GYN/OB-3. Retroperitoneal leiomyosarcoma weighing over 100 pounds.

Most gynecologic tumors that grow to be excessively large are benign and are frequently serous cystadenomas. It is rare for an excessively large tumor to be malignant, as patients frequently succumb to their disease prior to a malignancy reaching these proportions. A 41-year-old white female was referred for evaluation of a large mass arising from the pelvis noted on CT scan. The patient had become aware of increasing abdominal girth over the previous 12 months. She had seen her internist with this complaint, and he placed her on a weight loss program. On physical exam the patient was cachectic with decreased muscle mass and loose skin of the arms, chest, back, neck, and legs. The abdomen, however, was extremely enlarged and protuberant. No distinct or separate mass could be palpated. No ascites was noted. The patient was taken for exploratory laparotomy, at which time a 103-pound retroperitoneal leiomyosarcoma was resected. This represented over one third of the patient's pre-surgical total body mass. In addition her excess abdominal skin was extensive enough to require panniculectomy. Despite massive fluid shifts post-operatively, the patient made a successful recovery. Initial evaluation of this patient by her internist led to a misdiagnosis of obesity. On further examination, it was obvious that the patient was malnourished with a large abdominal mass, slow growing in nature. The mass was thus suspected to be benign. Exploratory laparotomy with subsequent histologic examination of the specimen revealed malignancy. This case serves to demonstrate that large slow growing abdominal masses can be malignant, and one should be prepared to perform a staging procedure as well as offer adjuvant treatment as indicated. This case represents removal of one of the largest retroperitoneal leiomyosarcomas ever reported.

Olivia J. McCallum, MD, James J. Burke II, MD, Alex Ferro, MD, Donald G. Gallup, MD. Department of Obstetrics and Gynecology, Mercer University School of Medicine, Savannah, GA. Memorial Health University Medical Center, Savannah, GA.