rare cases of uterine leiomyomas with postoperative leiomyosarcoma recurrences and/or metastases

Uterine sarcomas, accounting for only 1% of malignant genital system tumors, present significant diagnostic and therapeutic challenges due to their rarity, small size, and diverse clinical manifestations. leiomyosarcoma, a subtype of uterine sarcoma, is particularly difficult to differentiate from benign leiomyomas, as there are no distinct clinical or radiological criteria. the study aimed to identify specific structural changes in leiomyocytes of uterine leiomyomas that may indicate a high risk of developing leiomyosarcoma. through histological and immunohistochemical analyses, including hematoxylin and eosin staining and markers such as ki67, vimentin, and desmin, a detailed examination of operative materials from a single patient at two different times (2017 and 2023) was conducted. the initial histological diagnosis in 2017 suggested a leiomyoma with low malignant potential, but subsequent follow-up in 2023 revealed leiomyosarcoma with invasion into the sigmoid colon. this case emphasizes the diagnostic complexity of leiomyosarcoma, particularly when structural changes in leiomyocytes are present, and highlights the need for continuous monitoring of patients postoperatively, even in cases initially deemed to have low malignant potential. the study concludes that prognosis depends not on tumor size but on the degree of malignancy, with poorly differentiated sarcomas demonstrating a poor prognosis. these findings underscore the importance of histopathological evaluation and long-term follow-up to improve patient outcomes in uterine sarcoma cases.