Uterine sarcoma in a 14 year-old girl presenting with uterine rupture.

Uterine sarcomas are rare tumors with poor prognosis and even more rare in adolescents. They predominantly occur after the fourth decade and represent less than 3% of all genital tract malignancies (Seddon and Davda, 2011). The symptoms of uterine sarcomas are almost identical to leiomyomas such as abnormal uterine bleeding (60%), abdominal pain (50%), and gastrointestinal or genitourinary symptoms (30%). Uterine rupture and hemoperitoneum are rare presentations (Philip et al., 2011). The uterine sarcomas consist of pure mesenchymal tumors (leiomyosarcoma (LMS), endometrial stromal sarcoma (ESS), undifferentiated endometrial stromal sarcoma (UES)), and mixed epithelial and mesenchymal tumors (adenosarcoma (AS) and adenosarcoma with sarcomatoid overgrowth (ASSO)). Carsinosarcoma (CS) is reclassified as the metaplastic form of endometrial cancer but the aggressiveness resembles uterine sarcomas. STUMP is a smooth muscle tumor with uncertain malignant potential (D'Angelo and Prat, 2010). Characteristic pathologic features include high mitotic index, hypercellularity, nuclear atypia, tumor cell necrosis, tumor size and intratumoral hemorrhage. Pathologic diagnosis may be problematic because several variants have confusing, subtle tumor characteristics and overlapping morphologic features that make distinguishing among the entities challenging (Tiirumani et al., 2013, Shah et al., 2012). In this case report, we describe a large, rapidly growing tumor with subsequent uterine rupture and hemoperitoneum in a 14 year old African girl.