Pleural Effusion and Pregnancy: A Masquerading Presentation of a Leiomyosarcoma

Abstract

Introduction: Sarcomas arise from either soft tissues or bone. Leiomyosarcoma is a type of soft tissue sarcoma. It is an aggressive tumor arising most commonly from uterus, gastrointestinal system and vascular sites like pulmonary artery and inferior vena cava.
Case report: This is a case report of a patient with 20 weeks of gestation presented with fever and rapidly progressive dyspnoea which was not responding to symptomatic management. Examination was suggestive of right pleural effusion which progressed to superior vena cava obstruction during hospital stay. MRI thorax revealed a large soft tissue mass with areas of necrosis with a thin rim of pleural effusion and mediastinal shift to the left side. Histopathology revealed high grade leiomyosarcoma with brisk mitotic activity.
Conclusion: Leimyosarcoma in our patient had an initial presentation similar to pleural effusion which was eventually diagnosed after invasive procedure though its site of origin could not be determined. Thus we are reporting this case due to the rarity of incidence, atypical initial presentation, age of onset, site, possible relationship with estrogenic stimulation (pregnancy) and the rapidity with which it progressed.