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Uterine sarcomas
Author(s) -
Prat Jaime,
Mbatani 'Nomonde
Publication year - 2015
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.06.006
Subject(s) - carcinosarcoma , medicine , endometrial stromal sarcoma , leiomyosarcoma , uterine sarcoma , sarcoma , carcinoma , uterus , pathology , oncology
Uterine sarcomas account for approximately 1% of all female genital tractmalignancies and 3%−7% of all uterine cancers [1]. Their rarity and histopathological diversity have contributed to the lack of consensus on risk factors for poor outcome and optimal treatment [2]. Histologically, uterine sarcomas were classified initially into carcinosarcomas (malignant mesodermal mixed tumors), accounting for 50% of cases, leiomyosarcomas (30%), endometrial stromal sarcomas (15%), and undifferentiated sarcomas (5%). Subsequently, carcinosarcoma has been reclassified, largely based on its spreading pattern, as a dedifferentiated or metaplastic form of endometrial carcinoma. However, as it behaves more aggressively than the usual type of endometrial carcinoma, carcinosarcoma is still included in most retrospective studies of uterine sarcomas, as well as in the separate section of “mixed epithelial and mesenchymal tumors” of the 2014 WHO classification [3]. Tumor stage is the single most important prognostic factor. In the past, uterine sarcomas were staged using a staging system proposed in 1988 for endometrial carcinoma. This has not proven satisfactory and, in 2009, a new FIGO staging system was developed for uterine sarcomas (Table 1) [4]. The new staging system has two divisions, one for leiomyosarcoma and endometrial stromal sarcoma (ESS), and one for adenosarcoma. Carcinosarcoma is still staged using the endometrial carcinoma staging system [4]. Prolonged use of tamoxifen, a uterine estrogen receptor agonist, is associated with a three times risk of sarcoma development [5]. There have been reported cases of radiation-induced sarcomas occurring long after treatment for other cancers [6]. Neither preoperative imaging with ultrasonography nor PET scans are capable of differentiating between benign or malignant smooth muscle masses. The use of diffusion weighted magnetic resonance imaging (DWI) for tumor location and characterization has been suggested, but is yet to be validated. Patients with carcinosarcomas and adenosarcomas tend to be much older than patients with other sarcomas.