title: Uterine sarcoma with ambiguous histomorphology: A case report.
abstract: BACKGROUND
  Leiomyosarcomas (LMS) and endometrial stromal sarcomas (ESS) may display overlapping histomorphology, which may challenge diagnostic accuracy. Since LMS and ESS have vastly different clinical behavior and adjuvant therapy recommendations, accurate diagnosis is critical.
  
  
  METHODS
  We present the case of an 83-year-old female with postmenopausal bleeding who underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for clinically atypical appearing leiomyomata. Histologically, dual populations of cells with morphologic features of low-grade ESS and high-grade spindle cell sarcoma were seen. Immunohistochemistry and molecular studies revealed the cells to be of smooth muscle derivation, rendering a diagnosis of high-grade LMS with heterogeneous morphology (stage IB). The patient received adjuvant gemcitabine plus docetaxel. She recurred 8 months after completion of chemotherapy and was transferred to hospice care.
  
  
  CONCLUSIONS
  Ancillary studies, such as immunohistochemistry and molecular testing, aid in accurate subcategorization of uterine sarcomas with ambiguous histomorphology.
authors.affiliation: Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
authors.forename: Eirwen M
authors.initials: EM
authors.lastname: Miller
authors.affiliation: Department of Pathology & Laboratory Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
authors.forename: Yumei
authors.initials: Y
authors.lastname: Fu
authors.affiliation: Department of Obstetrics & Gynecology and Women's Health, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
authors.forename: Ruben Barrera
authors.initials: RB
authors.lastname: Vera
authors.affiliation: Division of Gynecologic Oncology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
authors.forename: Gary L
authors.initials: GL
authors.lastname: Goldberg
authors.affiliation: Department of Pathology & Laboratory Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY 10461, United States.
authors.forename: Rouzan G
authors.initials: RG
authors.lastname: Karabakhtsian
keywords: Endometrial stromal sarcoma; Histomorphology; Immunohistochemistry; Leiomyosarcoma; Molecular testing; Uterine sarcoma