[Uterine sarcomas: clinical and histopathological aspects. Report on 15 cases].

Objective: Sarcoma of the uterus are rare uterine cancers with poor prognosis. They are characterised by pathological diversity and their symptomatology is not specific. The aim of this study was to review our experience with uterine sarcomas, to analyze their clinical and histopathological features, to discuss about diagnostic and therapeutic difficulties associated with these tumours and to compare our findings with previously published data.
Patients and Methods: A retrospective review, from 1996 to 2005, of cases of uterine sarcomas diagnosed and treated at the department of obstetrics-gynaecology, Belfort Hospital. Clinical and pathological features, types of treatment, tumoral stage according to the FIGO histological classification and patients' outcome were recorded.
Results: From 1996 to 2005, 15 cases of uterine sarcomas have been diagnosed in our department. Our study included six histological types: carcinosarcoma (n=5), leiomyosarcoma (n=3), rhabdomyosarcoma (n=2), adenosarcoma (n=2), stromal sarcoma (n=2), and undifferentiated sarcoma (n=1). Patients' mean age at the time of diagnosis was 67.6 years (range: 48-91 years). Vaginal bleeding was the most common presenting symptom, being present in 10 patients (67%). The mean time from onset of symptomatology and pathological diagnosis of sarcoma was 17.1 weeks (range: one to 60 weeks). In 10 patients (67%), definitive diagnosis of sarcoma was achieved only after surgical specimen analysis and in only three of them (30%), physical examination combined with pelvic ultrasonography had suspected malignancy. Dilation and curettage was performed in nine patients and failed to rule out neoplasia in three cases (33.5%). Fourteen patients (93%) underwent surgery: total hysterectomy with bilateral salpingo-oophorectomy in all of them and pelvic lymphadenectomy in four of them. Eight patients were in FIGO stage I, one patient in stage II, three patients in stage III and two patients in stage IV. Six patients benefited from adjuvant treatment: external beam radiotherapy and brachytherapy in three cases, brachytherapy in one case and chemotherapy in two cases. At the time of analysis, four patients were lost to follow-up, four patients were dead and with an average follow-up of 25 months, seven patients had a favourable outcome.
Discussion and Conclusion: Uterine sarcomas are rare cancers with poor prognosis. Their symptomatology is non-specific and they are characterized by histopathological diversity. Early diagnosis is essential because patients' survival is correlated to tumour stage. However, preoperative diagnosis is often difficult and definitive diagnosis is frequently achieved after pathological analysis of hysterectomies specimens.