Lung Metastasis after an Eighteen-Years-Long Disease-Free Period since Uterine Leiomyosarcoma Diagnosis

Uterine leiomyosarcoma (ULMS) is an uncommon malignancy that accounts for one-third of uterine sarcomas and represents 1% of all uterine malignancies, with an incidence averaging 0.5–1/100,000/year. The prognosis is poor due to its intrinsic aggressiveness and its characteristic high metastatic potential with reported distant metastatic spread in lung, abdomen, soft tissue, and brain. We present the case of a 67-year-old woman with lung metastasis after eighteen years since uterine leiomyosarcoma diagnosis and its following surgical resection. The diagnosis of pulmonary metastases was obtained by reviewing the histology of the previous uterine tumor: the tumor cells were immunoreactive for CD10, PR, and smooth muscle actin (SMA), but negative for desmin, S100, CD34, CD 117, cytokeratins AE1AE3, CD68R, and ER. To our knowledge, this disease-free interval is the longest among previous reports of pulmonary metastasis of uterine leiomyosarcoma. 1. Introduction Uterine leiomyosarcoma (ULMS) is an uncommon aggressive uterine cancer characterized by a poor prognosis. Although these tumors are usually confined to the uterus at the time of diagnosis, there is a high incidence of recurrence. Often, patients show recurrency within 2 years from the initial diagnosis, and almost the total of these ones, in a percentage quantifiable in about 90%, develops distant metastases both alone or in association with pelvic recurrence [1]. ULMS usually metastasizes to the lungs, peritoneal cavity, and vagina, followed by the retroperitoneum, liver, and bone. The initial treatment of choice of uterine leiomyosarcoma is the surgical resection and, in addition to this, adjuvant therapy (including chemotherapy and radiotherapy) can be used to reduce the risk of recurrence, despite the fact that the clinical efficacy is still uncertain [2]. 2. Case Presentation In January 2013, a 67-year-old woman, with history of uterine leiomyosarcoma, was admitted to our department for chest discomfort. Her clinical data reported a total abdominal hysterectomy and right salpingo-oophorectomy due to the uterine tumor measuring 80？mm, both performed in 1995. The resected tumor was histologically identified as low-grade leiomyosarcoma. In fact, microscopically, it presented spindle cells with marked cytological atypia, necrosis, and a high mitotic index. The tumor cells were immunoreactive for CD10+, PR, and smooth muscle actin (SMA), but negative for desmin, S100, CD34, CD117, cytokeratins AE1AE3, CD68R, and ER. Staging imaging, performed through total body contrast enhanced CT (CECT) scan, was