Is uterine sarcomas malignant?

summary

Uterine sarcoma is a rare and highly malignant tumor of female genitalia. Its histological origin is mostly myometrium, or connective tissue in myometrium or endometrium. Sarcomas can be seen in all parts of the uterus, the uterine body is far more common than the cervix, about 15:1. Uterine sarcomas account for 2-5% of uterine malignant tumors. The most common age is about 50 years old, while cervical staphylococcal sarcomas are more common in young women. Because there was no specific symptom in the early stage of uterine sarcoma, the preoperative diagnosis rate was only 30-39%.

Is uterine sarcomas malignant?

Leiomyosarcoma of uterus is the most common, accounting for about 45%. From myometrium or uterine vascular wall smooth muscle fibers, can also come from uterine leiomyoma sarcomatosis. Pelvic vessels, lymph nodes and lung metastases are easy to occur. Giant examination: the sarcoma showed diffuse growth without obvious boundary with myometrium. If it is myoma, sarcomas often spread from the center to the surrounding. The profile loses the whirlpool structure, and is usually uniform flake or fish like. The color is gray yellow or yellow red, and more than half of them have hemorrhage and necrosis. Microscopically, smooth muscle cells proliferated with different sizes and disordered arrangement. Nuclear atypia, chromatin more, deep staining and uneven distribution, nucleolus obvious, multinucleated giant cells, mitotic phase > 5 / 10HP. Many scholars believe that the prognosis of patients with more mitotic phases is worse (survival rate: 42% for 5-10 / 10HP and 15% for > 10 / 10HP).

Malignant mixed mesodermal tumor of uterus is common. Uterine sarcomas can also be divided into homologous and heterogenous tumors according to whether the components of malignant mesoderms are normal in the uterus. Malignant smooth muscle and stroma are homologous components, while malignant striated muscle and cartilage are heterogenous components. Tumor contains sarcoma and cancer, also known as carcinosarcoma. Giant examination: the tumor grew from the endometrium and protruded into the uterine cavity, presenting polypoid, multiple or lobulated, with wide base or pedicle. In the late stage, it infiltrated the surrounding tissue. The tumor is soft and smooth. On the section, the capsule cavity was filled with mucus, which was grayish white or grayish yellow. Microscopically, there were two components: carcinoma and sarcoma.

Low grade endometrial stromal sarcoma: rare. There was a tendency of metastasis of parametrial tissue, and less lymph and lung metastasis. Giant examination: the uterus is spherical and enlarged, with multiple granular and small mass like protrusions, which are elastic like rubber, and can be retracted after being clamped with forceps, like pulling a rubber band. In the section, there was a polypoid mass in the endometrial layer, yellow, smooth surface, uniform section, no wave vortex arrangement. Microscopically, endometrial stromal cells invaded the myofascicles of myometrium with less cytoplasm, less cell atypia and less mitotic phase (< 10 / 10HP), surrounded by reticular fibers. Bleeding and necrosis are rare.

matters needing attention

Like endometrial carcinoma, uterine sarcoma infiltrates the myometrium and diffuses locally. However, uterine sarcoma has obvious tendency of early hematogenous metastasis, and lymphatic metastasis is not uncommon. That is to say, about 35% of cases have lymphatic metastasis when the tumor is still confined to the uterus and cervix.