Diagnosis Of Uterine Leiomyosarcoma Research Articles

Uterine leiomyosarcoma in a captive capybara (Hydrochoerus hydrochaeris): a case report

A captive female capybara (Hydrochoerus hydrochaeris) of unknown age discharged a bloody mass from the vaginal region. A histopathology examination revealed the mass to be a reproductive leiomyosarcoma, and an ovariohysterectomy was performed. The histopathology examination confirmed that the excised tissue was a uterine leiomyosarcoma. The purpose of this report is to describe clinical history and histopathological diagnosis of leiomyosarcoma in capybaras. This report is novel because it describes the first diagnosis of uterine leiomyosarcoma in a capybara. Since clinical data about capybaras are rare, this case report will help to diagnosis and treat reproductive diseases of this species.

Uterine leiomyosarcoma – a case report

Uterine leiomyosarcoma is a rare malignant neoplasm, with a very poor prognosis and higher prevalence in pre- and peri-menopause. It accounts for only 1-2% of uterine malignancies. We report the case of a 75-year-old postmenopausal woman, who presented a large abdominal mass, compatible with uterine leiomyoma. She underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy obtaining a surgical piece weighing 9820g. The diagnosis of Uterine leiomyosarcoma is made by histopathological examination after surgery. This clinical case demonstrates that it is essential to bear in mind a possible diagnosis of malignancy to reduce the prevalence of occult Uterine leiomyosarcoma.

Diagnostic Accuracy of Ultrasound in Differentiation Uterine Leiomyosarcoma from Uterine Leiomyoma: A Systematic Review

Background: Uterine leiomyosarcoma is a rare malignant pathology of smooth muscle of uterus which is mostly asymptomatic with a wide range of late onset of symptoms such as post-menopausal bleeding and severe abdominal pelvic pain and abnormal vaginal discharge. Uterine leiomyosarcoma characteristically has structural and clinical similarities with giant uterine leiomyoma because both originate from the smooth muscle cells of the uterus. The diagnosis of uterine leiomyosarcoma through ultrasound is very different difficult due to indistinguishable sonographic features of uterine leiomyoma and leiomyosarcoma but there are certain sonological features which can prove the reliability of ultrasound as the diagnostic tool for differentiating uterine leiomyosarcoma from uterine leiomyoma. Aim: To access the accuracy of ultrasound in differentiating uterine leiomyosarcoma from uterine leiomyoma. Methods: An electronic database search was performed (PubMed, Science direct, Google Scholar) with the data range from 2000 to 2021. All studies included in the research was in English language. Articles which had descriptive studies related to sonographic features of uterine leiomyosarcoma and uterine leiomyoma. Results: Total 15 articles were found regarding the prevalence, clinical manifestation and sonographic findings of uterine leiomyosarcoma and uterine leiomyoma ,10 articles were included in the introduction and technique where as 6 articles were selected for systemic review with the sample size ranging from 20-200 in all different articles and age criteria of the participant in the selected articles was above 40 years with most candidates were investigated in the post menopause period. Conclusion: We identified certain sonographic patterns that can accurately differentiate uterine leiomyoma sarcoma from uterine leiomyoma with moderate sensitivity and specificity. Keywords: Transvaginal ultrasonography, leiomyoma, leiomyosarcoma

Determining the optimal adjuvant therapy strategy in uterine leiomyosarcoma

<h3>Objectives:</h3> Uterine leiomyosarcoma (ULMS) is a rare tumor with limited therapeutic options and no clearly established best treatment sequence strategy. The objective of this study was to evaluate treatment sequencing for ULMS following primary surgical management and determine predictors of survival. <h3>Methods:</h3> Women with a diagnosis of ULMS between 1/2013 and 1/2018 were identified. Clinical data was collected; for this analysis, only women treated with primary surgical management were included. Descriptive statistics were performed and predictors of overall survival (OS) and progression free survival (PFS) were analyzed using Cox regression and Kaplan-Meier methodology. <h3>Results:</h3> 179 patients were included. Median age was 52 years (20-78), 94% had grade 3 tumors, and over half the total population were treated with adjuvant chemotherapy (n=100, 56%). In the subset of patients with early stage disease (126), 49% were treated with surgery only while 51% received adjuvant chemotherapy. There was no difference in PFS between early stage patients who did or did not receive adjuvant chemotherapy (p=0.60). For the overall cohort, the most common adjuvant therapy regimens were gemcitabine/docetaxel (gem/doce, 40.9%) or ifosphamide/doxorubicin (ifos/doxo, 11.4%).137 patients (76.5%) experienced recurrence, progression or death during their follow up. The median PFS was 1.76 years (95% CI: 1.27- 2.08). The median survival for those treated with surgery alone was 1.79 years, for those treated with gem/doce was 1.27 years, and other chemotherapy regimen was 0.43 years. Median survival was not estimated for the ifos/doxo regimen due to small patient number. Upfront therapy regimen significantly impacted PFS (Figure 1, p=0.003), but was not significantly associated with OS (p=0.069). The one-year PFS probability was 0.58 for gem/doce (95% CI 0.45-0.68) compared with 0.80 for ifos/doxo (95% CI 0.54-0.91). <h3>Conclusions:</h3> Median PFS was 1.76 years, despite many women undergoing adjuvant therapy after surgery, most commonly with either gem/doce or ifos/doxo regimens. Primary treatment with ifos/doxo was associated with higher one-year PFS. This finding warrants additional evaluation to determine the optimal adjuvant therapy for these women.

Diagnosis of Uterine Leiomyosarcoma and Leiomyoma after Pregnancy with Uterine Leiomyoma

Diagnosis of Uterine Leiomyosarcoma and Leiomyoma after Pregnancy with Uterine Leiomyoma

Endometrial Sampling for Preoperative Diagnosis of Uterine Leiomyosarcoma

Study Objective Preoperative detection of uterine leiomyosarcoma is important in hysterectomies performed for presumed benign indications. This study examined the effectiveness of endometrial sampling for preoperative diagnosis of leiomyosarcoma and the factors associated with a false negative. Design This is a retrospective analysis of linked data from the New York Statewide Planning and Research Cooperative System and the New York State Cancer Registry. Using procedure codes, we identified women who underwent preoperative endometrial sampling and hysterectomy in 2003-2015. We further limited the sample to women who had a subsequent diagnosis of uterine leiomyosarcoma based on histology, site and behavioral codes. We estimated the proportion of patients whose leiomyosarcoma was diagnosed preoperatively, and compared their characteristics with patients whose leiomyosarcoma was missed preoperatively (i.e., diagnosed postoperatively) using chi-square/Fisher's exact test and Wilcoxon rank sum test. Setting Inpatient and outpatient encounters at civilian hospitals and ambulatory surgery centers in New York state. Patients or Participants 79 adult women with leiomyosarcoma who underwent endometrial sampling (biopsy or dilation and curettage) within 90 days before hysterectomy. Interventions N/A Measurements and Main Results Among the 79 patients with leiomyosarcoma, 46 (58.2%) were diagnosed preoperatively, whereas 33 (41.8%) were diagnosed postoperatively. Patients diagnosed postoperatively did not differ significantly from those diagnosed preoperatively in cancer stage, grade, age, bleeding symptoms, or comorbidities. However, tumor size was larger among patients who were diagnosed postoperatively than those diagnosed preoperatively (median=12 versus 9 centimeters, p=0.04). The rate of preoperative diagnosis was higher among patients who underwent sampling with hysteroscopic guidance (66.7%) than sampling without hysteroscopic guidance (31.6%) (p=0.007). Among patients diagnosed postoperatively, 21.2% underwent a supracervical hysterectomy, compared to 0% among those diagnosed preoperatively (p=0.002). Conclusion Endometrial sampling was instrumental in diagnosing approximately half of uterine leiomyosarcomas preoperatively, which was more commonly achieved with hysteroscopic guidance.

Risk Factors for Occult Uterine Sarcoma Among Women Undergoing Minimally Invasive Gynecologic Surgery

Study ObjectiveTo determine factors that can identify a population at increased risk for uterine leiomyosarcoma. DesignRetrospective case-control study (Canadian Task Force classification II-2). SettingUniversity teaching hospitals. PatientsSeventy-two women who underwent minimally invasive gynecologic surgery for presumed leiomyoma. Patients diagnosed with leiomyosarcoma (cases) were matched with up to 4 controls on age, year of surgery, and surgeon specialty. InterventionCases were identified through the pathology database, and the diagnosis of leiomyosarcoma or leiomyoma was confirmed by gynecologic pathologists. The cumulative risk of leiomyosarcoma was calculated, and factors predictive of elevated risk for leiomyosarcoma were investigated using conditional logistic regression. Measurements and Main ResultsFifteen patients with the diagnosis of inadvertently morcellated leiomyosarcoma were identified and matched with 57 controls. The cumulative risk of diagnosing uterine leiomyosarcoma on pathology after performing minimally invasive gynecologic surgery with morcellation was 0.19% (95% confidence interval [CI], 0.06%–0.56%). The presence of a hematocrit value < 30% (adjusted odds ratio [aOR], 20; 95% CI, 1.08–100; p = .05) was independently associated with the diagnosis of uterine leiomyosarcoma on multivariate analysis. Increased myoma size (aOR, 9.73; 95% CI, 0.75–1.26; p = .08) and presence of a solitary myoma (aOR, 3.85; 95% CI, 0.65–25; p = .14) were associated with a greater risk of uterine leiomyosarcoma; however, the difference was not statistically significant. ConclusionAnemia and myoma size >7 cm may be associated with occult leiomyosarcoma; however, these criteria are not sufficiently discriminatory to allow for preoperative identification of patients with uterine sarcoma. Future large multicenter studies are needed to further investigate these findings and the discovery of innovative ways to detect uterine leiomyosarcoma are urgently needed.

Clinical outcomes and prognostic markers in uterine leiomyosarcoma: a population-based cohort.

The aim was to identify clinical parameters and immunohistochemical markers predictive of recurrence and overall survival (OS) in a community cohort of patients with primary uterine leiomyosarcoma (ULMS). All patients with new diagnosis of ULMS from 1999 to 2007 were identified from the Kaiser Permanente Northern California pathology database. A retrospective chart review was performed to gather demographic and clinical data. The primary outcomes were recurrence-free survival and OS. In addition, a subset of tumor samples was available to analyze 3 immunohistochemical markers using tissue microarray techniques; these are as follows: estrogen receptor (ER) alpha, epidermal growth factor receptor (EGFR), and Ki-67. Seventy-five patients with ULMS were identified, of which 63 had adequate tumor tissue available for immunohistochemical evaluation. The median follow-up for all stages was 28 months. The rate of recurrence or progressive disease was 76% for stage I patients compared with 85% for stage II to IV patients. At 3 years, 37% of stage I patients were recurrence free compared with 27% of stage II to IV patients. Overall survival for stage I patients declined from 64% to 38% between 3 and 5 years while remaining stable at 30% for stage II to IV patients. In multivariable analysis, increasing mitotic counts were associated with increased risk of recurrence (hazards ratio [HR], 3.2; P = 0.013) and a trend toward decreased OS (HR, 2.2; P = 0.10). Expression of ER (HR, 1.0), EGFR expression (HR, 1.0), and Ki-67 expression (HR, 1.0) were not predictive of recurrence or OS. Recurrence rate of 76% for patients with stage I ULMS was higher than previously published cohorts. Mitotic counts were associated with increased recurrence and decreased OS. Expressions of ER, EGFR, and Ki-67 were not useful for predicting overall recurrence or survival.

The value of re-exploration in patients with inadvertently morcellated uterine sarcoma

ObjectiveTo describe the role of immediate re-exploration in patients with inadvertently morcellated uterine leiomyosarcoma (ULMS) and smooth muscle tumors of uncertain malignant potential (STUMP). MethodsAll patients with ULMS/STUMP who were managed or referred to the participating institutions from January 2005 to January 2012 following minimally invasive gynecology surgery with morcellation were detected through the pathology database. The diagnosis was confirmed by gynecologic-pathologists following post-surgery pathology review. ResultsTwenty-one patients with the diagnosis of ULMS (N=15) and STUMP (N=6) after morcellation were identified. The median age of occurrence was 46years (range, 25–58years). Median follow-up duration was 27months (range, 1.8–93.1months). None of the 21 patients had documented evidence of extra-uterine disease at the time of original surgery. Ultimately 12 patients were immediately re-explored to complete staging. The median time to the staging surgery was 33days (range 15–118days). Two (28.5%) out of seven patients with presumed stage I ULMS and one (25%) out of four patients with presumed stage I STUMP had significant findings of disseminated intraperitoneal disease detected at immediate surgical re-exploration. One of the 8 patients with confined early ULMS and STUMP at the second surgery had intraperitoneal recurrence, while the remaining 7 patients have had no recurrence and remain disease free. ConclusionSurgical re-exploration is likely to show findings of disseminated peritoneal sarcomatosis in a significant number of patients diagnosed with ULMS after a morcellation procedure. Findings from re-exploration can contribute to the knowledge of natural history of morcellated ULMS/STUMP and allow for accurate prognostication.

Cutaneous skull metastasis from uterine leiomyosarcoma: a case report

BackgroundCutaneous metastases in the facial region occur in less than 0.5% of patients with metastatic cancer.Case presentationA 52-year-old woman who admitted with a lung and a skull skin nodule is presented. She had a known diagnosis of uterine leiomyosarcoma following an extended total hysterectomy two years ago. Excision biopsy of both nodules revealed metastatic disease.ConclusionThe appearance of a cutaneous nodule in a patient with a history of uterine leiomyosarcoma might indicate a metastatic tumor lesion. Biopsy and immunohistochemistry are essential for correct diagnosis.

Leiomyosarcoma of the Uterus With Sphenoid Bone and Orbital Metastases

A 55-year-old woman presented with a 1-week history of vision loss in the right eye associated with proptosis and diplopia. Past medical history was significant for high-grade leiomyosarcoma of the uterus status post total abdominal hysterectomy and bilateral salpingo-oophorectomy and postoperative pelvic radiation 18 months prior to presentation. Staging studies at the time of initial diagnosis of uterine leiomyosarcoma showed no evidence for metastatic disease. At presentation, CT and MRI showed a well-circumscribed 3.0 cm x 3.6 cm x 2.4 cm mass centered in the right greater sphenoid wing, extending into the middle cranial fossa and the superior and lateral orbital wall. Biopsy of the orbital mass revealed a poorly differentiated high-grade leiomyosarcoma, consistent with recurrent metastatic disease from the uterus. The patient subsequently underwent radiation treatment followed by a left orbital exenteration 6 months after the orbital biopsy. A left thoracostomy was performed 8 months after the orbital biopsy for a metastatic nodule in the left lower lobe of the lung. The clinicopathologic findings of this rare metastatic orbital lesion are presented.

A case of uterine adenomyoma with bizarre smooth muscle cells mimicking leiomyosarcoma

We report a case of adenomyoma of the uterus that was cytologically difficult to distinguish from leiomyosarcoma. Examination of a uterine cervical smear revealed numerous spindle cells that were present in cell clusters or as isolated cells. These cells contained nuclei that were oval-shaped/elongated with nucleoli and delicate wispy cytoplasm. Large and bizarre nuclei were also identified. Based on these cytological findings leiomyosarcoma was considered: however, this diagnosis remained uncertain because of the absence of mitosis and/or necrotic substance. Histologically, we recognized leiomyomatous smooth muscle cells growing in a solid pattern and intermingled with endometrial-type glands. Moreover, bizarre smooth muscle cells were observed in the surface layer of the tumor. These observations suggest that for a diagnosis of uterine leiomyosarcoma the presence of mitosis and/or necrosis is important in addition to nuclear atypia.

Histological diagnosis of uterine leiomyosarcoma after resectoscopy: A case report

Histological diagnosis of uterine leiomyosarcoma after resectoscopy: A case report

Laparoscopically Assisted Vaginal Hysterectomy Versus Total Abdominal Hysterectomy for Leiomyosarcoma Treatment: Analysis and Follow-Up of 20 Cases

This retrospective study aimed to review the prognostic factors for leiomyosarcoma (LMS) and to compare the efficacies of laparoscopically assisted vaginal hysterectomy (LAVH) and total abdominal hysterectomy (TAH) for the management of uterine LMS. The clinical records were reviewed for 20 patients who had undergone either LAVH or TAH between 1992 and 1998 at Shin-Kong Hospital, with subsequent diagnosis of uterine LMS. Mitotic index and tumor size appeared to be the factors significantly related to survival. After comparison of the two surgical procedures, it was concluded that LAVH can be as effective as the total abdominal variant for the management of LMS.

Fertility-Sparing Surgery in Uterine Leiomyosarcoma

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.

Leiomyosarcoma of the uterus

Eight patients with leiomyosarcoma (LMS) of the uterus recently treated at our institution are reported. Modes of initial therapy in these patients included surgery alone, radiation therapy alone, or surgery plus radiation therapy. Mitotic counts were greater than 10 per 10 high power fields in the tumors of all of these patients. Only two patients are currently alive, and both have been treated for metastatic neoplasm to the lungs. A comparison of the histological material of these patients with criteria outlined in the recent literature for a diagnosis of uterine LMS is made. The possible role of a hormonal influence on this neoplasm is discussed. It would appear that a more aggressive initial therapy plan may improve survival in patients with this lethal malignancy.