Leiomyosarcoma of the vagina: A case report

Abstract

Objective: Primary malignant tumors of the vagina represent only about 2% of all gynecological malignancies. Primary vaginal sarcomas account for about 2% of all malignant vaginal lesions, with leiomyosarcomas being the most common form of malignant vaginal mesenchymal tumors. Case report: We present a case of a 49-year-old woman who was admitted to the University Clinic of Obstetrics and Gynecology complaining of vaginal discharge, abdominal pain and vaginal bleeding within 8 months. Ultrasound and MR showed a solid tumor infiltrating the posterior wall of the vagina. Complete surgical excision of tumor was accomplished. The operative material was composed of two lobulated, solid tumor masses with a total weight of 192 g, with dimensions 11x7x2,5-4cm and 7x5x2cm. The cut surface of the tumor showed nonencapsulated, gray-white glistening mass with hemorrhagic and necrotic areas. The tissue specimens were fixed in 10% buffered formalin and embedded in paraffin. Immunostainings with antibodies against Vimentin, SMA, CD10, S100, Desmin, CD99, Caldesmon, Podoplanin, CKAE1/AE3 and CD31 were made. Histologically, this tumor was composed of spindle-shaped cells with blunt-ended nuclei, arranged in storiform pattern with marked pleomorphism and nuclear atypia. Many bizarre cells and multinucleated cells were also seen. There were large regions of coagulative necrosis and high mitotic rate (27 per 10 HPF). Immunohistochemically, the tumor cells were positive for Vimentin, SMA, CD10 and negative for S100, Desmin, CD99, Caldesmon, Podoplanin, CKAE1/AE3 and CD31. The Ki67 proliferative index was 40%. A final diagnosis of high grade leiomyosarcoma was made. Postoperatively, the patient received adjuvant chemotherapy with gemcitabine and docetaxel for eight cycles. The tumor showed a progressive growth with distant metastasis to liver and paraortal and retroperitoneal lymph nodes. The patient died of the disease 9 months after diagnosis. Conclusion: Vaginal leiomyosarcoma is an extremely rare disease with very poor prognosis in advanced stages and undetermined ideal treatment regimen. Reporting rare tumors contributes to collecting data for rare neoplasms in order for proper early diagnosis and adequate therapy to be established.