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LETTER TO EDITOR Table of Contents   
Year : 2008  |  Volume : 51  |  Issue : 3  |  Page : 448-449
Leiomyosarcoma of the vulva


1 Department of Pathology, Sri Venketeswar Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh, India
2 Department of Obstetrics and Gynecology, Maternity Hospital, Tirupati - 517 507, India
3 Department of Radiation Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh, India
4 Department of Medical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh, India
5 Department of Surgical Oncology, Sri Venketeswar Institute of Medical Sciences, Tirupati - 517 507, Andhra Pradesh, India

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How to cite this article:
Patnayak R, Manjulatha B, Srinivas S, Reddy M K, Sambasivaiah K, Jena A. Leiomyosarcoma of the vulva. Indian J Pathol Microbiol 2008;51:448-9

How to cite this URL:
Patnayak R, Manjulatha B, Srinivas S, Reddy M K, Sambasivaiah K, Jena A. Leiomyosarcoma of the vulva. Indian J Pathol Microbiol [serial online] 2008 [cited 2019 Dec 10];51:448-9. Available from: http://www.ijpmonline.org/text.asp?2008/51/3/448/42525


Sir,

Leiomyosarcoma of the vulva is a rare malignant neoplasm showing smooth muscle differentiation, comprising approximately 1% of vulvar cancers. [1] The majority of the reported cases, in the literature, are from the Western countries.

A 47-year-old, gravida 5, para 5, postmenopausal woman, presented with a 2-month history of 6.0 × 5.0 cm, ulcerated growth in the left labia majora. The growth was rapidly increasing in size for the past 1 month. There was no history of recent operation at that site.

Macroscopically, the lesion was 6.0 × 5.0 × 4.0 cm. Cut section of the mass revealed whorly and whitish areas [Figure 1]. Microscopically, the mass showed criss-cross and whorly spindle cell fascicles exhibiting nuclear pleomorphism, frequent mitotic activity (2-3/high-power field) with atypical mitotic figures [Figure 2] and giant tumor cells. However, there was no area of necrosis. The tumor margins were infiltrative in nature. Immunohistochemistry with smooth muscle actin showed positivity in the tumor cells.

Primary sarcoma of the vulva is rare. The most common histologic variant is leiomyosarcoma. [2],[3] According to Nielsen et al, tumors that manifest three or all of the four following features should be considered as sarcomas: 5 cm or more in the greatest dimension, infiltrative margins, five or more mitotic figures per 10 high-power fields and moderate-to-severe cytologic atypia. [4] The present tumor satisfied all the above criteria. Leiomyosarcomas should be differentiated from the post-operative spindle cell nodule, which can be mitotically active and may infiltrate the underlying tissue. History of recent operation at the same site usually gives the vital clue for the diagnosis of post-operative spindle cell nodule. [5] Surgical excision is the primary treatment, wherever possible. For residual tumor, combined chemotherapy and radiotherapy is advocated. Currently, the patient is receiving radiotherapy and is stable.

The present case is a rare case of leiomyosarcoma of the vulva. We would like to add another case of leiomyosarcoma of the vulva to the existing published cases, so that this could be considered in the differential diagnosis of mitotically active spindle cell lesions.


   Acknowledgments Top


The authors wish to thank senior technicians Mrs. Ushanandini and Mr. Ramana for their help.

 
   References Top

1.Behranwala KA, Latifaj B, Blake P, Barton DP, Shepherd JH, Thomas JM. Vulvar soft tissue tumors. Int J Gynecol Cancer 2004;14:94-9.  Back to cited text no. 1  [PUBMED]  
2.Curtin JP, Saigo P, Slucher B, Venkatraman ES, Mychalczak B, Hoskins WJ. Soft-tissue sarcoma of the vagina and vulva: A clinicopathologic study. Obstet Gynecol 1995;86:269-72.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]
3.Manson CM, Hirsch PJ, Coyne JD. Post-operative spindle cell nodule of the vulva. Histopathology 1995;26:571-4.  Back to cited text no. 3  [PUBMED]  
4.Nielsen GP, Rosenberg AE, Koerner FC, Young RH, Scully RE. Smooth-muscle Tumors of the Vulva: A clinicopathological Study of 25 cases and review of the literature. Am J Surg Pathol 1996;20:779-93.  Back to cited text no. 4  [PUBMED]  [FULLTEXT]
5.Ulutin HC, Zellars RC, Frassica D. Soft tissue sarcoma of the vulva: A clinical study. Int J Gynecol Cancer 2003;13:528-31.  Back to cited text no. 5  [PUBMED]  [FULLTEXT]

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Correspondence Address:
Rashmi Patnayak
Department of Pathology, Sri Venketeswar Institute of Medical Sciences, Tirupati, Andhra Pradesh - 517 507
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.42525

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