Stage IIIC Primary Ovarian Leiomyosarcoma Treated With Debulking Surgery and Chemotherapy

What happened, in summary

A woman in her late 40s had experienced lower abdominal pain and uterovaginal prolapse for 5 years. Ultrasound showed a 10 by 12 cm tubo-ovarian mass, and examination confirmed a large, poorly mobile pelvic tumor. At surgery, the right ovarian mass measured about 10 by 15 cm. Multiple tumor deposits were present on the fallopian tube, bladder peritoneum, bowel, mesentery, sigmoid colon, rectum, and parietal peritoneum. A larger 15 by 20 cm mass involved the ileum.

She underwent staging laparotomy, hysterectomy, removal of both ovaries and fallopian tubes, omentectomy, metastasectomy, and extensive tumor debulking. A 10 cm segment of ileum was removed and reconnected. The operation lasted 4.5 hours, involved about 1 L of blood loss, and required 2 units of packed red blood cells. Her postoperative recovery was uncomplicated, and she was discharged on day 8.

Pathology confirmed primary right ovarian leiomyosarcoma, FIGO stage IIIC. Tumor cells were positive for smooth muscle antigen and caldesmon, with a Ki-67 index of 15%–20%. She began adjuvant doxorubicin and ifosfamide on postoperative day 24, with 6 cycles planned every 3 weeks. She reported that her symptoms improved after surgery and that treatment began promptly.