A 45-year-old patient with a history of chronic hypertension treated with atenol (50 mg/day) and hydrochlorothiazide 12.5 mg + triamterene 25 mg three times a week.
Two children were multiparous, using an intrauterine device (T copper, for 7 years).
She presented with long-standing hypermenorrhea and dysmenorrhea of progressive intensity and resistant to medical treatment (non-steroidal anti-inflammatory drug withdrawal and intrauterine device withdrawal).
Physical examination revealed a nodular enlarged uterus (±15 weeks) with normal annexes.
Trans-aginal ultrasonography was requested, which confirmed the presence of multiple myomas, the largest in the uterine fundus 4 cm in diameter.
Blood count showed significant iron deficiency anemia (Hto.
26%).
Given the size of the fibroids and associated symptoms (hypermenorrhea, severe secondary anemia, dysmenorrhea and severe dyspareunia), surgical treatment was decided.
A total hysterectomy with preservation of annexes was performed on 21 July 2003.
There was only evidence of multiple fibroids, with no other significant findings.
He was discharged in good condition with oral iron supplementation.
The anatomopathological study revealed an 8 cm diameter uterine leiomyosarcoma with a high mitotic index (46 to 62 mitosis per 10 fields of increase) and a high number of atypias.
Immunohistochemical study was positive for aquena and desmin in tumor cells.
With these findings she was referred to our Cancer Center, being evaluated by gynecologic oncology, requiring a dissemination study.
Chest computed tomography showed a pulmonary nodule in the left upper lobe, with no evidence of other secondary locations.
The nodule was resected and discussed in the oncological committee.
On September 23, 2003, a left nodule was excised and two pulmonary nodules were resected.
The pathological study confirmed the presence of pulmonary metastases of uterine leiomyosarcoma in both.
It was subsequently decided to maintain strict follow-up.
He remained in good condition, performing normal life and reintegrating to work.
A new small nodule in the left lower lobe was observed in February 2004.
The case of strict follow-up and surgical resection in case of progression was discussed again in the Oncological Committee.
The patient remained in good condition until the end of 2004, when the pulmonary nodule grew, with no evidence of other secondary lesions.
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Therefore, in March 2005, a left re-thoracotomy and resection of metastases were performed.
The anatomopathological study confirmed the complete resection of two pulmonary metastases of leiomyosarcoma.
The patient remained asymptomatic and remained under strict follow-up.
In mid-2006, two new pulmonary nodules were detected in the left lower lobe, with no evidence of metastatic disease in other locations.
A new resection of metastases was performed in July 2006. Two new metastases were resected.
From that date to the present, it has remained in good general condition, completing 36 months of follow-up.
