Unveiling the hidden aggression: a rare case of uterine leiomyosarcoma and its diagnostic dilemmas

Abstract

Introduction and importance: Uterine leiomyosarcoma (uLMS) is a rare and highly aggressive malignancy of the uterine myometrium, accounting for only 1-2% of uterine cancers. Due to its nonspecific presentation and the difficulty in distinguishing it from benign conditions, preoperative diagnosis remains challenging. Advanced diagnostic tools and clinical vigilance are crucial to improving outcomes for affected patients. Case presentation: A 39-year-old woman with a 3-year history of progressive abdominal pain and a palpable mass was diagnosed with a large uterine mass. Imaging suggested a pedunculated leiomyoma with potential malignant features. Exploratory laparotomy revealed a mass compressing adjacent structures, which was completely resected. Histopathology confirmed uLMS. The patient recovered well and had no recurrence at 6 months of follow-up. Clinical discussion: This case underscores the diagnostic and therapeutic challenges of uLMS, which often mimics benign leiomyomas on imaging. Surgical resection remains the cornerstone of treatment, with histopathological confirmation being essential for diagnosis. Adjuvant therapies have limited efficacy, highlighting the need for personalized management strategies. Conclusion: Early diagnosis and timely surgical intervention are essential for optimal management of uLMS. The development of improved diagnostic modalities and targeted therapies is necessary to enhance patient outcomes for this rare malignancy.