Uterine Leiomyoma or Sarcoma?: What Should I Do?

Uterine Leiomyoma or Sarcoma?: What Should I Do?

Theodoros Theodoridis (1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece), Dimitra Aivazi (1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece), Leonidas Zepiridis (1st Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Greece) and Nikolaos Vlachos (1st Department of Obstetrics and Gynaecology, National Kapodestrian University, Athens, Greece)
DOI: 10.4018/978-1-7998-4213-2.ch020

Abstract

Uterine leiomyomas are benign neoplasms derived from the smooth muscle cells of the myometrium. In contrast, uterine sarcomas are rare tumors, with a prevalence of 3-7 per 100,000 women, originating from myometrial cells or endometrial connective tissue. Uterine sarcomas and especially leiomyosarcomas are more aggressive than uterine epithelial neoplasms. The differential diagnosis between leiomyoma and uterine sarcoma preoperatively remains challenging for the clinical practitioner in order to determine optimal treatment. The chapter aims to summarize current evidence regarding differential diagnosis and optimal management of these two challenging clinical entities.
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Introduction

Differentiating leiomyomas from sarcomas, is nowadays more essential than ever, given that conservative therapies for leiomyomas tend to gain ground over hysterectomy and, more significantly, that the trend to perform minimal invasive procedures instead of classical surgical management requires the best preoperative evaluation in the interest of patients’ safety.

Leiomyomas are benign monoclonal tumors, with a prevalence as high as 25% in women of reproductive age, although their true incidence remains unclear due to the fact that a significant number of cases continue to be undiagnosed, whereas, the possibility for a woman to be diagnosed with a fibroid during her lifetime is estimated near 70%, and this percentage is even higher in black women. The term “leiomyoma” reveals the origin of this tumor from soft muscle myometrial cells (Bulum, 2013; Downes, 2010; Hosh, 2016; Vlahos, 2017; Wysowski, 2002).

On the other hand, sarcomas are rare malignant tumors, arising from myometrial smooth muscle cells and their neighboring connecting tissue. Their prevalence is estimated 3-7/100000, while leiomyosarcomas constitute the 60-70% of cases. These malignant uterine neoplasms are rare in women under 40 years old, and their biological behavior is more aggressive in comparison to epithelial uterine malignant tumors.

Sarcomas have been recently histologically classified by World Health Organization (WHO) according their differentiation and the origin of neoplastic cells replacing the older classification (Oliva 2014, Prat 2009)

Table 1.
Classification of sarcomas according to WHO
Smooth Muscle Tumor of Uncertain Malignant Potential
Leiomyosarcoma
     • Epitheleioid leiomyosarcoma
     • myxoid leiomyosarcoma
Endometrial Stroma and Related Tumors
     • endometrial stromal nodule
     • low grade endometrial stromal sarcoma
     • high- grade endometrial stromal sarcoma
     • undifferentiated uterine sarcoma
     • uterine tumor resembling ovarian sex cord tumor
Miscellaneous Mesenchymal Tumors
     • rhabdomyosarcoma
     • perivascular epithelioid cell tumor
               ▪ benign
               ▪ malignant
Others
     • adenomyoma
     • atypical polypoid adenomyoma
     • adenofibroma
     • adenosarcoma
     • carcinosarcoma

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