Uterine leiomyosarcoma in a postmenopausal woman: a case report

Abstract

Uterine leiomyosarcoma (ULMS) is a rare but highly aggressive smooth muscle malignancy that often masquerades as benign fibroids, delaying diagnosis until advanced stages. The disease carries a grim prognosis, especially when clinical suspicion is low. We present the case of a 56-year-old multiparous, postmenopausal woman with a 20 day history of dysuria with unexpected vaginal bleeding. With no abdominal pain, postcoital bleeding, or systemic symptoms, the presentation initially appeared benign. However, imaging revealed a bulky uterus with mixed fibroid pathology and a thickened endometrium. Cytology was inconclusive for malignancy. Definitive diagnosis came from histopathological examination of endometrial curettage and a malignant fibroid polyp, revealing ULMS. Pelvic MRI confirmed lobulated anterior uterine wall lesions, pelvic lymphadenopathy, and endometrial collection. The patient underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy and lymphadenectomy. This case highlights the silent yet aggressive nature of ULMS and the importance of a high index of suspicion, even in seemingly routine gynecological presentations. Timely surgical management remains the cornerstone of care in achieving disease control.