Uterine leiomyosarcoma diagnostic challenges in a resource-limited setting: a case report and review of the literature.

introductionUterine leiomyosarcoma, constituting only 1-2% of all uterine malignancies, is a rare and aggressive cancer arising from the smooth muscles of the uterine wall. Owing to its rarity, identifying risk factors and clinical symptoms can be challenging, often leading to misdiagnosis as benign leiomyomas, particularly in settings with limited access to advanced imaging modalities. This case report presents a 40-year-old Ethiopian woman diagnosed with uterine leiomyosarcoma after presenting with nonspecific symptoms, underscoring the diagnostic difficulties associated with this malignancy in resource-limited environments. CASE PRESENTATION: A 40-year-old Nulliparous woman from North Western Ethiopia presented to the Gynecologic Outpatient Department with complaints of lower abdominal pain, intermittent vaginal bleeding, and abdominal swelling lasting 1 month. Initial imaging suggested a diagnosis of intramural myoma. She underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy, with histopathological examination confirming the diagnosis of uterine leiomyosarcoma. Unfortunately, she experienced rapid recurrence, presenting 77 days postoperation with a vaginal mass, foul-smelling discharge, and fever. Despite the suspicion of local metastasis based on magnetic resonance imaging findings, the patient was lost to follow-up before definitive treatment could be initiated. This case represents the first documented instance of uterine leiomyosarcoma in East Africa, underscoring significant diagnostic and management challenges faced in resource-limited settings. DISCUSSION: The case underscores critical diagnostic challenges, particularly the difficulty in distinguishing uterine leiomyosarcoma from benign tumors such as leiomyomas. Furthermore, it reveals the impact of limited access to advanced imaging techniques on timely diagnosis and treatment. Despite complete surgical resection, the patient's follow-up revealed rapid disease recurrence, compounded by the loss to follow-up before definitive treatment could be initiated.

conclusionThis case emphasizes the aggressive nature of uterine leiomyosarcoma and the need for heightened clinical suspicion, particularly in low-resource environments. It calls for the development of a preoperative risk assessment tool tailored to leiomyosarcoma, enabling better differentiation from benign conditions and informing surgical management. The rapid progression of this patient's disease highlights the urgent need for effective follow-up strategies and access to comprehensive oncological care in developing regions.