Beyond the Primary Tumour: Rare Cutaneous Metastases in Uterine Leiomyosarcoma a Case Report

Abstract

Introduction: Uterine leiomyosarcoma is a rare, aggressive malignant mesenchymal tumour with a tendency for haematogenous dissemination. Cutaneous metastases are uncommon and may occur in the setting of advanced systemic disease. Case Description: A 43-year-old Para 3 presented with symptomatic anaemia secondary to prolonged heavy menstrual bleeding attributed to presumed uterine fibroids. She underwent total laparoscopic hysterectomy and bilateral salpingectomy, after which histopathological examination confirmed uterine leiomyosarcoma. Postoperative staging demonstrated nodal, lung, liver, and bone metastases. She received six cycles of single-agent doxorubicin, but subsequent imaging showed progressive bone disease despite improvement at other metastatic sites. Second-line gemcitabine-docetaxel was commenced. During the third cycle, she developed multiple painless nodules over the scalp and labia majora. Excisional biopsies showed malignant spindle cell lesions, and immunohistochemistry confirmed metastatic leiomyosarcoma of uterine origin. Restaging demonstrated multiple brain and scalp metastases, local recurrence, and persistent nodal, liver, and bone disease. Following multidisciplinary review, she received whole-brain radiotherapy at 20 Gy in five fractions. Although third-line ifosfamide was planned, her condition deteriorated and she died from a pulmonary embolism. Conclusion: This case highlights cutaneous metastases as an unusual manifestation of disseminated uterine leiomyosarcoma and supports prompt histopathological assessment of new skin nodules in patients with an underlying malignancy.