A 47-year-old woman comes to the physician because of a history of prolonged menstrual bleeding. The patient has had irregular menses for the past 2 years, but now she has been bleeding daily for 2 weeks. She also feels fatigued. She is sexually active with her husband and does not use contraception. Vital signs are within normal limits. Pelvic examination shows a firm, irregularly-shaped uterus The patient has completed childbearing and would like definitive treatment for her symptoms. The patient undergoes hysterectomy with bilateral salpingo-oophorectomy. The final pathology report notes nuclear atypia and numerous mitoses in the affected portion of the myometrium. Which of the following is the most likely diagnosis?

Question

A 47-year-old woman comes to the physician because of a history of prolonged menstrual bleeding. The patient has had irregular menses for the past 2 years, but now she has been bleeding daily for 2 weeks. She also feels fatigued. She is sexually active with her husband and does not use contraception. Vital signs are within normal limits. Pelvic examination shows a firm, irregularly-shaped uterus The patient has completed childbearing and would like definitive treatment for her symptoms. The patient undergoes hysterectomy with bilateral salpingo-oophorectomy.  The final pathology report notes nuclear atypia and numerous mitoses in the affected portion of the myometrium.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: Uterine sarcoma is a rare but aggressive malignant tumor of the uterine myometrium and/or endometrial stromal tissue.  Patients typically have clinical features similar to those with uterine leiomyomas (eg, abnormal uterine bleeding, immobile pelvic mass), but uterine sarcoma can be distinguished by microscopy, which typically shows characteristic malignant features such as nuclear atypia, abundant mitoses, and tumor necrosis.

A 47-Year-Old Woman Comes to the Physician Because of a History