Patterns of metastasis in uterine sarcoma. An autopsy study

Abstract

The autopsy findings of 73 patients with uterine sarcoma were studied to determine the sites and possible modes of metastasis. Homologous mixed mesodermal tumors were the most frequent (41%) followed by leiomyosarcoma (26%), heterologous mixed mesodermal tumor (18.3%), stromal sarcoma (12%), and endolymphatic stromal myosis (3%). The peritoneal cavity and omentum were the most frequently involved sites (59%), followed by the lung (52%), pelvic lymph nodes (41%), paraaortic lymph nodes (38%), and liver parenchyma (34%). The presence of lung metastasis was not associated with pelvic or paraaortic node metastasis or intraperitoneal disease. Metastasis to other distant sites including the brain, heart, kidney, and bone were independent of pelvic and paraaortic nodal metastasis or intraperitoneal disease. Metastatic sites were not different among various histologic types. Distant metastatic sites were statistically associated with lung metastasis. Hematogenous metastasis best explains this metastatic pattern and adjuvant systemic therapy seems indicated.

Pazopanib-mediated long-term disease stabilization after resection of a uterine leiomyosarcoma metastasis to the brain: A case report

“…The risk of recurrence after complete resection of uterus-limited LMS, which was estimated to be 70% after 2 years in a retrospective study, is high (Major et al, 1993 Feb 15). The most common sites of uterine LMS metastasis are the lung, pelvis, and vagina (Rose et al, 1989 Mar 1, Mayerhofer et al, 1999 Aug), but brain metastasis is rare. To the best of our knowledge, only case reports of uterine LMS metastasis to the brain are available (Wroński et al, 1994 Aug, Honeybul and Ha, 2009 Mar, Yamada et al, 2011 Dec).…”

“…Yamada et al reviewed in their case report that there had been 21 such cases (Yamada et al, 2011 Dec). Brain metastasis incidence has been reported to be 1 in 19 (Rose et al, 1989 Mar 1) and 1 in 4 from autopsies of patients with uterine LMS (Fleming et al, 1984 Oct). In a retrospective study of brain metastases from gynecologic malignancies, 4 cases out of 139 cases of gynecologic malignancies were uterine LMS (Nasu et al, 2013 Feb).…”

“…Brain metastasis of uterine leiomyosarcoma (LMS) is rare (Wroński et al, 1994 Aug, Honeybul and Ha, 2009 Mar, Yamada et al, 2011 Dec, Rose et al, 1989 Mar 1, Fleming et al, 1984 Oct). Several case reports suggest a resection of brain metastases of uterine LMS could result in longer survival, for which controlling systemic disease is a prerequisite (Wroński et al, 1994 Aug, Honeybul and Ha, 2009 Mar, Yamada et al, 2011 Dec, Gadducci et al, 1996 Jul).…”

Uterine lipoleiomyosarcoma: Complete medullary compression as presentation of a solitary metastasis

“…Distant metastases arrive late in the disease and the predilection sites are lungs, liver, kidneys and skin through hematogenous dissemination. Although rare, cases of uterine leiomyosarcoma with skeletal metastasis have been reported in the literature (Rose et al, 1989, Ziewacz et al, 2012). Lipoleiomyosarcoma is a rare subtype containing both leiomyosarcomatous and lipomatous components.…”

Can surgical management of bone metastases improve quality of life among women with gynecologic cancer?

“…Improvements in surgery, radiation and the development of novel chemotherapeutic agents have led to prolonged survival and an increase in the prevalence of bone metastasis [2]. The incidence of bone metastasis secondary to endometrial cancer is reported to be 6 to 15% [3,4]. Bone metastases occur in approximately 1.2% of patients with ovarian cancer [5] and represent the third most common site of metastasis in cervical cancer, occurring in 1.1% of patients [6,7].…”