Spontaneous rupture during observation for degenerated uterine leiomyoma revealing uterine leiomyosarcoma: a case report

This case report describes a 47-year-old premenopausal woman who presented with abdominal discomfort and had been previously monitored for a suspected uterine leiomyoma. MRI revealed a 15 cm mass within the uterine body and slight intratumoural haemorrhage. One month later, the patient presented with acute abdominal pain and was admitted to the hospital. Contrast-enhanced CT and MRI scans showed significant tumour enlargement to 20 cm, with disruption along the left margin, haemorrhagic ascites, and potential dissemination to the omentum. Total hysterectomy, bilateral salpingo-oophorectomy, and retroperitoneal lymph node dissection revealed uterine leiomyosarcoma with extensive necrosis and rupture. Pathological examination classified the tumour as stage IIB under the International Federation of Gynecology and Obstetrics system, with confirmed omental metastasis. Despite adjuvant chemotherapy, the patient experienced pelvic recurrence 10 months later and died 15 months postoperatively. This case emphasizes the importance of prompt gynaecological intervention for uterine masses exceeding 10 cm, as the risk of rupture increases, particularly when malignancy cannot be excluded based on imaging. Rupture in such cases is associated with a higher risk of recurrence and poor prognosis, making early surgical resection a reasonable consideration. Radiologists should actively communicate these risks to gynaecologists to facilitate timely surgical decision-making and improve patient outcomes.