Uterine diverticulum mimicking endometriotic cyst of the ovary.

Uterine diverticulum is a rare congenital malformation caused by abnormal fusion of the Müllerian ducts. The diagnosis of uterine diverticulum is difficult, and it is often misdiagnosed as a Müllerian duct anomaly, degenerated uterine fibroid, or ovarian cyst. We herein report a case of uterine diverticulum mimicking an ovarian endometriotic cyst. A multiparous woman with a history of normal vaginal delivery underwent magnetic resonance imaging for investigation of lower abdominal pain and fever. A 155-mm cystic lesion was observed on the ventral side of the uterus. The content of the cyst showed high signal intensity on T1- and T2-weighted images with precipitates of low signal intensity on the dorsal side, suggesting an endometriotic cyst of the ovary. Surgical and pathological findings revealed that the cyst was pedunculated from the anterior uterine body and composed of 3 layers: CD10-positive endometrium, a smooth muscle layer, and serosa. A uterine diverticulum was definitively diagnosed.

Diagnosis of Leiomyosarcoma after Uterine Artery Embolization for Multiple Leiomyomas.

Uterine sarcoma is significantly rarer than leiomyoma and has poor prognosis. Moreover, the diagnosis of leiomyosarcoma is difficult because its symptoms, including pelvic pain, uterine mass, and/or uterine bleeding, are very similar to those of leiomyoma. There are a few cases of leiomyosarcoma wherein leiomyoma was treated with uterine artery embolization (UAE); these reports revealed that the symptoms of hypermenorrhea or/and pelvic pain persisted even after UAE. Symptoms persisting even after UAE treatment for leiomyomas, especially multiple leiomyomas, should be investigated to rule out leiomyosarcoma. Therefore, long-term follow-up is needed. Here, we describe a case of a 39-year-old woman diagnosed with leiomyosarcoma 3 years after undergoing UAE for multiple leiomyomas.

A Case of Uterine Leiomyosarcoma with Long-Term Disease Control by Pazopanib.

Uterine leiomyosarcoma (ULMS) is an aggressive tumor associated with high rates of progression, recurrence, and mortality. Pazopanib is the only approved molecular targeted drug for advanced soft tissue sarcoma, and it has been proven to prolong progression-free survival relative to placebo. We herein report a case of ULMS with multiple lung metastases treated with pazopanib, which led to sustained disease control for 44 weeks. A 53-year-old woman was referred to our hospital due to massive uterine bleeding from a uterine corpus tumor mass. Total abdominal hysterectomy with bilateral salpingo-oophorectomy was performed as emergency surgery. The final histopathological diagnosis was uterine leiomyosarcoma, and computed tomography revealed multiple lung metastases. After chemotherapy with 17 cycles of gemcitabine and docetaxel and two cycles of doxorubicin, the lung metastases had increased in size and new lesions had appeared. Pazopanib administration at 800 mg/day was started as third-line therapy. Ten weeks later, the dose of pazopanib was reduced to 600 mg/day because of hepatic impairment and hypertension. However, lung metastases of ULMS were stabilized by pazopanib administration for about 44 weeks without a decline in the patient's quality of life. After 44 weeks of therapy, pazopanib administration was discontinued because of progressive disease and worsening of the patient's respiratory status. Pazopanib is an oral multityrosine kinase inhibitor of vascular endothelial growth factor receptor-1, -2, and -3; platelet-derived growth factor-α and -ß; and c-Kit receptor. The role of pazopanib may be clinically significant in the treatment of advanced ULMS.