Clinical Characteristics Analysis And Diagnosis Of31Cases Of Uterine Sarcoma

Objective: To explore the clinical characteristics, diagnosis and misdiagnosis ofuterine sarcoma with different histological types. The purpose is expected to provide areference for improving the preoperative diagnostic rate.Methods: Thirty-one cases with uterine sarcoma treated in the first and secondaffiliated hospital of Da Lian Medical University from December2002to December2012were analysed retrospectively. According to the histology categorization of GOG，among which there were4cases of leiomyosarcoma (LMS),20cases of endometrialstromal sarcoma (ESS),7cases of malignant mixed mullerian tumors (MMMT).Among them26cases were on stage I,2cases were on stage Ⅱ,2cases on stage Ⅲ,and1cases with stage Ⅳ. Clinicopathological characteristics were analyzedretrospectively. SPSS18.0statistical software for statistical analysis. A statisticallysignificant difference was indicated by P<0.05.Results:(1) uterine sarcomas are uncommon tumours from mesenchymal elements. Thepatients’ onset age span of uterine sarcoma is larger.The average age is about55yearsold. Among them the average onset age was63.43±9.85years old of MMMT,53.55±11.50years old of ESS,47.50±3.51years old of LMS. The differences of threegroups have statistical significance (P<0.05).(2)The patients usually manifested with palpable abdominal mass（14/31）,abdomenal pain（9/31）, abnormal vaginal bleeding (8/31), vaginal discharge (6/31). Thedifferences of this four clinical characteristics between pre-menopausal women andpost-menopausal women have statistical significance（P<0.05）.(3)The preoperative diagnosis rate of uterine sarcoma was29.03%.In the auxiliaryexamination，the Positive rate of Color doppler ultrasound was29.03%while CT andMRI was66.67%. (4)There are17patients who did the preoperative diagnostic curettage and vaginalneoplasm biopsy(there were15patients for reoperative diagnostic curettage, and2forvaginal neoplasm biopsy). The positive rate was64.71%.12cases underwent frozenslice and10cases were diagnosed suffering from uterine sarcoma, the positive rate was83.33%（10/12）. The number of ESS which had8cases was maximum, the positive ratewas75%.(5)There were22cases misdiagnosed in this research. Among them12cases wereuterine fibroids, which accounted for54.55%.3cases were misdiagnosed as ovariantumor and endometrial carcinoma respectively, which accounted for13.64%.4caseswere misdiagnosed as other diseases, which accounted for18.18%. And the differencesbetween the misdiagnosis group and the control group have statistical significance（P<0.05）.(6) A total of4cases with LMS（12.9%）,3for pre-menopausal women（75%）.20cases with ESS（64.5%）, and there was no difference between pre-menopausal womenand post-menopausal women.7cases with MMMT （22.6%）, all of them arepost-menopausal women. The differences of pathological pattern betweenpre-menopausal women and post-menopausal women have statistical significance（P<0.05）.In the pathological stage, stage I with83.87%, stage Ⅱand Ⅲ with6.45%respectively, stage Ⅳ with3.23%, and there was no difference between them（P>0.05）.Conclusion:(1)The patients of uterine sarcoma mainly were post-menopausal women, and theincidence of post-menopausal women was higher than pre-menopausal women In thethree histological types. The patients with MMMT were oldest and the patients withLMS were youngest.(2) The patients mainly manifested with palpable abdominal mass, abdomenal pain,abnormal vaginal bleeding and vaginal discharge. The clinical manifestations of ESSand pre-menopausal women was lower abdomen and pain on lower abdomen; And theclinical manifestations of MMMT and post-menopausal women was abnormal vaginalbleeding and vaginal discharge.(3) Color doppler ultrasound is one of the widely used screening method of uterinesarcoma.(4) The diagnostic curettage and biopsy were the most valuable method ofpreoperative diagnosis of uterine sarcoma. Intraoperative frozen pathology which had aspecial value to the diagnosis of uterine sarcoma and higher positive rate can be used to decide the method of operation.(5) The diagnosis of uterine sarcoma is very difficult, so its misdiagnosis rate ishigher. At least50%misdiagnosed as uterine fibroids, and merger of uterine fibroidswas the risk factors of misdiagnosis.(6)In the pathology types of uterine sarcoma, pre-menopausal patients mainly forLMS, post-menopausal patients mainly for MMMT, the pathological staging is givenpriority with stage I.