Uterine Sarcoma Simulating Placenta Praevia

Abstract

BY AND SARCOMA of the uterus is a rare tumour, and the great rarity of uterine sarcoma associated with pregnancy is indicated by the fact that search of the literature revealed 9 cases only of this association since 1870. Der Brucke (1 933) found 3 cases recorded in the preceding 60 years. In the first of these, described by Bernardy in 1885, pregnancy ended in abortion in the fifth month, the patient dying shortly afterwards of secondary spread of the tumour. The diagnosis in this case is open to question, as the tumour was said to be "adenosarcoma". In the second case, reported by Eastman in 1897, a 3-months pregnancy was found to be complicated by fibrosarcoma. Panhysterectomy was performed. The third case, described by Nisot in 1922, was diagnosed during the fourth month of pregnancy. Sarcomatous change had occurred in a pedunculated fibroid. Subtotal hysterectomy was performed. The final outcome of the second and third cases is not recorded.To these, Der Brucke (1933) added a fourth case, in which myosarcoma was found in a pedunculated uterine fibroid, which had undergone torsion, and had been removed by myomectomy during the fourth month of pregnancy. Five months later, spontaneous vertex delivery of a normal child occurred. Postnatal examination of the mother revealed no abnormality. Hesseltine (1930) records a case of endometrial sarcoma, diagnosed on the nineteenth day of the puerperium. Panhysterectomy was performed, and a course of deep X-ray therapy was administered. The patient was well 7 months later.

Inflammatory Myofibroblastic Tumor of the Placenta

“…The remaining sarcomas that have been reported involving the placenta either do not resemble IMT (40,41) or the reports predate current classification systems, and their diagnosis cannot be verified (42). Of interest, a coexisting leiomyosarcoma that was discovered at the time of cesarean section has been reported, but it did not involve the placenta (43). Certainly leiomyosarcoma, especially a myxoid leiomyosarcoma, could enter into the differential diagnosis of an IMT, but the latter should be well circumscribed compared with the diffuse infiltrative pattern of a leiomyosarcoma.…”