PMC4406529_01
Ultrasonography of whole abdomen and pelvis showed a large mass occupying whole of pelvis just superior to fundus of uterus (not arising from the uterus).
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There was also moderate free fluid seen in the peritoneal cavity with moving internal echoes (Figure 1a-b).
Chest x-ray PA digital view did not reveal any major abnormalities except for marginal increase of cardiac size in transverse diameter.
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The chest x-ray did not reveal any major abnormalities except for marginal increase of cardiac size in transverse diameter without any clinical cardiac abnormalities (Figure 2).
MRI of pelvis (coronal, sagittal, and transverse view) shows large oval well-defined mass lesion occupying whole of pelvis just superior to fundus of uterus (not arising from the uterus indicated by arrow mark).
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On the basis of these findings, a provisional diagnosis of leiomyoma, possibly pedunculated, was made (Figure 3a-c).
Cut section of right ovary specimen shows variegated appearance with focal areas of hemorrhage.
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The patient underwent laparotomy followed by right salpingo-oophorectomy and peritoneal lavage with perioperative findings revealing 15 cm x 15 cm ovarian mass with clotted blood (Figure 4a-b), areas of hemorrhage, and necrosis.
Photomicrograph showing oval to spindle cells with mild to moderate pleomorphism and high mitotic activity, H & E stain (200X).
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Finally the patient was diagnosed as primary leiomyosarcoma of right ovary based on histopathological examination and immunohistochemistry (Figure 5).
Photomicrograph showing tumour cells showing SMA positivity (200X).
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Immunohistochemistry of the tissue revealed positive for vimentin (Figure 6b), smooth muscle actin (Figure 6a), desmin, and it was negative for inhibin.
Photomicrograph showing tumour cells showing vimentin positivity (20X).
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Six months after the treatment completion, the patient is on regular follow-up and is disease-free on clinical and radiological examination (Figure 7a-c).