Clinical manifestations and prognosis of unexpected uterine sarcoma of uterine fibroids in Tianjin China

Abstract

Background Uterine sarcoma is a rare malignancy of women and fewer uterine sarcomas are detected preoperatively. The reported incidence of preoperatively diagnosed uterine sarcoma (PDUS) was 0.07%. This study aims to identify the prevalence of unexpected uterine sarcoma (UUS) after operation for presumed leiomyoma and compare clinical outcomes after primary therapy. Methods A retrospective study was performed evaluating all uterine sarcoma diagnosed in Tianjin Central Hospital of Gynecology and Obstetrics between May 2011 and July 2016.We used the χ2 and T tests to assess the incidence and clinical features of patients. The Kaplan–Meier method was used to calculate disease-related survival. Results The study retrospectively analyzed 6625 patients with uterine fibroids and found 45 UUS patients and 21 patients of PDUS. The incidence of UUS is (45/6625) 0.67%. The incidence of UUS in patients undergoing total hysterectomy was higher undergoing tumor resection (P < 0.001); the age of UUS is younger than PDUS (P = 0.046); the differences in menopausal status and primary complaints between the two groups are not statistically significant. The PDUS group had more patients with Stage II and III sarcomas than the UUS group (P < 0.001); the duration of symptoms in the PDUS group was longer than in the UUS group (P = 0.033). The 5-year overall survival (OS) rate of the UUS group (77.7%) is higher than the PDUS group (46.3%) (P < 0.001). Conclusions The incidence of UUS is low. UUS has a younger age of onset, shorter history of the disease, earlier clinical stage, and better prognosis.

Metastatic Uterine Leiomyosarcoma as a Rare and Sinister Cause of Respiratory Distress: A Case Report and Literature Review

“…Its aggressive metastatic pattern also infers that patients may present with complications of spread [ 9 ], such as acute respiratory distress secondary to pulmonary metastases, as demonstrated in our patient. Other features of metastases, such as ascites, pelvic lymphadenopathy, and constitutional symptoms, namely weight loss, generalised weakness, and fatigue, may be noted in leiomyosarcomas but not in leiomyomas, as the latter are benign with negligible metastatic potential [ 3 , 9 , 10 , 12 , 15 ].…”

“…Delayed or inaccurate diagnosis and treatment of uterine leiomyosarcomas result in tumour progression and subsequent metastasis [ 3 ], as they are strongly associated with a high propensity for hematogenous spread [ 1 , 6 , 8 ]. Surgical intervention is the treatment of choice, with an en bloc total hysterectomy without morcellation [ 1 , 8 , 10 , 17 ]. Care should be taken to prevent intraoperative rupture and spillage of the mass, aiming to minimise dissemination.…”

“…Risk factors for the development of this cancer include age over 40 and obesity, as observed in this patient. Hormonal therapies (tamoxifen, exogenous oestrogen, and/or progesterone use), African ancestry, exposure to pelvic radiation, and rare genetic associations such as retinoblastomas and Li-Fraumeni syndrome are also recognised [1,3,[8][9][10][11]15]. Traditionally, patients present with abnormal vaginal bleeding, a palpable pelvic mass, pelvic pain, and compressive symptoms resembling those of uterine leiomyomas [3,9,10,12,15] compounding its diagnostic challenges.…”

“…The diagnostic challenges encountered with leiomyosarcomas, especially in premenopausal women, are well established [1,[3][4][5][6][7][8][9][10][11][12]. Owing to similarities in their clinical presentation, uterine leiomyosarcomas may be misdiagnosed as uterine leiomyomas [3,[10][11][12], which are prevalent and present in up to 80% of women [13].…”

“…Features that increase one's suspicion of leiomyosarcomas include age over 40, obesity, a single uterine mass, a rapidly enlarging mass, continued mass growth during menopause, prior history of tamoxifen or oral contraceptive pill use, menopausal use of oestrogen and/or progesterone, pelvic radiation, and the presence of ascites [3,[9][10][11][12].…”