What Is a Uterine Sarcoma?

Uterine sarcomas are a group of malignant tumors that originate from uterine smooth muscle tissue, uterine interstitial tissue, intrauterine tissue, or extrauterine tissue. The histological origin is mostly myometrium, but also connective tissue in the myometrium or connective tissue in the endometrium. More common in women between 30 and 50 years of age, sarcoma can be found in various parts of the uterus, the uterine body is much more common than the cervix about 15: 1. Uterine sarcoma accounts for 2% to 5% of uterine malignancies, and the age of onset is about 50 years, and cervix glucosarcoma is more common in young girls. Because there are no specific symptoms early, the preoperative diagnosis rate is only 30% to 39%.

Basic Information

English name: uterinesarcoma
Visiting department: Gynecology

Multiple groups: 30 to 50 year old women
Common symptoms: Abnormal vaginal bleeding, abdominal mass, abdominal pain, increased vaginal discharge, if the tumor is large, etc.

Causes of uterine sarcoma

The exact etiology of uterine sarcoma is unknown. Some people think that it is related to embryonic cell residues and mesenchymal metaplasia. Histological history of pelvic radiotherapy and long-term stimulation of estrogen may be risk factors for the disease. infer.

Clinical manifestations of uterine sarcoma

Abnormal vaginal bleeding

The most common symptoms are abnormal menstruation or vaginal bleeding after menopause. 65.5% 78.2%

2. Abdominal mass

It is more common in those with uterine fibroid sarcoma; the mass increases rapidly. If the sarcoma grows into the vagina, it often feels that there are protruding masses in the vagina. The uterus is often enlarged, irregular in shape, and soft in texture.

3. Abdominal pain

It is also a more common symptom due to the rapid growth of fibroids, which makes the patient feel abdominal pain or dull pain.

4. Increased vaginal discharge

It can be serous, bloody, or white, and can be purulent and foul when combined with infection.

5. If the tumor is large

Can irritate the bladder or rectum, and edema of the lower limbs when the vein is compressed;

6. Advanced patients

May have wasting, anemia, fever, general failure, pelvic mass infiltration of the pelvic wall, immobilization and immobility.

Uterine sarcoma examination

Gynecological examination: The uterus is significantly enlarged, showing multiple nodules, and soft. If the sarcoma prolapses from the cervix or the vagina from the uterine cavity, a purple-red mass can be seen, and the surface has purulent secretions when the infection is combined. In the case of grape-like sarcoma, soft, brittle, and bleeding-prone tumors are found in the cervix or vagina.

Uterine sarcoma diagnosis

Medical history

(1) The symptoms of uterine leiomyosarcoma are non-specific and similar to those of female reproductive system tumors, so preoperative diagnosis is difficult. With a history of uterine fibroids, the uterus grows rapidly, especially after menopause, not only does not shrink, but continuously increases. Irregular vaginal bleeding around the menopause or young girls with uterine enlargement. In patients who have previously received radiation therapy, the uterus suddenly increases Large, with abnormal vaginal bleeding; or with abdominal pain and other symptoms, the possibility of uterine sarcoma should be considered.

(2) The enlargement of the uterus and the presence of polypoid and lobular necrosis in the uterine uterus should consider the possibility of endometrial stromal sarcoma and malignant Mullerian mixed tumor.

2. Signs

(1) Pelvic abdominal mass, or ascites, abdominal pain and low back pain.

(2) Gynecological examination: The uterus is enlarged, and it is often difficult to distinguish it from uterine fibroids. The mass can be hard or soft, and the surface can be uneven or nodular.

(3) It can be transferred to various organs of the pelvic and abdominal cavity in the late stage, with bloody ascites.

3. Auxiliary inspection

(1) B-ultrasound can show the internal structure of the uterine tumor, the marginal condition, and the signal of low obstruction blood flow.

(2) Preoperative diagnosis and curettage have a low diagnosis rate for uterine leiomyosarcoma and have high diagnostic value for endometrial stromal sarcoma and malignant mesoderm mixed tumor of the uterus.

(3) Intraoperative specimens of uterine leiomyosarcoma are rarely diagnosed before surgery. If intraoperative fissures are found to have an unclear boundary between myomas and myometrium, the vortex-like structure disappears, and raw fish-like structures are present. If the tissue is crunchy, you should send Frozen sections quickly, but still rely on postoperative paraffin pathology to confirm the diagnosis.

Differential diagnosis of uterine sarcoma

Uterine fibroids

Patients with uterine fibroids have no obvious symptoms and are only found by accident during gynecological examination or surgery. The main symptoms of uterine fibroids can be menstrual changes (increased menstrual flow, shortened cycles or extended periods, and irregular bleeding), pain (generally no, but red degeneration of uterine fibroids or twisted pedicled fibroids and Submucosal fibroids can cause acute abdominal pain when they cause spastic contractions in the uterus, and compression symptoms (fibroids compress the bladder, frequent urination, dysuria, urinary retention, etc.) Uterine fibroids can cause hydronephrosis when the ureter is compressed. Mural fibroids can squeeze the rectum, causing difficulty in stool), increased vaginal secretions, infertility, anemia (long-term menstrual flow can lead to secondary anemia), and so on.

2. Other

Endometrial stromal sarcoma is distinguished from endometrial polyps and submucosal fibroids, as well as from intravenous leiomyomatosis and malignant potential untyped leiomyomas, which are ultimately identified by paraffin pathology.

Uterine sarcoma treatment

Surgical treatment

Uterine sarcoma is mainly treated by surgery. Simple hysterectomy + bilateral appendectomy is the standard surgical procedure. However, there are still some disputes about the specific surgical method, which is mainly reflected in the clinical significance of whether ovarian and lymph node resection can be retained. Whether it is necessary to perform lymph node resection and the role of tumor cytoreductive surgery in advanced disease.

(1) Surgical resection of leiomyosarcoma of the uterus is the only treatment that has proven to be of curative value. The classic surgical scope includes transabdominal hysterectomy + bilateral appendectomy. If extrauterine lesions are found during the operation, tumor cytoreductive surgery is required.

(2) The standard surgical procedure for low-grade endometrial stromal sarcoma includes transabdominal hysterectomy + bilateral appendectomy. Patients with extrauterine metastases should undergo tumor cytoreductive surgery. For endometrial stromal sarcoma, bilateral appendectomy has become part of standard surgery, because estrogen may be an agonist of endometrial stromal sarcoma, which can stimulate tumor growth and may increase the risk of tumor recurrence. Nevertheless, the impact of ovarian preservation surgery on early patient survival remains a controversial issue.

(3) Highly malignant endometrial stromal sarcoma is highly malignant, prone to metastatic lesions outside the uterus, and has a poor prognosis. The surgical range is total hysterectomy + bilateral appendectomy, and pelvic and para-aortic lymphadenectomy is recommended. Lymph node metastasis is a significant prognostic factor. The prognosis of patients with lymph node metastasis is significantly worse than that of patients without lymph node metastasis.

(4) Uterine adenosarcoma is a low-grade malignant tumor with an incidence of distant metastases of only 5%. The standard surgical procedure is total hysterectomy + bilateral appendectomy. Compared with other pathological types of uterine sarcoma, it has a better prognosis. However, this type of tumor has a tendency of late local recurrence. About 20% of patients have vaginal, pelvic or abdominal recurrence. Therefore, patients need long-term follow-up.

(5) The biological behavior of uterine cancer sarcoma is highly malignant, with the dual biological behavior characteristics of cancer and sarcoma, and it is easy to cause extrauterine metastasis with lymph and blood circulation. The lymph node metastasis rate is as high as 20% to 38%, and the prognosis is extremely poor. The new surgical staging criteria are the same as those for endometrial cancer. The surgical procedure is total hysterectomy + bilateral appendectomy + omentectomy + pelvic and para-aortic lymph node resection, and tumor cells removed by metastatic disease The number of lymph nodes removed is related to the survival of the patient.

2. Radiation therapy

Because uterine sarcoma is less sensitive to radiation, the literature reports that there are very few 5-year survivors of radiation therapy alone. Radiation therapy is better for endometrial stromal sarcoma and mixed mesodermal sarcoma than leiomyosarcoma.

3. chemotherapy

Many cytotoxic anticancer drugs have a certain effect on the metastasis and recurrence of uterine sarcoma. Chemotherapy drugs can be used alone or in combination. Drugs recommended by the NCCN guidelines in 2012 include doxorubicin, gemcitabine / docetaxel, and other optional single drugs are dacarbazine, docetaxel, epirubicin, gemcitabine, and isocycline. Phosphamide, liposomal doxorubicin, paclitaxel, temozolomide, etc. Hormonal therapy is only available for endometrial stromal sarcoma, including medroxyprogesterone acetate, megestrol acetate, aromatase inhibitors, GnRH antagonists, and tamoxifen.

References:

1. Cao Zeyi, editor. People's Medical Publishing House. Chinese Obstetrics and Gynecology, 1999: 1802 ~ 1872.

2. Guonan Zhang. Surgical treatment of uterine sarcoma. Journal of Practical Obstetrics and Gynecology, 2012, 28 (1): 11-13.