UTERINE LEIOMYOSARCOMAS COEXISTENT WITH CELLULAR AND ATYPICAL LEIOMYOMATA IN A YOUNG WOMAN DURING THE TREATMENT WITH LUTEINIZING-HORMONE-RELEASING HORMONE AGONIST

We report a case of a 28-year-old woman who had received 2 months of i ntranasal buserelin (a luteinizing hormone-releasing hormone agonist; LH-RH agonist) therapy for presumed uterine leiomyomata. In addition t o no reduction of the tumor size evaluated by sonography, heavy vagina l bleeding and abdominal pain recurred and worsened during the therapy . Pathological examination of the myomectomy and hysterectomy specimen s revealed leiomyosarcomas coexistent with cellular, atypical, and cla ssical leiomyomata. We suggest that this is a case of leiomyosarcomas arising in preexisting leiomyomata rather than de novo from the smooth muscle fibers of the myometrium. Furthermore, the potential of LH-RH, agonist therapy to delay the surgical treatment of an unsuspected lei omyosarcoma is high-lighted. Close monitoring of the treatment respons e by improvement of clinical symptoms and sonographic assessment of tu mor size may be helpful in early diagnosis of an underlying malignant tumor. (C) 1994 Academic Press, Inc.