Uterine sarcoma: a clinical case and a literature review

Abstract

Background. Uterine sarcomas are rare gynaecologic tumours representing 3–7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. Materials and methods. We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. Results and conclusions. Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3–7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.

Adjuvant radiotherapy shows benefit in selected stage I uterine sarcoma: A risk scoring system based on a population analysis

“…Among the three factors, tumor grade was the strongest prognostic factor. Stage was the most consistent prognostic factor for survival, and this has been previously demonstrated in several studies 15,16 . Among the histological types of uterine sarcoma, LMS is aggressive, with a reported 5‐year survival of 51%–76% for stage I disease, 6,17 which is similar to the 65.36% rate in our study cohort.…”

“…Stage was the most consistent prognostic factor for survival, and this has been previously demonstrated in several studies. 15,16 Among the histological types of uterine sarcoma, LMS is aggressive, with a reported 5-year survival of 51%-76% for stage I disease, 6,17 which is similar to the 65.36% rate in our study cohort. A previous study indicated that ESS and AS showed a more favorable 5-year crude survival of 84% and 76%, respectively.…”

An enormous pelvic tumor in a 46-year-old woman with an elevated serum CA 125 level, what lies beneath it? Investigation of uterine tumors in postmenopausal women

“…However, their diagnosis is extremely challenging. Imaging tools are not very helpful to distinguish sarcoma from endometrial hyperplasia or carcinoma, but it seems that endometrial biopsy is the best choice [ 14 ]. Finally, uterine lymphomas usually cause uterine bleeding and abdominal pain, but it is very important to distinguish them from other diseases such as endometrial cancer as they require different treatment options.…”

Successful Laparoscopic-Assisted Supracervical Hysterectomy in a 14-Week-Sized Fibroid Uterus: An Autobiographical Case Report

“…The literature reflects numerous cases of large 12+ week-sized fibroid uteruses being amenable to laparoscopic-assisted myomectomy or hysterectomy, including contained morcellation [7][8][9][10]. Physicians and patients must be made aware of the relatively low risk (1%-2%) of sarcoma in leiomyomas [11], updated American College of Obstetricians and Gynecologists (ACOG) committee opinion summary [12], and the 2020 FDA recommendation for power morcellation only with a tissue containment system [13].…”