensus statement. J Gynecol Oncol. 2017;28(3):1–22.

Zhao WC, Bi FF, Li D, Yang Q. Incidence and clinical characteristics of unexpected uterine sarcoma after hysterectomy and myomectomy for uterine fibroids: A retrospective study of 10,248 cases. Onco Targets Ther. 2015;8:2943–8.

Wu TI, Yen TC, Lai CH. Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol. 2011;25(6):681–9.

Salani R, Khanna N, Frimer M, Bristow RE, Chen L may. An update on post-treatment surveillance and diagnosis of recurrence in women with gynecologic malignancies: Society of Gynecologic Oncology (SGO) recommendations. Gynecol Oncol. 2017;146(1):3–10.

Wais M, Tepperman E, Bernardini MQ, Gien LT, Jimenez W, Murji A. A Multicentre Retrospective Review of Clinical Characteristics of Uterine Sarcoma. J Obstet Gynaecol Canada. 2017;39(8):652–8.

Benson C, Miah AB. Uterine sarcoma - Current perspectives. Int J Womens Health. 2017;9:597–606.

Denschlag D, Ulrich UA. Uterine carcinosarcomas - Diagnosis and management. Oncol Res Treat. 2018;41(11):675–9.

Mainz U. Sarcoma of the Uterus . Guideline of the DGGG and OEGGG ( S2k Level , AWMF Register Number 015 / 074 , February 2019 ) Uterine Sarkome . Leitlinie der DGGG und OEGGG. Thiem. 2019;(015):1043–59.

Yen M, Chen J, Wang P, Wen K. Taiwanese Journal of Obstetrics & Gynecology Uterine sarcoma part III d Targeted therapy : The Taiwan Association of Gynecology ( TAG ) systematic review. 2016;55.

Yorganc? A, Meydanl? MM, Kad?o?lu N, Ta?k?n S, Kay?kç?o?lu F, Alt?n D, et al. Incidence and outcome of occult uterine sarcoma: A multi-centre study of 18604 operations performed for presumed uterine leiomyoma. J Gynecol Obstet Hum Reprod. 2019;

Ebina Y, Katabuchi H, Mikami M, Nagase S, Yaegashi N, Udagawa Y, et al. Japan Society of Gynecologic Oncology guidelines 2013 for the treatment of uterine body neoplasms. Int J Clin Oncol. 2016;21(3):419–34.

Ganjoo KN. Uterine sarcomas. Curr Probl Cancer. 2019;43(4):283–8.

Dangoor A, Seddon B, Gerrand C, Grimer R, Whelan J, Judson I. UK guidelines for the management of soft tissue sarcomas. Clin Sarcoma Res. 2016;1–26.

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