Sarcoma (Uterine)

Introduction

• Description: Uterine sarcoma is characterized by a sarcomatous change in the tissues of the Müllerian system, including the endometrial stroma and myometrium. Mixed Müllerian sarcomas may include elements not native to the genital tract such as cartilage or bone (heterologous type).

• Prevalence: Less than 10% of uterine malignancies, 1/800 smooth muscle tumors, 2.8/100,000 women aged 30–79 years.

• Predominant Age: 40–70 years; mean age is 60 years. Reported in patients as young as 20 years of age.

• Genetics: No genetic pattern. Leiomyosarcoma is found 2-fold more often in Black women, although there is no racial predisposition for other sarcomas. A small increase in risk for patients with hereditary leiomyomatosis and renal cell carcinoma syndrome, a rare autosomal dominant disorder, has been proposed but is unproven.

  

Etiology and Pathogenesis

• Causes: Etiology unknown.

• Risk Factors: Leiomyomata, tamoxifen use. Estrogen, radiation exposure, and obesity have also been proposed. Oral contraceptive use is associated with a reduced risk.

Signs and Symptoms

• Bleeding (40%) and passage of tissue

• Lower abdominal pain and mass (15%)

• Rapid enlargement of the uterus (doubling in 3–6 months)

• Uterine growth after menopause

Diagnostic Approach