Retrospective analysis of clinical, pathological characteristics and prognosis of the patients with endometrial stromal sarcomas
Main Article Content
Objective: Endometrial stromal sarcoma (ESS) is a rare mesenchymal tumor of the uterus.Literature has limited data about the ESS. The aim of the present study was to contribute to literature by reporting the histo-pathological findings, clinical characteristics of ESS patients and the data about the accuracy of preoperative diagnosis and prognosis.
Material and Methods: A total of 33 patients who were diagnosed and followed up with ESS at Department of Gynecology and Obstetrics of Bursa Uludağ University between 2007 and 2017 were retrospectively analyzed with regard to clinical and pathologic characteristics, surgical procedures they underwent and survival.
Results: Mean age of the patients was 49.5 years and 60.2 years for low grade ESS (LG-ESS) and high grade ESS (HG-ESS) (p=0,01). Post-menopausal hemorrhage was the most common complaint on admission. Correct histological diagnosis was made in only 72.7% of the patients from whom pre-operative endometrial biopsy was obtained. Twelve out of 16 cases (75%) were in Stage 1. While all patients underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH+BSO), 14 underwent pelvic and para-aortic lymphadenectomy for surgical staging. Lymph node involvement was detected in no patients who underwent lymphadenectomy. The patients with LG-ESS were found to have a good prognosis however the ones with HG-ESS had a high mortality rate even in the early stages (mean survival of 10 months).
Conclusion: High grade ESS cases show different clinical characteristics and prognosis than LG-HSS. Diagnostic accuracy of endometrial sampling is much lower when compared to epithelial uterine malignancies. Metastasis of pelvic-paraaortic lymph nodes of which removal is reported which not to contribute to survival is rare.
C.G. Trope, V.M. Abeler, G.B. KristensenDiagnosis and treatment of sarcoma of the uterus. A review Acta Oncol., 51 (6) (2012), pp. 694-705
Hoang L, Chiang S, Lee CH. Endometrial stromal sarcomas and related neoplasms: new developments and diagnostic considerations. Pathology. 2018; 50(2):162–177.
Abeler VM, Røyne O, Thoresen S, Danielsen HE, Nesland JM, Kristensen GB. Uterine sarcomas in Norway. A histopathological and prognostic survey of a total population from 1970 to 2000 including 419 patients. Histopathology. 2009;54(3):355–364.
Harlow BL, Weiss NS, Lofton S. The epidemiology of sarcomas of the uterus. J Natl Cancer Inst. 1986;76(3):399–402.
M.R. Hendrickson, F.A. Tavassoli, R.L. Kempson, et al.Mesenchymal tumors and related lesions. F.A. Tavassoli, P. Devilee (Eds.), World Health Organization Classification of Tumors: Pathology and Genetics - Tumors of the Breast and Female Genital Organs, International Agency for Research on Cancer, Lyon, France (2003)
H. Machida, M.J. Nathenson, T. Takiuchi, C.L. Adams, J. Garcia-Sayre, K. MatsuoSignificance of lymph node metastasis on survival of women with uterine adenosarcoma. Gynecol. Oncol., 144 (2017), pp. 524-530
B. Barney, J.D. Tward, T. Skidmore, D.K. GaffneyDoes radiotherapy or lymphadenectomy improve survival in endometrial stromal sarcoma Int. J. Gynecol. Cancer, 19 (7) (2009), pp. 1232-1238
J.P. Shah, C.S. Bryant, S. Kumar, R. Ali Fehmi, J.M. Malone Jr., R.T. MorrisLymphadenectomy and ovarian preservation in low-grade endometrial stromal sarcoma. Obstet. Gynecol., 112 (5) (2008), pp. 1102-1108
H.L. EvansEndometrial stromal sarcoma and poorly differentiated endometrial sarcoma. Cancer, 50 (10) (1982), pp. 2170-2182
Pautier P, Nam EJ, Provencher DM, et al. Gynecologic Cancer InterGroup (GCIG) consensus review for high-grade undifferentiated sarcomas of the uterus. Int J Gynecol Cancer. 2014;24(9 Suppl 3):S73–S77.
Benson C, Miah AB. Uterine sarcoma – current perspectives. Int J Womens Health. 2017;9:597–606
Juang CM, Yen MS, Horng HC, Twu NF, Yu HC, Hsu WL (2006) Potential role of preoperative serum CA125 for the differential diagnosis between uterine leiomyoma and uterine leiomyosarcoma. Eur J Gynaecol Oncol 27(4):370–374
Aviram R, Ochshorn Y, Markovitch O, Fishman A, Cohen I, Altaras MM, Tepper R (2005) Uterine sarcomas versus leiomyomas: gray-scale and Doppler sonographic findings. J Clin Ultrasound 33(1):10–13, doi:10.1002/jcu.20075
Kido A, Togashi K, Koyama T, Yamaoka T, Fujiwara T, Fujii S (2003) Diffusely enlarged uterus: evaluation with MR imaging. Radiographics 23(6):1423–1439
F.P. Dijkhuizen, B.W. Mol, H.A. Brolmann, A.P. HeintzThe accuracy of endometrial sampling in the diagnosis of patients with endometrial carcinoma and hyperplasia.Cncer 2000;89:1765
T.J. Clark, C.H. Mann, N. Shah, et al.Accuracy of outpatient endometrial biopsy in the diagnosis of endometrial cancer: a systematic quantitative review BJOG 2002;109:313
Bansal N, Herzog TJ, Burke W, Cohen CJ, Wright JD. The utility of preoperative endometrial sampling for the detection of uterine sarcomas. Gynecol Oncol. 2008 Jul;110(1):43-8
Nagai T, Takai Y, Akahori T, Ishida H, Hanaoka T, Uotani T, Sato S, Matsunaga S, Baba K, Seki H.Springerplus. 2014 Nov 18;3:678
S. Sagae, K. Yamashita, S. Ishioka, et al.Preoperative diagnosis and treatment results in 106 patients with uterine sarcoma in Hokkaido Oncology, 67 (2004), pp. 33-39.
Giuntoli RL 2nd, Metzinger DS, DiMarco CS, Cha SS, Sloan JA, Keeney GL, Gostout BS (2003) Retrospective review of 208 patients with leiomyosarcoma of the uterus: prognostic indicators, surgical management, and adjuvant therapy. Gynecol Oncol 89(3):460–469
Patsner B, Mann WJ (1988) Use of serum CA-125 in monitoring patients with uterine sarcoma. A preliminary report. Cancer 62(7):1355–1358
Li N, Wu LY, Zhang HT, An JS, Li XG, Ma SK. Treatment options in stage 1 endometrial stromal sarcoma:Aretrospective analysis of 53 cases Gynecol Oncol. 2008 Feb;108(2):306-11. Epub 2007
Seagle BL, Shilpi A, Buchanan S, Goodman C, Shahabi S. Low-grade and high-grade endometrial stromal sarcoma: A National Cancer Database study. Gynecol Oncol. 2017 Aug;146(2): 254-262
Horng HC, Wen KC, Wang PH, et al. Uterine sarcoma Part II – uterine endometrial stromal sarcoma: the TAG systematic review. Taiwan J Obstet Gynecol. 2016;55(4):472–479
Reed NS, Mangioni C, Malmström H, et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874) Eur J Cancer. 2008;44(6):808–818
Desar IME, Ottevanger PB, Benson C, van der Graaf WTA. Systemic treatment in adult uterine sarcomas. Crit Rev Oncol Hematol. 2018;122:10–20