Uterine sarcoma
What is it?
Uterine sarcomas are a heterogeneous group of neoplasms that develop from the body of the uterus. These rare tumors constitute about 3% of malignant tumors of the body of the uterus.
Uterine sarcomas are characterized not only by their rarity but also by their heterogeneity.
In fact, several histotypes are recognized:
- leiomyosarcoma, which is the most frequent histotype;
- endometrial stromal sarcoma;
- undifferentiated uterine sarcoma;
- adenosarcoma.
STUMP (Smooth Muscle Tumors of Uncertain Malignant Potential) is a smooth muscle tumor, the malignancy potential of which is uncertain; in fact, very rarely it can recur and give metastasis.
Causes and risk factors
Previous pelvic radiotherapy may be a risk factor for the development of uterine sarcomas.
Which are the symptoms?
The signs and symptoms of uterine sarcomas are quite nonspecific and can be confused with other diseases that present with the same symptomatology. Among these, special attention should be paid to:
- abnormal uterine bleeding;
- pelvic and/or abdominal pain;
- feeling of abdominal weight;
- frequent urination;
- palpable pelvic mass.
How is it diagnosed?
Most uterine leiomyosarcomas are diagnosed incidentally following surgery performed for uterine fibromatosis. In fact, ultrasonography, an examination most frequently used in the evaluation of uterine myomas, does not effectively differentiate a benign form from a malignant one. Sometimes the diagnosis is made by endometrial biopsy and subsequent histologic examination in symptomatic patients.
How is it treated?
En bloc hysterectomy and eventual bilateral adnexectomy are the standard of care for these forms. In the case of women of childbearing age, removal of the ovaries can be avoided in selected cases in order to preserve endocrine function. After diagnosis, if incidental, it is mandated to perform staging by CT scan that allows for assessment of the extent of the disease and the setting of post-surgical treatment, which may be chemotherapy, hormone therapy, or radiation therapy.
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