Fertility-Sparing Surgery in Uterine Leiomyosarcoma

Abstract

Background.Leiomyosarcoma of the uterus is a rare malignancy with a poor prognosis. Total abdominal hysterectomy is considered the treatment of choice. Occasionally, the diagnosis is made on myomectomy specimen, and in young patients the role of conservative management is not well defined.Patients and Methods.Between 1982 and 1996, eight patients with a diagnosis of uterine leiomyosarcoma following myomectomy were conservatively managed at our institution. Median age of the patients was 29 years (range 19–32 years), and all were nulliparous. The tumor was confined to a myoma in all patients. Patients were adequately informed about the risk and were submitted to strict follow-up including pelvic examination, hysteroscopy, ultrasonography, chest X-ray, and abdominopelvic MRI or CT scan.Results.Mean mitotic count of leiomyosarcomas was 6 per 10 HPF, ranging between 5 to 33. At a median follow-up of 42 months three pregnancies were recorded. Two patients had a spontaneous delivery at term. The third patient had diagnosis of recurrent disease at the time of cesarian section. Despite further surgery and chemotherapy, she died of disseminated disease 26 months after diagnosis. The remaining seven patients are alive and well. Two patients received a second surgical procedure after diagnosis of leiomyosarcoma, 24 and 16 months after primary operation. Both were found to have leiomyomas.Conclusions.Selected cases of uterine leiomyosarcoma might be managed conservatively in young nulliparous women desiring pregnancy. A strict follow-up is mandatory, and at the completion of the reproductive life, a demolitive procedure could be considered.