Uterine leiomyosarcoma: A 10-year review in a referral hospital in Peru, 2005 - 2014

Abstract

Background. Uterine leiomyosarcoma (LMS) accounts for more than 50% of uterine sarcomas, representing 1.3% of all uterine malignancies. The presenting symptoms of uterine LMS are the same as those of leiomyoma. This characteristic hinders a prompt diagnosis, or suspicion, before a surgical intervention. Patients diagnosed with uterine LMS are often in an early stage of the disease. Nonetheless, the overall prognosis is poor. Objective. To describe the general characteristics, clinical features, diagnosis and treatment of patients with LMS. Methods. From 2005 to 2014, clinical files of patients diagnosed with a uterine LMS at Hospital Nacional Edgardo Rebagliati Martins in Peru were reviewed. Results. Eleven cases with complete information were identified. The mean age at diagnosis was 45.36 years (range 27 -61 years); the most frequent symptom reported was pelvic pain in 54% (n=6/11) patients; 72% (n=8/11) patients were diagnosed after surgical intervention. The most frequent clinical stage was IB in 90% (n=10/11) cases. Initial treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO) in 62% (n=7/11) cases. The prevalence of undiagnosed uterine LMS in hysterectomies and myomectomies performed for presumed leiomyomas was 0.24% and 0.22%, respectively. Conclusion. The clinical presentation of uterine LMS does not differ from usual leiomyomas. Most of the cases were diagnosed incidentally after surgical specimen analysis. The most accepted initial management to date is still en bloc TAH and BSO. Follow-up strategies should be implemented and be the goal of any long-term programme.