Development of Uterine Leiomyosarcoma During Follow-up After Caesarean Section in a Woman With Uterine Leiomyoma.

BACKGROUND/AIM: During pregnancy, uterine leiomyomas may cause problems and treatment typically entails uterine conservation. However, for cases of leiomyomas larger than a particular size with some clinical symptoms, enucleation should be performed. In clinical practice, the importance of postpartum follow-up of pregnancies with uterine fibroids must be established.

PATIENTS AND METHODS

A 47-year-old female visited an obstetrics and gynecology clinic with a primary complaint of irregular bleeding. We suspected an 8.4×6.6 cm myoma uteri and recommended immediate surgery. During the next visit, a pregnancy test was positive and the patient requested a follow-up for her myoma uteri diagnosis. Because of a breech presentation, we performed an elective cesarean section (CS) at 38 weeks and 1 day. The patient's myoma uteri was stable throughout the pregnancy, and after delivery, we continued to follow her up as an outpatient.

RESULTS

Two years after the CS, the myoma uterus was 6 cm in size, and 6 months later, it had increased to 10 cm. Magnetic resonance imaging (MRI) supported a diagnosis of uterine leiomyosarcoma and she underwent surgery. Ultimately, she was pathologically diagnosed with uterine leiomyoma, uterine leiomyoma with bizarre nuclei, and uterine leiomyosarcoma following examination of the excised tissue by using molecular pathological examination with anti-cyclin E antibody and anti-Ki-67 antibody.

CONCLUSION

Notably, this case demonstrated the usefulness of cyclin E and Ki-67 as biomarkers for the malignancy of uterine mesenchymal tumors. Presently, she is being monitored for tumor recurrence and metastases on a quarterly basis. In order to detect the rapid increase in uterine mesenchymal tumor, regular follow-up after birth is important.