Abstract
Locally advanced high-grade leiomyosarcomas (LMS) with visceral involvement are difficult
to manage. Here, we present a case of locally advanced high-grade sarcoma where total
pelvic exenteration was undertaken to achieve complete cytoreduction. A 54-year-old
lady with a prior history of hysterectomy and bilateral salpingoophorectomy done 8
years back for heavy menstrual bleeding presented to us with an abdomino-pelvic mass.
Magnetic resonance imaging of the abdomen suggested large heterogeneous pelvic mass
displacing urinary bladder anteriorly and abutting recto-sigmoid posteriorly with
no luminal involvement. There was bilateral hydronephrosis. Computed tomography of
the thorax revealed no evidence of metastatic disease. A review of previous biopsy
and a repeat ultrasound-guided biopsy from the pelvic mass done at our institute suggested
spindle-cell neoplasm. In view of pelvis confined disease in a young woman with well-preserved
general condition, decision for surgical excision was taken. She underwent total pelvic
exenteration with en bloc removal of mass, bladder, and involved portion of recto-sigmoid as the disease was
infiltrating both the bladder and the recto-sigmoid. Her postoperative course was
turbulent, but she recovered fully and was discharged 20 days after surgery. The operative
specimen histopathology revealed high-grade LMS. She received four cycles of adjuvant
chemotherapy and thereafter was kept on follow-up. Although she was clinically doing
well, her general condition never improved beyond Eastern cooperative oncology Group
2. She also had persistent depressive symptoms. After 14 months of completion of treatment,
she recurred with a huge abdominal disease. In view of her general condition and huge
disease volume, decision was taken for supportive care only. LMS in advanced stages
are difficult to manage. Even after aggressive management with radical exenterative
surgery and chemotherapy, we could achieve only temporary control of locally advanced
LMS.
Keywords
Chemotherapy - exenteration - extrauterine - leiomyosarcoma
