Abstract
Background: Leiomyosarcoma is a malignant mesenchymal neoplasm of smooth-muscle differentiation that accounts for 10% to 20% of all soft tissue sarcomas. Uterine leiomyosarcoma is well recognized to metastasize secondarily to the ovary in approximately 2% to 5% of cases. In contrast, ovarian metastasis originating from a leiomyosarcoma of extrauterine soft tissue (for example, an extremity or the retroperitoneum) has not, to our knowledge, been confirmed histopathologically in the indexed literature reviewed for this report.
Case Presentation: We describe a 66-year-old woman who presented with a six-month history of a left thigh mass, previously resected elsewhere with pathology showing a malignant spindle-cell neoplasm. Staging computed tomography, obtained approximately four months after that resection, incidentally revealed a solid-cystic pelvic mass, and core-needle biopsy of the thigh lesion confirmed high-grade leiomyosarcoma. The patient underwent exploratory laparotomy with resection of a right ovarian mass; intraoperative (frozen section) pathology identified a sarcoma, prompting total abdominal hysterectomy, left salpingo-oophorectomy, and excision of nodules within the prior thigh surgical bed. Final pathology confirmed the right ovarian lesion as a high-grade sarcoma (9.5 x 4.4 x 2.5 cm) concordant with the primary thigh leiomyosarcoma, consistent with metastasis (staged pT4N0M1, grade 3, stage IV); the uterus and left adnexa were free of malignancy, and the thigh nodule proved benign. Over the following year, the patient developed two further local recurrences (pubic and thigh), each managed with wide resection and radiotherapy. At last follow-up, the tumor board favored palliative reirradiation over hemipelvectomy for the most recent thigh recurrence; the patient remains alive with disease, currently partway through this course of palliative radiotherapy.
Conclusion: This case suggests that leiomyosarcoma of extrauterine soft tissue origin can, in rare instances, metastasize to the ovary independently of uterine involvement, a pattern essentially the reverse of the more commonly reported spread from uterine leiomyosarcoma to the ovary. Confirming true metastasis through immunohistochemical and pathological correlation with the primary tumor, as performed here, is essential to exclude an independent primary ovarian leiomyosarcoma. Awareness of this atypical pattern may prompt earlier gynecologic imaging during staging of extremity or retroperitoneal leiomyosarcoma.