Epithelioid leiomyosarcoma of uterine cervix: A case report with immunohistochemical study

Primary epithelioid leiomyosarcoma of uterine cervix (UC) has rarely been reported. A 90-year-old woman presented abnormal uterine bleedings. Colposcopy revealed erosions of cervix, and biopsy was taken. It showed proliferation of atypical spindle and epithelioid cells with hyperchromatic nuclei and prominent nucleoli. Mitotic figures including atypical mitosis were noted. The histological features were apparent malignancy. The gradual merges between epitheliod malignant cells and malignant spindle cells were seen. Immunohistochemically, both elements (spindle and epithelioid) were positive for vimentin, α-smooth muscle actin, smooth muscle actin (HHF-35), h-caldemon, cytokeratin (CK) AE1/3, CK CAM5.2, CK WSS, CK8, CK18, CK19, p53 and Ki67 (labeling index = 57%). They were negative for S100 protein, NSE, NCAM, synaptophysin, chromogranin, desmin, CK34BE12, CK5, CK6, CK7, CK14, CK20, CD1a, CD99, CD31, factor VIII-related antigen, CD34, HMB45, KIT, PDGFRA, CA125, CA19-9, CEA, bcl-2, CD3, CD20, CD45, CD138, and myoglobin. The tumor histologically showed epithelioid and mesenchymal features, and immunohistochmeically the tumor was positive for vimentin, smooth muscle markers, and CK. The following three possibilities of pathological diagnosis were considered; epithelioid leiomyoma, sarcomatoid carcinoma, and epithelioid carcinoma. The author stressed the expressions of various smooth muscle antigens, and diagnosed this tumor as epithelioid leiomyosarcoma. The patient refused operation and chemo-radiation. The patient showed no metastatic lesions, but died of pneumonia three years after the diagnosis at the age of 93 years. This is a rare case report of epithelioid leiomyosarcoma in UC.