Gyne Onc: Uterine Sarcoma - Williams Gyne

Front 1

What % of all malignancies of uterine corpus do sarcomas count for?

Back 1

3-8%

Front 2

What is the most common uterine sarcomas?

Back 2

- leiomyosarcoma

- classically carcinosarcoma, but now re-classified as a metaplastic form of endometrial carcinoma

Front 3

risk factor for uterine sarcoma

Back 3

- chronic excess estrogen exposure
- tamoxifen use
- African American race
- prior pelvic radiation

- OCP use and smoking may lower risk

Front 4

common signs of uterine sarcoma

Back 4

- abnormal vaginal bleeding (most frequent)
- pelvic/abdominal pain
- from passage of clots, rapid uterine enlargement, or prolapse of a sarcomatous polyp through an effaced cervix
- profuse, foul-smelling discharge
- GI/GU complaints

- can be mimicked by a degenerating fibroid

Front 5

Do leiomyosarcomas usually arise from benign leiomyomas?

Back 5

- no, usually de novo lesion

Front 6

histologic types of uterine mesenchymal tumours

Back 6

- endometrial stromal and related tumours
- endometrial stromal sarcoma, low grade
- endometrial stromal nodule
- undifferentiated endometrial sarcoma
- smooth muscle tumours
- leiomyosarcoma, epithelial variant and myxoid variant
- smooth muscle tumour of uncertain malignant potential (STUMP)
- leiomyoma
- miscellaneous mesenchymal tumours

- mixed epithelial and mesenchymal tumours
- MMMT
- adenosarcoma
- carcinofibroma
- adenofibroma
- adenomyoma

Front 7

histopathologic criteria for leiomyosarcoma

Back 7

2 out of 3:
- coagulative tumour cell necrosis
- moderate to severe nuclear atypia
- mitotic index >= 10 mitotic figures/10 HPF

- STUMP do not meet these criteria

Front 8

What are endometrial stromal nodules?

Back 8

- benign, characterized by a well-delineated margin, and composed of neoplastic cells that resemble proliferative-phase endometrial stromal cells

- grossly, solitary, round or oval, fleshy nodule measuring a few cm

- histologically distinguished by a lack of myometrial infiltration

- myomectomy may be appropriated, but hysterectomy may be required for larger lesions (must remove the entire nodule)

Front 9

Which benign condition can adenosarcomas be associated w/?

Back 9

adenomyosis (possible precursor)

Front 10

How are adenosarcomas different from carcinosarcomas?

Back 10

- the epithelial component is benign
- generally low-grade tumours w/ better prognosis
- 10% will have sarcomatous overgrowth and have similarly poor prognosis like carcinosarcomas

Front 11

Which sarcomas are more indolent w/ longer disease-free intervals?

Back 11

- ESS
- adenosarcoma

Front 12

common methods of spread for leiomyosarcomas

Back 12

- direct extension
- hematogenous (lung mets common)
- less commonly lymphatic

Front 13

What is the mainstay of therapy for leiomyosarcoma?

Back 13

- hysterectomy (may need radical if parametrial infiltration)
- ovarian preservation is an option for pre-menopausal women
- LN dissection should be reserved for clinically suspicious nodes

- hysterectomy alone is sufficient for STUMP

- same for ESS and adenosarcoma if no evidence of extrauterine disease

Front 14

In which sarcoma types should estrogen replacement be avoided?

Back 14

- ESS
- carcinosarcoma

- appropriate to use in leiomyosarcoma, undifferentiated sarcoma, and adenosarcoma

Front 15

What is the role of chemotherapy in treatment of uterine sarcomas?

Back 15

- frequently used though no clear survival benefit

- observation alone is recommended for stage I and II ESS and adenosarcoma

Front 16

chemotherapy for recurrent leiomyosarcoma

Back 16

- gemcitabine and docetaxel has highest current response rate (36%)
- doxorubicin is most active single agent

- still dismal response

- surgical resection still advised (even pulmonary resection for lung mets)

Front 17

treatment for recurrent ESS

Back 17

- usually ER/PR positive
- Megace or Provera commonly used as post-op adjuvant therapy or for recurrences
- aromatase inhibitors and GnRH agonists also used

Front 18

chemotherapy for carcinosarcoma

Back 18

- ifosfamide and paclitaxel = current treatment of choice for advanced or recurrent carcinosarcoma
- ifosfamide = most active single agent
- carbo/taxol also considered

Front 19

poor prognostic factors for uterine sarcomas

Back 19

- stage
- older age
- African American race
- lack of primary surgery

- tumour histology: leiomyosarcoma worst followed by carcinosarcoma, then ESS