Uterine leiomyosarcoma – incidence, treatment, and the impact of morcellation. A nationwide cohort study

Abstract

The most frequent symptom in women suffering from LMS was abnormal uterine bleeding [110/212 (51.9%)]. LMS was histopathologically verified in 49/212 (23.1%) preoperatively. In 48/212 (22.6%), a malignant condition was suspected and they were treated accordingly. In 115/212 (54.2%), malignancy was not suspected at time of surgery and the women were treated according to the treatment protocol for fibroids. In only four patients was tissue retrieval by power morcellation conducted, accounting for 1.9% of all LMS cases. Conclusions. In more than 50% of women suffering from LMS, a malignant diagnosis was not confirmed or suspected prior to surgery. In our material, power morcellation of LMS has not lead to reduced survival. We suggest that power morcellators may be used in surgical treatment of selected cases of premenopausal women with symptomatic, presumed benign uterine leiomyomas.

Integrated genome analysis of uterine leiomyosarcoma to identify novel driver genes and targetable pathways

“…Overall, this simulation identified 29 genomic regions (10 amplifications and 19 deletions) for which the random chance of being affected by an SCNA twice was very low (p < 5.0E-03; supplementary Table S5). Interestingly, pathway analysis of genes located in these 29 regions revealed that the PTEN pathway (FDR 5 2.4E-02), the glioblastoma multiforme signaling pathway (FDR 5 3.6E-02) and the PI3K/AKT pathway (FDR 5 6.3E-02) were enriched (supplementary 1 For deleted (del) and amplified (amp) regions, only downregulated and upregulated genes were selected, respectively, in the regions identified in uLMS (FDR < 5E-02). Additional genes of interest were selected in the smallest region (overlap of uLMS and euLMS).…”

“…Uterine leiomyosarcomas (uLMS), arising from the myometrium, are rare malignancies with an annual incidence rate of 0.4-0.9/100,000 women. 1 Although prognosis depends on the stage, uLMS are generally aggressive tumors, with 5-year survival rates ranging from 16% for stage IV uLMS to 57% for stage I uLMS. 2 The cornerstone of treatment is hysterectomy with or without bilateral salpingo-oophorectomy.…”

Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study

“…Unfortunately, a rare malignant sarcoma subtype, leiomyosarcoma (LMS) has many similar features to benign fibroids and may consequently escape diagnosis preoperatively. LMS accounts for approximately 1.9% of uterine cancers and has an estimated incidence of 0.36–0.86 per 100 000 women . Occult LMS in women surgically treated for presumed benign fibroids has been found to be 0.07–0.49% of cases .…”

Is Laparoscopic Power Morcellation of Fibroids a Cardinal Sin in 2017?

“…The objective of Skorstad et al's [21] In 48/212 (22.6%), a malignant condition was suspected and they were treated accordingly. In 115/212 (54.2%), malignancy was not suspected at time of surgery and the women were treated according to the treatment protocol for fibroids.…”

“…In this study, power morcellation of LMS has not lead to reduced survival. The authors suggest that power morcellators may be used in surgical treatment of selected cases of premenopausal women with symptomatic, presumed benign uterine leiomyomas [21].…”