Uterine leiomyosarcoma

Is a rare neoplasm of the uterus

• annual incidence is around 0.64 per 100,000 women
• accounts for <5% of all uterine malignancies and approximately 30% of all uterine sarcomas
• majority are seen in women over 40 years of age

Early hematogenous spreads is common. Leiomyosarcomas are considered as neoplasms of high metastatic potential with 5-year overall survival rates varying between 0% and 73%.

Patients usually presents with abnormal vaginal bleeding and pelvic pain

• clinically they may be difficult to differentiate from fibroids.
  • this is especially important in fibroids which are untreated or managed conservatively
  • a meta analysis reported that a diagnosis of leiomyosarcomas was made in about 2.94 per 1000 women (1in 340 women) who underwent surgery for supposed benign fibroids

Treatment options include:

• total abdominal hysterectomy and debulking of tumour if present outside the uterus
• ovaries may be preserved in premenopausal women with early stage leiomyosarcoma
• radiotherapy may help to control local recurrence
• advanced or recurrent disease, doxorubicin or docetaxel/gemcitabine can be used

A retrospective study revealed a 5-year disease-free survival rate was 55% (3)

Reference:

• (1) Lumsden MA et al. Fibroids: diagnosis and management. BMJ. 2015;351:h4887
• (2) Khan AT, Shehmar M, Gupta JK.Uterine fibroids: current perspectives. Int J Womens Health. 2014;6:95-114.
• (3) Acta Obstet Gynecol Scand. 2003 Jan;82(1):74-81.