LEIOMYOSARCOMA OF THE VAGINA

Purpose: To present a case report and review of the literature of a patient with leiomyosarcoma, a rare tumor of the vagina. Methods: A 38-year-old Caucasian female, gravida 7, para 6, presented to the hospital with vaginal bleeding from a mass in the vagina. On physical exam the mass filled the entire upper vagina. A biopsy was performed and showed a partially necrotic spindle cell tumor with atypia. The diagnosis of a leiomyosarcoma was made. Results: An ultrasound of the uterus determined that it measured 10.5 x 5.7 x 8 cm. An MRI was performed and it indicated a very large lobulated mass along the posterior aspect of the uterus. The mass appeared to originate from and partially obscure the cervix; it was well circumscribed and measured 7.5 x 4.7 x 7.3cm. The original assessment was that the patient had a large fibroid uterus with a leiomyosarcoma protruding from the cervix. A mass was detected arising from the mid portion of the right lateral vaginal wall via a 7 mm pedicle. The mass was removed with a wide radical resection. Pathology revealed a leiomyosarcoma with 21 mitotic figures per 10 high-power fields making it an aggressive sarcoma. Radiological imaging including a PET CT scan and MRI revealed no metastatic disease. The patient was presented at Tumor Board and adjuvant therapy including chemotherapy and radiotherapy was considered. Although the literature is unclear as to the benefits of radiotherapy or chemotherapy it was determined that she has had a 50-60% chance of recurrence either locally or distally, particularly in the lungs. The decision was made to give pelvic radiotherapy followed by chemotherapy in the form of Adriamycin. Conclusions: Vaginal leiomyosarcomas are uncommon with approximately 140 cases reported in the literature. This results in a lack of evidence to guide treatment modalities. The literature shows that these cancers tend to reoccur locally and undergo hematogenous metastasis into adjacent organs, specifically the lungs. The primary treatment is wide surgical resection of the tumor with post-operative consideration for radiation and/or chemotherapy. Although, there is no good evidence of the benefits of radiation or chemotherapy, due to the high incidence of local and distant recurrences radiation and/or chemotherapy is usually given.