Advances in the Preoperative Identification of Uterine Sarcoma

Abstract

Uterine sarcomas are rare malignant tumors of the uterus with a high degree of malignancy. Their clinical manifestations, imaging examination findings, and laboratory test results overlap with those of uterine fibroids. No reliable diagnostic criteria can distinguish uterine sarcomas from other uterine tumors, and the final diagnosis is usually only made after surgery based on histopathological evaluation. Conservative or minimally invasive treatment of patients with uterine sarcomas misdiagnosed preoperatively as uterine fibroids will shorten patient survival. Herein, we will summarize recent advances in the preoperative diagnosis of uterine sarcomas, including epidemiology and clinical manifestations, laboratory tests, imaging examinations, radiomics and machine learning-related methods, preoperative biopsy, integrated model and other relevant emerging technologies.

Metastatic Uterine Leiomyosarcoma as a Rare and Sinister Cause of Respiratory Distress: A Case Report and Literature Review

“…Its aggressive metastatic pattern also infers that patients may present with complications of spread [ 9 ], such as acute respiratory distress secondary to pulmonary metastases, as demonstrated in our patient. Other features of metastases, such as ascites, pelvic lymphadenopathy, and constitutional symptoms, namely weight loss, generalised weakness, and fatigue, may be noted in leiomyosarcomas but not in leiomyomas, as the latter are benign with negligible metastatic potential [ 3 , 9 , 10 , 12 , 15 ].…”

“…Magnetic resonance imaging (MRI) is the preferred radiographic modality for distinguishing between leiomyomas and leiomyosarcomas, as it allows greater differentiation of soft tissue types [ 15 ]. The standard radiographic characteristics of leiomyomas include solitary or multiple distinct, spherical masses with well-delineated margins [ 3 , 7 , 9 , 12 ]. Comparatively, leiomyosarcomas are usually a singular mass with ill-defined borders, infiltrative growth patterns, and areas of hemorrhagic necrosis [ 3 , 7 , 9 , 12 ].…”

“…Uterine leiomyosarcomas account for 2%-5% of all uterine malignancies [ 1 ], with an annual incidence of 0.35-0.64 per 100,000 women [ 2 ]. They convey a poor prognosis [ 3 ], and as such, distant metastases may be present in up to 81.4% of patients [ 4 ], with dissemination most commonly noted in the lung [ 1 ].…”

Management of Uterine Fibroids and Sarcomas: The Palermo Position Paper

“…Six out of the eight retrospective studies report an increased level of LDH in uterine sarcoma. There is a substantial overlap in LDH levels between uterine sarcomas and degenerated or atypical uterine fibroids [21].…”

“…Only three out of six retrospective studies show a significant increase in CA-125 levels in uterine sarcoma cases. CA-125 levels in the early stages of leiomyosarcoma overlap with those in uterine fibroids [21, 22].…”