Histopathologic Prognostic Factors in Stage I Leiomyosarcoma of the Uterus

Abstract

Uterine leiomyosarcomas (Ut-LMSs) are aggressive tumors with an overall poor prognosis (15% to 25% 5-year survival rate). However, patients with stage I Ut-LMSs are reported to have a relatively better outcome when compared with the overall group with a 5-year survival rate ranging from 25% to 75%. The purpose of this study was to evaluate the histopathologic parameters that may impact outcome in stage I Ut-LMSs. Twenty-seven patients with stage I Ut-LMSs were identified from the files of 5 tertiary care hospitals between 1974 and 2006. Tumors were primarily staged based on pathologic information, supplemented with radiologic findings (10 cases) and clinical records (1 case). Patients with stage I tumors with no additional clinical or radiologic staging information were included in the study if no recurrence was documented after 6 months from the initial staging operation (16 cases). Clinicopathologic parameters that were statistically evaluated included age [mean, 54 y (37 to 73)], tumor size [mean, 9.5 cm (5.5 to 16)], cell type (17 spindled, 5 epithelioid, 2 myxoid, and 3 mixed), mitotic activity [mean count, 24 (4 to 69)/10 high-power fields], marked cytologic atypia (26 of 27 cases), tumor cell necrosis (12 of 27 cases), and lymphovascular invasion (6 of 27 cases). Follow-up was available for all the patients. Poor outcome was defined when patients either died of disease or were alive with disease. Overall, accounting for any length of follow-up, 16 of 27 (59%) patients with stage I Ut-LMSs had poor outcome; 7 died of disease (mean follow-up, 13 mo) and 9 were alive with disease (mean follow-up, 31 mo). The remaining 11 patients were alive and well with a mean follow-up of 48 months. However, at 2 years of follow-up by univariate analysis, only nonspindle morphology (P<0.0183) and diffuse high-grade cytologic atypia (P<0.02) were statistically associated with poor outcome. No statistically significant association with survival was identified by univariate analysis when evaluating mean age, mean tumor size, presence of tumor cell necrosis, mean mitotic count, or lymphovascular invasion. In conclusion, stage I leiomyosarcoma is associated with poor prognosis. No conclusive differences were observed among different clinicopathologic parameters and prognosis, although it seemed that spindle cell morphology and diffuse high-grade cytologic atypia were associated with longer overall survival and higher death rates, respectively.

Comparative clinicopathologic and immunohistochemical analysis of uterine sarcomas diagnosed using the World Health Organization classification system

“…Factors associated with poor prognosis have not been consistent in different series of uterine leiomyosarcomas [7,8,10,22,32]. However, in a recent study of 245 leiomyosarcomas confined to the uterus [11], tumor size and mitotic index were found to be significant prognostic factors and allowed for separation of patients into 3 risk groups with marked differences in prognosis.…”

“…However, carcinosarcomas are no longer considered uterine sarcomas but metaplastic forms of endometrial carcinomas or tumors undergoing divergent differentiation [5]. Most of the reported series of pure uterine sarcomas have focused on specific histologic types, such as leiomyosarcomas [6][7][8] or endometrial stromal sarcomas [9], and very few comparative studies including all major clinicopathologic categories have been reported [10,11].…”

Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia

“…Correct classification is important as currently prognosis of its malignant counterpart, leiomyosarcoma, is dismal even when confined to the uterus at time of diagnosis. [1][2][3] Interestingly, the recent AJCC staging system of soft tissue sarcomas has been recommended to stage uterine malignant smooth muscle tumors. However, it is important to note that several studies have shown no advantage of this system over the old FIGO staging system to improve prediction of overall survival in patients with leiomyosarcoma, [4][5][6][7] whereas neither system is ideal in classifying patients into four clinically significant stages.…”

Uteri̇n Lei̇omyosarkom: 22 Olguda Patolojik Değerlendirme (Uterine Leiomyosarcoma: Pathologic evaluation of 22 Cases)

“…Olgularımızdan 3'ünde tanı anında servikste, 2'sinde overde, 2'inde parametriyumda, 2'inde de omentumda tutulum mevcuttu. LMS'lar oldukça agresif seyirli neoplazilerdir ve konvansiyonel iğsi hücreli LMS'ların epiteloid ve miksoid LMS'lara göre daha iyi prognoza sahip olduğu gösterilmiştir (8). Lusby ve ark.…”