Sarcomatoid transformation of uterine myoma identified through physical examination: a case report.

Abstract

Background: Uterine myomas are the most common benign tumors in the female reproductive system. The incidence of malignant transformation within a uterine myoma is low, but once it occurs, the prognosis is usually poor. The clinical symptoms of this disease are not specific, which can easily lead to misdiagnosis or missed diagnosis. Therefore, early diagnosis and timely treatment are crucial for improving the prognosis of patients.

Case presentation: A 58-year-old married Chinese female patient had undergone annual check-ups at our hospital from 2007 to 2024, totaling 18 visits. During her initial examination in 2007, uterine fibroids were detected. She experienced natural menopause in 2010. By 2019, no significant changes were observed in the size or characteristics of the uterine fibroids. In 2020, follow-up examinations revealed an increase in the size of the fibroids, although the patient reported no significant subjective symptoms. A preliminary diagnosis of sarcomatous transformation of uterine myomas was made. Subsequently, the patient underwent surgical intervention at an alternative medical facility. Postoperative pathology confirmed the diagnosis of sarcomatous transformation of uterine fibroids. As of the time of writing, she has been attending regular follow-up appointments annually since then, with the most recent visit occurring in November 2024. Currently, the patient's overall health status remains stable, with no reported discomfort. Gynecological examinations and tumor markers (carbohydrate antigen 125 [CA125], carbohydrate antigen 199 [CA199], alpha-fetoprotein [AFP], and carcinoembryonic antigen [CEA]) are all within normal limits.

Conclusion: The malignant transformation of a uterine myoma is a rare but extremely serious complication. Timely and accurate diagnosis, followed by appropriate therapeutic interventions, is crucial for improving patient prognosis. Clinicians should maintain heightened vigilance for postmenopausal uterine fibroids that do not undergo expected regression but instead demonstrate growth.