gynecology and obstetrics
Uterine Sarcomas
Introduction
Uterine sarcomas are a group of disparate, aggressive cancers of the uterine corpus. Common manifestations include abnormal uterine bleeding and pelvic pain or mass. For suspected uterine sarcoma, endometrial biopsy or dilation and curettage may be done, but results are often falsely negative; most sarcomas are diagnosed histologically after hysterectomy or myomectomy. Treatment requires total abdominal hysterectomy and bilateral salpingo-oophorectomy; for advanced cancer, chemotherapy and sometimes radiation therapy are indicated. Uterine sarcomas are rare, accounting for 2 to 5% of all uterine cancers ( General reference ). Leiomyosarcoma and endometrial stromal sarcoma are the most common types. Average age at diagnosis is 60 years old. Uterine leiomyosarcoma incidence in the United States is 2 times higher in Black women than in White women. Risk factorsfor uterine sarcomas are Prior pelvic radiation Tamoxifenuse Uterine sarcomas include Leiomyosarcoma (the most common subtype [63%]) Endometrial stromal sarcoma (21%) Undifferentiated uterine sarcoma Rare uterine mesenchymal sarcoma subtypes include Adenosarcomas Perivascular epithelioid cell tumor (PEComas) Rhabdomyosarcoma Carcinosarcomas used to be categorized as sarcomas but are now considered and treated as Endometrial Cancer ). High-grade uterine sarcomas tend metastasize hematogenously, most often to the lungs; lymph node metastases are uncommon. 