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      Prevalence and occult rates of uterine leiomyosarcoma

      , MD a , b , b , , MD, PhD a , , MD a , , MD, PhD b ,
      Lippincott Williams & Wilkins
      leiomyosarcoma, myomas, prevalence, uterine neoplasms

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          This study aimed to assess the prevalence and occult rates of uterine leiomyosarcoma (ULMS) in women with smooth-muscle tumors undergoing gynecological surgery. A retrospective study was performed at an academic cancer center from 2008 to 2015. Patients undergoing either hysterectomy or myomectomy via laparoscopic, abdominal, vaginal, and hysteroscopic approaches were identified with the validated pathology diagnosis of either ULMS or leiomyomas. All patients initially operated at our institute were included and reviewed. The prevalence and occult rates of ULMS were calculated and compared between different age groups.

          Twenty-eight patients with original ULMS were identified in 9556 gynecological surgeries. The prevalence of overall and occult ULMS in our study was 0.25% (1 in 345 patients) and 0.07% (1 in 1429 patients). The proportion of occult in all ULMSs was 25%. The prevalence rates of overall ULMS were 0.21%, 0.13%, 0.52%, 2.12%, and 6.67% in the 30 to 39, 40 to 49, 50 to 59, 60 to 69, and ≥70-year age groups, respectively. There was a significantly increased risk of ULMS after 50 years of age. The prevalence rates of occult ULMS were 0.05%, 0.08%, and 0.12% for the 30 to 39, 40 to 49, and 50 to 59 year age groups, respectively. There was no statistically significant difference among age the groups. The prevalence of ULMS was 0.41% and 0.16% for solitary and multiple tumor masses, respectively. Patients with solitary uterine tumors were at a significantly increased risk of ULMS (OR = 2.601, 95% CI = 1.108–6.141).

          Our retrospective data in part reflects the clinical characteristics of overall and occult ULMS and forms the basis for further prevention of occult ULMS.

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          Most cited references14

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          Uterine sarcomas: a review.

          Uterine sarcomas are rare tumors that account for 3% of uterine cancers. Their histopathologic classification was revised by the World Health Organization (WHO) in 2003. A new staging system has been recently designed by the International Federation of Gynecology and Obstetrics (FIGO). Currently, there is no consensus on risk factors for adverse outcome. This review summarizes the available clinicopathological data on uterine sarcomas classified by the WHO diagnostic criteria. Medline was searched between 1976 and 2009 for all publications in English where the studied population included women diagnosed of uterine sarcomas. Since carcinosarcomas (malignant mixed mesodermal tumors or MMMT) are currently classified as metaplastic carcinomas, leiomyosarcomas remain the most common uterine sarcomas. Exclusion of several histologic variants of leiomyoma, as well as "smooth muscle tumors of uncertain malignant potential," frequently misdiagnosed as sarcomas, has made apparent that leiomyosarcomas are associated with poor prognosis even when seemingly confined to the uterus. Endometrial stromal sarcomas are indolent tumors associated with long-term survival. Undifferentiated endometrial sarcomas exhibiting nuclear pleomorphism behave more aggressively than tumors showing nuclear uniformity. Adenosarcomas have a favorable prognosis except for tumors showing myometrial invasion or sarcomatous overgrowth. Adenofibromas may represent well-differentiated adenosarcomas. The prognosis of carcinosarcomas (which are considered here in a post-script fashion) is usually worse than that of grade 3 endometrial carcinomas. Immunohistochemical expression of Ki67, p53, and p16 is significantly higher in leiomyosarcomas and undifferentiated endometrial sarcomas than in endometrial stromal sarcomas. Evaluation of H&E stained sections has been equivocal in the prediction of behavior of uterine sarcomas. Immunohistochemical studies of oncoproteins as well as molecular analysis of non-random translocations will undoubtedly lead to an accurate and prognostically relevant classification of these rare tumors.
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            Uterine sarcoma in patients operated on for presumed leiomyoma and rapidly growing leiomyoma.

            To determine the incidence of uterine sarcoma in patients operated on for symptomatic uterine leiomyomas or "rapidly growing" leiomyomas. We reviewed the medical records of 1332 women admitted to either of two community hospitals between 1988-1992 for hysterectomy or myomectomy for uterine leiomyomas. The incidence of leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor was calculated. Patient ages, admitting symptoms, and operative and pathologic findings were analyzed. The study included 371 women (28%) operated on for rapidly growing leiomyomas. All patients operated on during the same interval and found to have a uterine sarcoma were reviewed. One of the 1332 patients operated on for presumed leiomyoma was found to have a leiomyosarcoma. This women was the only patient found to have a sarcoma among 371 women operated on for rapid growth of the uterus. None of 198 patients who met a published definition of rapid growth had a uterine sarcoma. Two women (0.15%) had endometrial stromal sarcoma, but none had a mixed mesodermal tumor. During the same interval, nine additional patients were found to have uterine sarcomas, and for these women, the preoperative diagnosis was sarcoma in four, endometrial cancer in three, ovarian cancer in one, and prolapsed uterus in one. The total incidence of uterine sarcoma (leiomyosarcoma, endometrial stromal sarcoma, and mixed mesodermal tumor) among patients operated on for uterine leiomyoma is extremely low (0.23%). The incidence of sarcoma among patients having surgery for "rapidly growing" leiomyoma (0.27%) or among those who met published criteria for rapid growth (0%) does not substantiate the concept of increased risk of sarcoma in these women.
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              Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus.

              This prospective study was conducted to identify the magnetic resonance imaging (MRI) characteristics of uterine leiomyosarcoma (LMS) and to evaluate the diagnostic accuracy of conventional MRI and dynamic MRI with or without serum measurement of lactate dehydrogenase (LDH) levels. Two hundred ninety-eight consecutive patients were entered in this study. In eligible 227 patients, ten patients with LMS and 130 patients with uterine degenerated leiomyoma (DLM) were included for the present study. Precontrast T1, T2 weighted images were obtained in all patients. Serum LDH and its isozymes were also measured. Dynamic MRI by Gd-DTPA was obtained in all patients with LMS and 32 patients with DLM in whom elevated LDH levels were observed. The contrast enhancement at 60 s after administration of Gd-DTPA was detected in all LMS, but absent in 28 of 32 DLM patients. Concerning serum LDH isozymes, both total LDH and LDH isozyme type 3 were elevated in all 10 patients with LMS. The sensitivity for determination of LMS with MRI alone, dynamic MRI alone, and combined use of MRI (including dynamic MRI) and serum LDH levels was 100% in each group. The specificity, positive predictive value, negative predictive value, and diagnostic accuracy were 93.1%, 52.6%, 100%, and 93.1% with MRI alone, and 93.8%, 83.3%, 100%, and 95.2% with dynamic MRI alone, and 100%, 100%, 100%, 100% with combined use of LDH and MRI, respectively. In conclusion, the combined use of dynamic MRI and serum measurement of LDH (isozymes) seems to be useful in making a differentiated diagnosis of LMS from DLM before treatment.

                Author and article information

                Medicine (Baltimore)
                Medicine (Baltimore)
                Lippincott Williams & Wilkins (Hagerstown, MD )
                14 August 2020
                14 August 2020
                : 99
                : 33
                [a ]Department of Gynecology
                [b ]Cancer Institute, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, Hebei, China.
                Author notes
                []Correspondence: Baoen Shan, Cancer Institute, Hebei Medical University Fourth Affiliated Hospital and Hebei Provincial Tumor Hospital, 12 Jiankang Road, Shijiazhuang, Hebei 050011, China (e-mail: baoenshan@ 123456hotmail.com ).
                MD-D-20-00546 21766
                Copyright © 2020 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal. http://creativecommons.org/licenses/by-nc/4.0

                Funded by: Medical Scientific Research Foundation of Hebei Province
                Award ID: 20150313
                Award Recipient : Lingxiang Wang
                Research Article
                Observational Study
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                leiomyosarcoma,myomas,prevalence,uterine neoplasms
                leiomyosarcoma, myomas, prevalence, uterine neoplasms


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