Leiomyosarcoma of cervical stump following subtotal hysterectomy: a case report and review of literature

Background: Leiomyosarcoma that arises in the uterine cervix stump after subtotal hysterectomy is exceedingly rare. Only one case has been documented. The authors report an unusual case of leiomyosarcoma that arose in the cervix stump. Case presentation: A 46-year-old female presented with a one-month history of vaginal bleeding. Vaginal and ultrasonography examination revealed a mass in the cervix. The patient underwent radical resection of the cervix, bilateral salpingo-oophorectomy, and pelvic lymphadenectomy. Chemotherapy and radiotherapy was given after the operation. The patient suffered from severe menopausal symptoms and received hormone replacement therapy. She eventually committed suicide. Conclusion: Given the rarity of cases of leiomyosarcoma of cervical stump, its proper treatment remains to be determined. In dealing with benign uterus diseases, we should pay adequate attention in retaining the cervix. If the cervix is retained, patients require appropriate follow-up. The authors hope that this work will benefit the fields of gynecology and oncology.

Leiomyosarcoma; Cervical stump; Subtotal hysterectomy.

[1] Ouh Y.T., Hong J.H., Min K.J., So K..A, Lee J.K.: “Leiomyosarcoma of the rectum mimicking primary ovarian carcinoma: a case report”. J. Ovarian. Res., 2013, 15, 27. doi: 10.1186/1757-2215-6-27.

[2] Sturdy D.E.: “Leiomyosarcoma of cervical stump following subto-tal hysterectomy”. Br. J. Surg., 1959, 46, 369.

[3] Villena-Heinsen C., Diesing D., Fischer D., Griesinger G., Mass N., Diedrich K., Friedrich M.: “Carcinosarcomas-a retrospective analysis of 21 patients”. Anticancer Res., 2006, 26, 4817.

[4] Wright J.D., Rosenblum K., Huettner P.C., Mutch D.G., Rader J.S., Powell M.A., Gibb R.K.: “Cervical sarcomas: an analysis of incidence and outcome”. Gynecol. Oncol., 2005, 99, 348.

[5] Khosla D., Gupta R., Srinivasan R., Patel F.D., Rajwanshi A.: “Sarcomas of uterine cervix: clinicopathological features, treatment, and outcome”. Int. J. Gynecol. Cancer, 2012, 22, 1026. doi: 10.1097/IGC.0b013e31825a97f6.

[6] Ouh Y.T., Hong J.H., Min K.J., So K.A., Lee J.K.: “Leiomyosarcoma of the rectum mimicking primary ovarian carcinoma: a case report”. J. Ovarian Res., 2013, 6, 27. doi: 10.1186/1757-2215-6-27.

[7] Kapp D.S., Shin J.Y., Chan J.K.: “Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas”. Cancer, 2008, 112, 820.

[8] Wong P., Han K., Sykes J., Catton C., Laframboise S., Fyles A., et al.: “Postoperative radiotherapy improves local control and survival in patients with uterine leiomyosarcoma”. Radiat. Oncol., 2013, 8, 128. doi: 10.1186/1748-717X-8-128.

[9] Giuntoli R.L. 2nd., Metzinger D.S., DiMarco C.S., Cha S.S., Sloan J.A., Keeney G.L., Gostout B.S.: “Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy”. Gynecol. Oncol., 2003, 89, 460.

[10] Thakar R., Ayers S., Clarkson P., Stanton S., Manyonda I.: “Outcomes after total versus subtotal abdominal hysterectomy”. N. Engl. J. Med., 2002, 347, 1318-1325.

[11] van Evert J.S., Smeenk J.M., Dijkhuizen F.P., de Kruif J.H., Kluivers K.B.: “Laparoscopic subtotal hysterectomy versus laparoscopic total hysterectomy: a decade of experience”. Gynecol. Surg., 2010, 7, 9. Epub 2009 Nov 14.

[12] Maina W.C., Morris E.P.: “Management of women requesting subtotal hysterectomy”. Menopause Int., 2010, 16, 152. doi: 10.1258/

mi. 2010.010038..

[13] Hellström A.C., Hellman K., Pettersson B.F., Andersson S.: “Carcinoma of the cervical stump: fifty years of experience”. Oncol. Rep., 2011, 25, 1651. doi: 10.3892/or.2011.1228. Epub 2011 Mar 22..