Obstetrics and Gynecology - A.M. Gromova 2000

Malignant neoplasms of the female reproductive organs
Uterine sarcoma

Uterine Sarcoma develops primarily in women over 50 years of age. In nearly half of the patients, the tumor originates in the myometrium, and in the remainder, within fibromatous nodes and the endometrium.

Sarcomatous nodes differ from fibromatous ones by their soft consistency; on cross-section, they resemble Brain tissue or boiled fish meat.

Histologically, polymorphocellular, fibroplastic, spindle-Cell, round-cell, myocellular, and giant-cell forms of uterine sarcoma are distinguished. Metastasis occurs primarily via the hematogenous route.

Clinical Classification of uterine sarcoma

Stage I: a small-sized formation is confined within the myometrium or the mucous membrane of the Uterus;

Stage IIa: invasion into adjacent layers is present;

Stage IIb: infiltration of the parametrial tissue is observed;

Stage IIc: uterine sarcoma with extension to the cervix;

Stage IIIa: infiltration of the parametrial Tissues on one or both sides extends to the pelvic walls;

Stage IIIb: metastases are present in regional Lymph Nodes, Ovaries, and Vagina, along with involvement of major Veins;

Stage IIIc: the tumor invades the Middle layer of the uterus, forming a conglomerate with adjacent unaffected Organs;

Stage IV: tumor invasion into adjacent organs and the peritoneal cavity is noted, with distant metastases present.

Initially, uterine sarcoma develops asymptomatically. Patients complain of general weakness and acyclic uterine bleeding. Objective Examination reveals rapid tumor growth accompanied by anemia (unrelated to Blood loss) and an elevated ESR. The definitive Diagnosis is established based on histological examination of tissues obtained during diagnostic uterine curettage or from the gross specimen following Surgical Treatment. Diagnostic Procedures that help determine the extent of tumor involvement include hysterosography with pneumoperitoneum, lymphography, angiography, Liver scan, chest radiography, excretory urography, chromocystoscopy, sigmoidoscopy, and barium enema.

The most effective treatment method for uterine sarcoma is surgical removal of the tumor. The Scope of surgery is chosen depending on the stage of the process: procedures range from total Hysterectomy with adnexa to radical hysterectomy with removal of parametrial infiltrates and ligation of the internal iliac artery (a. hipogastrica). Resection of affected adjacent organs is also possible. Treatment is supplemented with Radiation therapy. Uterine sarcoma has low sensitivity to Chemotherapy, which is primarily prescribed as a palliative treatment method.

The prognosis for uterine sarcoma is unfavorable, particularly in cases of mucosal sarcomas. The most favorable localization is a tumor situated within a Fibromatous node. In such patients, the five-year survival rate reaches 60%.