Diagnosis and treatment of sarcoma of the uterus. A review

Figures & data

Table I. Presenting symptoms.

Presenting symptoms	LMS	ESS
Postmenop. bleeding	22 (31%)	22 (46%)
Mennorhagia	7 (10%)	6 (13%)
Meno/metrorrhagia	11 (17%)	10 (21%)
Abdominal pain	9 (13%)	2 (4%)
Abdominal distensy	12 (17%)	4 (8%)
Urinary symptoms	1 (1%)	1 (2%)
Unspecified	7 (10%)	2 (4%)
None	1 (1%)	1 (2%)
TOTAL	70 (100%)	48 (100%)

ESS, endometrial stromal sarcoma; LMS, leiomyosarcoma.

From Nordal [23] with permission.

Figure 1. Crude survival related to tumor type.From Abeler et al. [11] with permission.

Table II. Staging for uterine sarcomas (leiomyosarcomas, endometrial stromal sarcomas, adenosarcomas, and carcinosarcomas).

(1) Leiomyosarcomas and endometrial stromal sarcomas (ESS)*
Stage		Definition
I		Tumor limited to uterus
	IA	≤ 5 cm
	IB	> 5 cm
II		Tumor extends beyond the uterus, within the pelvis
	IIA	Adnexal involvement
	IIB	Involvement of other pelvic tissues
III		Tumor invades abdominal tissues (not just protruding into the abdomen)
	IIIA	One site
	IIIB	> one site
	IIIC	Metastasis to pelvic and/or para-aortic lymph nodes
IV	IVA	Tumor invades bladder and/or rectum
	IVB	Distant metastasis
(2) Adenosarcomas
Stage		Definition
I		Tumor limited to uterus
	IA	Tumor limited to endometrium/endocervix with no myometrial invasion
	IB	Less than or equal to half myometrial invasion
	IC	More than half myometrial invasion
II		Tumor extends beyond the uterus, within the pelvis
	IIA	Adnexal involvement
	IIB	Involvement of other pelvic tissues
III		Tumor invades abdominal tissues (not just protruding into the abdomen)
	IIIA	One site
	IIIB	> one site
	IIIC	Metastasis to pelvic and/or para-aortic lymph nodes
IV	IVA	Tumor invades bladder and/or rectum
	IVB	Distant metastasis
(3) Carcinosarcomas
Carcinosarcomas should be staged as carcinomas of the endometrium.

*Note: Simultaneous endometrial stromal sarcomas of the uterine corpus and ovary/pelvis in association with ovarian/pelvic endometriosis should be classified as independent primary tumors.

From [31] with permission.

Figure 2. Crude survival in leiomyosarcoma confined to uterus. (a) Related to tumor size. (b) Related to number of mitoses per 10 high power fields. (c) Risk grouping based on mitoses and tumor size.

Figure 3. Crude survival in ESS. (a) Number of mitoses. (b) Tumor necrosis. (c) ESS risk groups.

From Abeler et al. [11] with permission.

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