Incidence: Sarcoma of the uterus is rare and constitutes about 3 percent of uterine malignancy.
CLASSIFICATION OF UTERINE SARCOMA: -
The commonest one arises from the intramural part. The consistency is soft and friable. The cut surface shows hemorrhage and irregular margins. There is no whorl appearance nor any capsule. Tumors with more than 10 mitotic figures/10 high-power field have poor prognosis.
Endometrial stromal tumors arises from endometrial stromal cells. Depending on mitotic activity endometrial stromal tumors are of three types:
(i) endometrial stromal nodule (mostly benign),
(ii) endolymphatic stromal myosis (low grade malignancy)
(iii) endometrial stromal sarcoma (high grade malignancy).
Leiomyosarcomas are of different clinicopathologic types:- Intravenous leiomyomatosis — where benign smooth muscle grows into venous channels within the broad ligaments, uterine and iliac veins. Prognosis following surgery is excellent.
Leiomyomatosis peritonealis disseminata:- – where benign smooth muscle nodules grow over the peritoneal surfaces. It is thought to arise from the metaplasia of subperitoneal mesenchymal stem cells to smooth muscle, fibroblasts, myofibroblasts under the influence of estrogen and progesterone.
Sarcomatous change of fibroid occurs in about 0.1 percent cases. When it does, the fibroid becomes soft. The cut section shows yellowish appearance with hemorrhage and cystic degeneration. The whorl appearance is lost.
Malignant mixed mullerian tumors: - (MMMT) of the uterus usually forms a large fleshy mass protruding into the uterine cavity with a broad base. Majority (90%) presents with postmenopausal bleeding.
SPREAD: -
- Blood borne: This is the commonest mode of spread. The organs involved are liver, lungs, kidneys, brain, bones, etc.
- Directly to the adjacent structures.
- Lymphatic spread to the regional lymph glands.
CLINICAL FEATURES:-
Patient profile: The age is usually between 40 and 60 years. There may be history of pelvic irradiation either for induction of menopause or malignancy.
- Irregular premenopausal or postmenopausal vaginal bleeding.
- Abnormal vaginal discharge — offensive, watery associated at times with expulsion of fleshy necrotic mass.
- Abdominal pain — due to involvement of the surrounding structures.
- Pyrexia, weakness and anorexia. Suspected sarcomatous change in a fibroid is evidenced by:
- Postmenopausal bleeding.
- Rapid enlargement of fibroid.
- Recurrence following myomectomy or polypectomy.
Pelvic examination: There is no specific finding. The uterus may be enlarged and irregular. Parametrium may be thickened and indurated. Speculum examination may reveal a polypoidal mass protruding out through the external os.
- Diagnosis is made usually following histological examination of the removed uterus.
- Diagnostic uterine curettage may reveal the mucosal form of sarcoma.
- Histologic examination of the removed polyp.
The medicines that can be thought of use are:-
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