High grade sarcoma with chondrosarcomatous differentiation in primary uterine leiomyosarcoma; A rare case and review of literature

Primary uterine leiomyosarcoma (LMS) with chondrosarcomatous differentiation is extremely rare. We report a case of a 68-year-old, African American woman who presented with postmenopausal bleeding. Ultrasonography (USG) revealed multiple uterine fibroids. Total abdominal hysterectomy with bilateral salpingo-oophorectomy (TAH/BSO) was performed. Microscopic examination of the largest intramural nodule showed high-grade sarcoma, comprising of LMS with a focal transformation to undifferentiated sarcoma with chondrosarcomatous differentiation. Endometrium was benign excluding carcinosarcoma. Heterologous differentiation has rarely been described in metastatic or recurrent uterine LMS; however, a primary uterine LMS with chondrosarcomatous differentiation has not been reported previously.