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Objectives: Leiomyosarcomas are relatively rare uterine smooth muscle tumors. Surgery is the most common therapy choice for uterine leiomyosarcomas. However, controversy exists over the appropriate initial surgical management, especially about the role of lymph node sampling. The aim of our study is to analyze the prognostic factors and the role of lymphadenectomy in overall survival and in disease-free survival. Methods: We analyzed retrospectively 31 patients suffering from uterine leiomyosarcomas at Institute of Salah Azaiez during 2000–2014. Demographic and clinical features such as age, menopausal status, stage, tumor size, and management options were examined, and pathological characteristics such as mitotic count, lymphovascular space invasion, and tumor necrosis were evaluated. Results: Out of 31 patients treated for uterine leiomyosarcomas, pelvic lymphadenectomy was done for 18 patients. No para-aortic lymphadenectomy was performed. Median number of resected lymph nodes was 13 ± 7 (range: 3–27). Lymphatic metastasis was observed in 2 out of 18 patients with clinical stage IA and IIIB. The distribution of different variables (age, International Federation of Gynecology and Obstetrics stage, tumor size, mitotic count, and adjuvant treatment) between the group of patients, who had or had not lymphadenectomy done, had no significant difference. The 5-year overall survival and disease-free survival were 61% and 50%, respectively. Clinical stage, presence of lymphovascular space invasion, and lymph nodal dissection were found to be relevant for disease-free survival on univariate analysis. Only age and menopausal status were found to be a prognostic factor for overall survival. Conclusion: Hence, routine lymph node dissection was not generally recommended. Our study demonstrates that lymphadenectomy has a statistically significant effect on disease-free survival but not on overall survival.

Patients with advanced endometrial cancer had generally a poor prognostic with a median survival often less than one year. Isolated bone metastases as the first sign of the disease of endometrial cancer was a very exceptional situation rarely described in the literature. The goal of this report is to describe the management of this rare site of metastases and to reviewed Clinic pathological features and prognosis of isolated bone metastases. We present a case of a 56-year-old woman treated for endometrial cancer with isolated ribs bone metastases. She was complaining about progressive right rib pain as a first sign of the disease of endometrial cancer. She had a biopsy of the lesion in the last right thoracic rib. This has proved a metastatic adenocarcinoma compatible with an endometrial primary cancer. An endometrial biopsy showed moderately differentiated endometrioid adenocarcinoma. Imagery did not reveal any other sites of metastatic disease. The patient underwent bilateral salpingo-oophorectomy and hysterectomy, peritoneal washing, omentectomy, bilateral pelvic and par aortic lymphadenectomy. In addition, a right thoracotomy was carried out and complete surgical excision of the rib mass was successfully performed. Adjuvant chemotherapy was administrated. The patient is clinically free of disease 10 months following diagnosis. Single-bone extrauterine metastatic site and local disease limited to the uterus had better survival outcomes than Stage IVb endometrial cancer with multiple metastatic sites. Therefore, the patient treated with surgery with a clear margin continued to behave as early-stage endometrial cancer. [ABSTRACT FROM AUTHOR]