Classification and types of sarcomas
Morphological classification includes several main histological variants:
- Leiomyosarcoma — more commonly occurs in women aged 43–53.
- Endometrial stromal sarcoma — typically develops during the postmenopausal period.
- Mixed homologous Müllerian sarcoma (carcinosarcoma).
- Mixed heterologous Müllerian (mesodermal) sarcoma.
- Other rare forms of uterine sarcoma.
According to clinical and anatomical spread, four stages are distinguished: from localization within the organ body (stage I) to invasion of neighboring organs and distant metastases (stage IV).
Clinical manifestations
Symptoms of the disease depend on the rate of growth and exact localization of the tumor process:
- Main complaints include rapid enlargement of the uterus, menstrual irregularities, pelvic pain, and profuse watery discharge (sometimes with an unpleasant odor).
- If the tumor develops inside myomatous nodes, its symptoms may completely mimic a conventional myoma.
- When necrosis develops and infection joins, anemia, fever, and rapid cachexia occur.
- An important warning sign is the unexpected growth of a myomatous node during the postmenopausal period.
Diagnostic approaches
Patient evaluation is based on a combination of clinical and instrumental methods:
- Anamnesis: the growth rate of nodes and the appearance of neoplasms in postmenopause are assessed.
- Ultrasound and Doppler sonography: determine heterogeneous echostructure, necrosis zones in nodes, and pathological blood flow with a decreased resistance index (RI) below 0.40.
- Aspiration biopsy: has low efficacy in leiomyosarcomas, but helps suspect endometrial sarcoma or carcinosarcoma in approximately 30% of cases.
- Hysteroscopy with fractional D&C: possesses high diagnostic accuracy ranging from 80 to 100%.
- Intraoperative biopsy: used to verify intramural sarcomas.
Management tactics and prognosis
Treatment is comprehensive and requires radical approaches:
- Surgical intervention: the primary method, consisting of an extended hysterectomy along with adnexa.
- Radiation therapy: prescribed additionally for pelvic irradiation with a total dose of 45–50 Gy.
- Chemotherapy: actively used postoperatively in advanced forms (drugs of choice include doxorubicin with vincristine, dactinomycin, cyclophosphamide).
Prognosis: The overall prognosis is considered pessimistic due to low survival rates against the background of rapid metastasis. A relatively favorable course is observed exclusively when sarcoma develops directly inside a benign node.
Briefly: answers to topical questions
What are the pathways of metastasis and target organs in uterine sarcoma?
The main pathway of sarcoma metastasis is hematogenous. Lymphogenous metastasis is also possible.
In uterine sarcoma:
- metastatic involvement of the uterine adnexa is noted at stage IIIa;
- at stage IIIb, metastasis to lymph nodes or the vagina is possible.
For sarcomas in general, the lungs are the most frequent localization of distant hematogenous metastases.
Uterine sarcoma is a "fast postmenopausal enemy": rapid node growth, RI below 0.4 on Doppler, high recurrence rate, and mandatory surgical treatment with adnexa.
Class and exam questions
What are the main symptoms characteristic of uterine sarcoma?
Key manifestations include rapid uterine enlargement, lower abdominal pain, menstrual irregularities, watery leukorrhea, as well as signs of necrosis and infection (fever, cachexia).
Which method is leading in the diagnosis of endometrial sarcomas?
Hysteroscopy and fractional diagnostic curettage (D&C) have high diagnostic value (80–100%), whereas aspiration biopsy is effective in only 30% of cases.
What is the prognosis for uterine sarcoma and the frequency of recurrence?
The prognosis is pessimistic due to early metastasis. Recurrences after stage I occur in every second patient (50%), and in stages II and III — in 90% of patients.
What else to study on this topic
- Morphological differences between leiomyosarcoma and endometrial stromal sarcoma
- The role of dopplerometry in the differential diagnosis of myoma and sarcoma
- Features of metastasis in uterine body sarcomas
- Combination chemotherapy regimens in advanced stages
- Management tactics for patients with node growth in postmenopause
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