Elsevier

Gynecologic Oncology

Volume 95, Issue 3, December 2004, Pages 712-715
Gynecologic Oncology

Case Report
Malignant mesenchymoma arising from a uterine leiomyoma in the menopause

https://doi.org/10.1016/j.ygyno.2004.08.014Get rights and content

Abstract

Background

Malignant mesenchymoma is a rare tumor and location in the uterus is even rarer. We describe the first case of malignant mesenchymoma arising from a uterine fibroid in the menopause.

Case report

A 64-year-old woman presented with abdominal pain and underwent surgery for a large “uterine fibroid” with suspicious features on ultrasound scan. The mass had developed after the menopause. Histology showed benign leiomyomatous tissue with malignant areas consistent with malignant mesenchymoma.

Conclusion

We report the first case of malignant mesenchymoma arising from the uterus in menopause. Certain radiological features may be associated with this tumor. Due to its rarity, information on management of uterine malignant mesenchymoma is lacking and management options of uterine leiomyosarcomas are reviewed as a surrogate.

Introduction

Malignant mesenchymoma is a rare malignant tumor, which by definition shows differentiation into at least two different malignant mesenchymal components. An alternative designation for this tumor is leiomyosarcoma with heterologous differentiation. Its most common location is in the retroperitoneum, but occurrences in the several other locations have been reported. Malignant mesenchymoma arising from the uterus is extremely rare and information about its management is lacking. To our knowledge, this is the first case of malignant mesenchymoma arising from a uterine fibroid in the menopause.

Section snippets

Case report

A 64-year-old woman presented with 6 months history of left iliac fossa pain. There was no associated postmenopausal bleeding, urinary symptoms, change in bowel habit, or rectal bleeding. There was no history of loss of appetite or loss of weight. She has been menopausal for 10 years and had a past history of treatment for cervical polyps at the time of her menopause with no evidence of uterine enlargement and is currently on medication for hypertension. There was no history of use of oral

Discussion

Uterine fibroids are common neoplasms in women, but malignant transformation of fibroids are very rare occurrences. Malignant transformation of fibroids by development along differential cell lines is even more uncommon. The diagnostic criteria for malignant mesenchymoma, which were first described by Stout [1] and supported by Enzinger and Weiss [2] are malignant soft tissue tumors that are characterized by the presence of two or more tissue mesenchymal components in the same neoplasm. The

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