Primary vaginal leiomyosarcomas (pvLMS) are rare, recurrent tumours accounting
for ca. 2% of all vaginal cancers. The etiology is still unknown, the prognosis is poor
and there is no consensus guideline on its management. Diagnosis is usually made
during the 5th decade due to the presence of a vaginal mass or nodule [1-2]. Current
medical literature reports about 200 cases (PubMed®); only 3 studies have considered
the ultrastructure [2-4]. Herein a pvLMS is presented and discussed. A nodular, 25 x
23 x 28 mm-mass, infiltrating the urethra but not the rectovaginal septum, was widely
excised from the superior vaginal wall of a 58-year-old previously hysterectomized
woman. Macroscopic images and MRI were performed. Iliac lymph nodes and HMB45
were negative. The sample was fixed and prepared for light microscopy, transmission
(TEM) and scanning (SEM) electron microscopy. Semithin sections showed
a storiform pattern of spindle shaped cells with blunt-ended nuclei. Cells arranged
in interwoven fascicles within a dense and richly vascularised stroma (neoangiogenesis).
Some atypic mitotic figures and focal necrosis were seen. SEM evidenced a
dense collagenous stroma with numerous microvessels. TEM showed neoplastic and
pleomorphic cells with complex cytoplasm projections containing paranuclear crowds
of dilated mitochondria, free ribosomes and a well-developed rough endoplasmic
reticulum. Nuclei were large, mostly hyperchromatic, usually indented, with prominent
nucleoli and nucleolonema. The dense intercellular space contained dense bundles
of collagen fibers. A high and reactive endothelium lined blood vessels. After 4
follow-ups, the patient is fine and without recurrence. Best outcomes occur when the
tumour is small, localized, and can be removed surgically with wide, clear margins,
as it was for this case. As there are different kinds of LMS, biopsy followed by immunohistochemistry
and electron microscopy still represents a good diagnostic choice.
References
[1] Umeadi et al. (2008) Vaginal leiomyosarcoma. J Obstet Gynaecol 28(5): 553-554.
[2] Tobon et al. (1973) Primary leiomyosarcoma of the vagina. Light and electron microscopic observations.
Cancer 32(2): 450-457.
[3] Akhtar et al. (1978) Primary leiomyosarcoma of the vagina: light and electron microscopic study of
a case with review of literature. Tex Med 74(9): 67-71.
[4] Rastogi et al. (1984) Primary leiomyosarcoma of the vagina: a study of five cases. Gynecol Oncol
18(1): 77-86
