UTERINE LEIOMYOSARCOMA WITH INVERSION UTERUS - A RARE CASE REPORT

Uterine sarcomas are rare and aggressive cancers constituting 3-6 of all uterine malignancies. Uterine leiomyosarcomas are rare smooth muscle tumors accounting for 30 of all uterine sarcomas. Non-puerperal inversion of uterus is an uncommon presentation of uterine leiomyosarcomas. We report this case of uterine leiomyosarcoma with inversion in a 50 year old woman due to its rarity of clinical presentation.50 year old perimenopausal woman, para 4 live 4,presented in May 2010 with complaints of mass descending per vaginum for 3 months associated with abnormal uterine bleeding and lower abdominal pain of 6 months duration. She was thin-built and anemic. Examination revealed no mass palpable abdominally. Local examination showed a large irregular proliferative mass at the introitus covered with necrotic slough. Metastatic work up normal with no evidence of liver metastasis on ultrasound and chest Xray was normal. A preliminary biopsy from the mass showed it to be high grade uterine leiomyosarcoma. Surgery planned after anemia correction. Under general anaesthesia, uterine inversion confirmed through midline abdominal incision. Excision of the mass from the fundus done vaginally followed by correction of uterine inversion and vaginal hysterectomy with bilateral salpingo-oophorectomy done. Histology proved to be HIGH GRADE UTERINE LEIOMYOSARCOMA STAGE 1B. Post operative pelvic radiotherapy given. Recovery was good. Out of 28 cases of uterine sarcomas reported in our institute from 2006-2010, we had 32.1 (9 cases) of leiomyosarcoma out of which only this case presented with inversion. Patient on regular follow up with disease-free survival of 19 months. Current literature describes only 17 cases of inversion with uterine sarcomas reported so far. Although uterine leiomyosarcomas are tumors of high metastatic potential, our patient had a good clinical outcome with no distant spread or recurrence.