A Case of Leiomyosarcoma of Vaginal Vault in a Post-hysterectomy Patient

Leiomyosarcoma usually arises de novo from uterine smooth muscle, although it may rarely arise from a preexisting leiomyoma.They are usually accompanied by pain, sensation of pressure, and abnormal uterine bleeding (AUB).Rapid enlargement of fibroid or rapidly increasing pain may be a symptom too.In this case, a 62-year-old woman came to the outpatient department (OPD) with a complaint of pain abdomen for the last 3 months.She is (P2L2), post-menopausal for the last 12 years.She had a history of total abdominal hysterectomy (TAH) + bilateral salpingo-oophorectomy (BSO) 10 years back.On examination, she had a pelvic mass of 8 × 6 cm solid variegated.Outside, fine needle aspiration cytology (FNAC) report revealed it to be a spindle cell carcinoma.In our institute, tumor markers came out to be normal and contrast-enhanced computed tomography (CECT) imaging suggested a solid mass arising from vaginal vault.On laparotomy, a solid mass of 8 × 8 cm was found attached to the vaginal vault.All other organs were normal.Final holoprosencephaly (HPE) report came out to be leiomyosarcoma with immunohistochemistry (IHC) of smooth muscle antigen (SMA)-positive.