Primary ovarian leiomyosarcomas is a rare neoplasm which comprises less than 3% of ovarian tumors. Their origin, etiology, histologic features, clinical behavior, and optimal treatment are still obscure. We report a case of leiomyosarcoma of ovary, diagnosed on histopathology in a 60 year old female and discuss the literature

Kaul, R

Sharma, J

English

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Case Report:
Primary Leiomyosarcoma of Ovary 
Rashmi Kaul, Senior Resident,
Jaishree Sharma, Ex-Professor & Head
Department of Pathology, Indira Gandhi Medical College, Shimla - 171001, Himachal Pradesh
Address For Correspondence:
Dr Rashmi Kaul
Fire Officers Building, Stokes Place,
Shimla (H.P) 171002, India
E-mail: shivanshraina@yahoo.co.in
Citation: Kaul R, Sharma J. Primary Leiomyosarcoma of Ovary. Online J Health Allied Scs. 2009;8(3):16
URL: http://www.ojhas.org/issue31/2009-3-16.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Jul 20, 2009; Accepted: Aug 18, 2009 Published: Nov 15, 2009
Abstract:
Primary ovarian leiomyosarcomas is a  rare neoplasm which 
comprises less than 3% of ovarian tumors.  Their origin,  eti-
ology, histologic features, clinical behavior, and optimal treat-
ment are still obscure. We report a case of leiomyosarcoma of 
ovary,  diagnosed on histopathology in a 60 year old female 
and discuss the literature.
Key Words: Ovary, Leiomyosarcoma, Ovarian neoplasms
Introduction:
Primary ovarian sarcomas are rare gynecological tumors ac-
counting for less than 3% of all ovarian tumors.[1,2] These 
malignant  smooth  muscle  tumors  have  an  uncertain  origin, 
since smooth muscle is not present in the ovary. Behavior is 
aggressive with a poor prognosis particularly in the postmeno-
pausal woman, where these neoplasms usually occur. Primary 
ovarian sarcomas are usually diagnosed at an advanced stage 
and may present with abdominal pain and a mass. These neo-
plasms are rare with less than 50 cases in the literature.[1] Be-
cause of  its  extreme rarity;  we present this  case  of  ovarian 
neoplasm in a postmenopausal woman. Literature of primary 
leiomyosarcoma of the ovary is reviewed.
Case Report:
A 60 year old female, para six, postmenopausal for 20 years, 
was  admitted  in  the  gynecology  department  of  our  hospital 
with complaints of having lower abdominal mass for last five 
months. She was found anemic on general physical examina-
tion.  On per vaginum examination  a mass was felt  in  right 
fornix of variegated consistency with restricted mobility and 
was non tender. On per rectal examination, mass was felt from 
anterior  rectal  wall  but  rectal  mucosa  was  free.  Her  hemo-
globin  was  7.2 gm%.  Hematological  and biochemical  para-
meters including tumor marker CA-125 were normal. Cervical 
PAP smear was also normal. Transabdominal sonography con-
firmed  the  presence  of  a  12.8x10.3 cm pelvic  mass  arising 
from right  adnexa with cystic  and solid  areas,  separated by 
septations. There was no evidence of metastasis or free fluid in 
the pelvis. At laparotomy,  right ovary was replaced by a fri-
able  growth  of  25×20 cm size  with  capsule  ruptured,  solid 
areas  and  papillary  excrescences  present.  Tumor  was  in-
volving 20cm of gut loop in ileal portion. Uterus, left fallopian 
tube and left ovary were grossly normal.
Total  abdominal  hysterectomy  with  bilateral  salpingo-oo-
phorectomy along with ileo-ileal anastmosis was performed.
Figure  1:  Photomicrograph  showing  pleomorphic  tumor 
cells, high mitotic activity and tumor giant cells along with 
a focus of necrosis. (400x, H&E.)
Peritoneal washings with omental biopsy were taken. Micro-
scopic examination demonstrated ovarian stroma replaced by 
highly vascular tumor, pleomorphic spindle shaped cells, in-
creased mitotic  activity  (greater than 10 per 10 high power 
fields), tumor giant cells and necrosis.(Fig-1) The pleomorphic 
cells had abundant eosinophilic cytoplasm with vesicular nuc-
lei and prominent nucleoli. Van Gieson’s and Masson’s trich-
ome stains helped to confirm the smooth muscle origin. Mi-
croscopic examination of left ovary revealed normal ovarian 
stroma along with foci of whorled bundles of benign smooth 
muscle cells, depicting features of leiomyoma. No leiomyoma 
were detected in sections taken from uterus and tubes.[2] Peri-
toneal washing, omental biopsy and gastrointestinal tract mu-
cosa was normal on histopathology.
Discussion:
The most common primary ovarian sarcomas are fibrosarco-
mas, endometrial stromal sarcomas, and rhabdomyosarcoma.
[3,4] Primary ovarian leiomyosarcomas usually occur in post-
menopausal women although there have been a few reported 
cases  occurring  in  younger  women.[1,3]  They  typically 
present as a solitary, lobular, soft fleshy solid mass with hem-
orrhage  and cystic  degeneration.  Most  are unilateral  lesions 
greater  than  one  cm in  diameter.  Pathogenesis  is  uncertain 
with  many theories  including  malignant  degeneration  of  an 
ovarian leiomyoma,  or  of  the smooth muscle  present in the 
1
This work is licensed under a Creative 
Commons Attribution-No Derivative Works 
2.5 India License
Online Journal of Health and Allied Sciences
Peer Reviewed, Open Access, Free Online Journal
Published Quarterly :  Mangalore, South India : ISSN 0972-5997
Volume 8, Issue 3; Jul-Sep 2009
wall  of  the  blood  vessels  in  the  cortical stroma  and corpus 
luteum, muscular attachments of the ovarian ligament, wolfian 
duct remnants, or totipotential ovarian mesenchyme, or arising 
in a teratoma.[1] Treatment of choice is radical surgery fol-
lowed by adjuvant chemotherapy or radiotherapy.[4]
References:
1. Bouie  SM,  Cracchiolo  B,  Heller  D.  Epithelioid 
leiomyosarcoma of  the ovary. Gynecologic Onco-
logy 2005;97:697–9.
2. Dixit S, Singhal S, Baboo H, Vyas RK, Neema JP, 
Murthy R et al.  Leiomyosarcoma  of  the ovary. J 
Postgrad Med 1993;39:151–3
3. Friedman HD, Mazur M. Primary ovarian leiomy-
osarcoma.  An  immunohistochemical  and  ultra-
structural  study. Arch  Pathol  Lab 
Med 1991;115:941–5.
4. Kurian RR, Preethi J, Remadevi AV. Leiomyosar-
coma of ovary- a case report. Indian J Pathol Mi-
crobiol 2005;48:19-20
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