42-year-old techie from Bihar treated for rare leiomyosarcoma in the city

PUNE: A 42-year-old software engineer residing in Patna was diagnosed with a rare tumour of leiomyosarcoma and successfully operated at Jehangir Hospital in Pune recently. 

She had frequent episodes of heavy menstrual bleeding for the last four months. Her sonography showed a tumor in the uterus which was possibly diagnosed with fibroid. She was advised to have a Uterus removal surgery for the same.

The tumor was 18cms large and she was advised laparoscopic surgery for the same. However, she was not convinced and travelled from Bihar to meet Dr Jyotsna Angom who is a gynaecologist at Pune-based Jehangir hospital for a second opinion.

Dr Angom said that after clinical examination and perusing through the ultrasonography reports, 

the findings did not appear like a classical fibroid which is a benign tumour and can be safely removed laparoscopically.

“Because the suspicion of a malignant tumor was high, in order to further characterise the lesion, I advised additional MRI of the abdomen and pelvis. The MRI report was highly suggestive of a possibility of a malignant tumour--in this case a uterine Leiomyosarcoma. Therefore, the laparoscopic approach was deferred and I then discussed the case with our surgical oncologist Dr Snita Sinukumar,” said Dr Angom.

Speaking about the rare tumour of leiomyosarcoma, Dr Sinukumar of Jehangir Hospital said it was the size of the tumour that confirmed her suspicions.

“At 18 cms, it is definitely not a simple fibroid of the uterus. The patient was counselled and the possibilities were explained. The tumour was malignant, and in such cases, if a laparoscopy is done, the tumour could be minced into smaller pieces and spread even further, which can be a disastrous clinical situation in case of leiomyosarcoma. The tumour could spread intraperitoneally and is therefore associated with poor prognosis and it could have resulted in cancer,” said Sinukumar.

She further said that uterine leiomyosarcomas are extremely rare tumors and mimic benign fibroid of the uterus, but high clinical suspicion for leiomyosarcoma is required especially with larger tumours which are greater than 8 cms, with abnormal bleeding and with rapidly growing ‘fibroids’. 

“Complete removal of the uterus is obligatory for the surgical management of uterine leiomyosarcomas. We managed to avoid tumor enucleation and morcellation at all costs. This case needed an open surgery which is a gold standard to ensure the tumour comes out with the minimum contact with other parts/organs of the body. When the tumour is 18 cm, it should not be taken lightly and further investigations before surgery are advised,” said Dr Sinukumar.

The surgery took seven hours at Jehangir Hospital with an intraoperative frozen evaluation which confirmed the diagnosis of leiomyosarcoma. The patient was discharged on the fifth day after surgery and her subsequent follow-ups show no further complications or issues.