Key result
A 90-year-old woman was diagnosed with rare primary epithelioid leiomyosarcoma of the uterine cervix and died of pneumonia 3 years later without metastatic lesions.
Case Report (n=1)
This case report describes a rare presentation of primary epithelioid leiomyosarcoma of the uterine cervix in a 90-year-old woman, highlighting its immunohistochemical profile.
Supports awareness of indolent primary cervical epithelioid leiomyosarcoma; leaves open evidence-based management strategies.
Primary epithelioid leiomyosarcoma of uterine cervix (UC) has rarely been reported. A 90-year-old woman presented abnormal uterine bleedings. Colposcopy revealed erosions of cervix, and biopsy was taken. It showed proliferation of atypical spindle and epithelioid cells with hyperchromatic nuclei and prominent nucleoli. Mitotic figures including atypical mitosis were noted. The histological features were apparent malignancy. The gradual merges between epitheliod malignant cells and malignant spindle cells were seen. Immunohistochemically, both elements (spindle and epithelioid) were positive for vimentin, -smooth muscle actin, smooth muscle actin (HHF-35), h-caldemon, cytokeratin (CK) AE1/3, CK CAM5.2, CK WSS, CK8, CK18, CK19, p53 and Ki67 (labeling index = 57%). They were negative for S100 protein, NSE, NCAM, synaptophysin, chromogranin, desmin, CK34BE12, CK5, CK6, CK7, CK14, CK20, CD1a, CD99, CD31, factor VIII-related antigen, CD34, HMB45, KIT, PDGFRA, CA125, CA19-9, CEA, bcl-2, CD3, CD20, CD45, CD138, and myoglobin. The tumor histologically showed epithelioid and mesenchymal features, and immunohistochmeically the tumor was positive for vimentin, smooth muscle markers, and CK. The following three possibilities of pathological diagnosis were considered; epithelioid leiomyoma, sarcomatoid carcinoma, and epithelioid carcinoma. The author stressed the expressions of various smooth muscle antigens, and diagnosed this tumor as epithelioid leiomyosarcoma. The patient refused operation and chemo-radiation. The patient showed no metastatic lesions, but died of pneumonia three years after the diagnosis at the age of 93 years. This is a rare case report of epithelioid leiomyosarcoma in UC.
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Tadashi Terada (2016) conducted a case report in Epithelioid leiomyosarcoma of uterine cervix (n=1). Biopsy and immunohistochemical study was evaluated on Pathological diagnosis and clinical course. A 90-year-old woman was diagnosed with rare primary epithelioid leiomyosarcoma of the uterine cervix and died of pneumonia 3 years later without metastatic lesions.
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