| Study aimIn the present study,we aimed to compare the age of onset,clinical features,surgical procedures,and prognosis of uterine smooth muscle tumors of uncertain malignant potential(SMTUMP),cellular uterine leiomyoma(CUL),and uterine leiomyosarcoma(ULMS).We sought to enhance the knowledge of physicians regarding uterine SMTUMPs and guide the diagnosis and treatment of these tumors through an analysis of the available data.Study methodClinical data were collected from Provincial Hospital affiliated to Shandong University from January 2005 to December 2015 A total of 192 patients was histopathologically diagnosed following surgery,including 57 cases of uterine SMTUMP,120 cases of CUL,and 15 cases of ULMS.All the patients were followed up and examined via retrospective analysis.Moreover,the age composition,clinical features,imaging features,surgical procedures,postoperative recurrence,metastasis,and malignant transformation were compared among the 2 tumor groups via statistical analysis.Study result1.The mean age of the patients with uterine STUMP,CUL,and ULMS was 42.9(range,26-58)years,41.8(range,21-54)years,and 50.8(range,14-79)years,respectively.2.The shortest duration was 0.5 months and the longest duration was 60 months in the 3 groups.Patients with STUMP had an average duration of 9.85 months and those with CUL had an average duration of 9.39 months.The duration did not significantly differ between the SMTUMP and CUL groups(p>0.05).Patients with ULMS had an average duration of 3.13 months,which was significantly shorter than that of the other 2 groups(p<0.05).3.The most common manifestation of uterine SMTUMP and CUL was menstrual change with menorrhagia and prolonged menstrual bleeding.In fact,menstrual change was the main clinical manifestation among those with uterine SMTUMP(45.67%)and among those with CUL(46.69%).However,among patients with ULMS,the most common manifestation was irregular vaginal bleeding(46.7%).The second most common clinical manifestation overall was a lower abdominal mass.Patients with a larger tumor mass may be accompanied with compression symptoms such as frequent urination,constipation,and pain in the lumbosacral portion.Other clinical manifestations,such pain in the lower abdomen,enlargement of the original tumor mass,and dysmenorrhea,are relatively infrequent.Moreover,some of the patients with uterine SMTUMP or CUL had no clinical manifestations,and the uterine tumor was incidentally detected during health examinations.4.On preoperative color Doppler ultrasonography,the uterine STUMP and CUL groups primarily exhibited a low echo or heterogeneous echo mass,a rich blood flow signal in the mass,and a clear boundary.The ULMS group exhibited a lower echo mass and an unclear boundary at the muscle layer.A rich blood flow signal could be observed in the tumor and a tumor capsule was occasionally detected.No specific findings were noted on ultrasonographic examination.5.The surgical method was chosen based on the tumor size,age.fertility requirements,general condition,and quick intraoperative pathologic results.Of those with uterine SMTUMP,34 underwent surgery with uterine preservation,17 underwent total hysterectomy,and 6 underwent hysterectomy and bilateral adnexectomy.Of those with CUL,69 underwent surgery with uterine preservation,41 underwent total hysterectomy,6 underwent hysterectomy and unilateral adnexectomy,and 4 underwent hysterectomy and bilateral adnexectomy.Of those with ULMS,4 underwent radical hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy,2 underwent hysterectomy and unilateral adnexectomy,1 underwent radical hysterectomy with wedge biopsy of the ovary,3 underwent hysterectomy and bilateral adnexectomy,4 underwent hysterectomy and bilateral adnexectomy with pelvic lymphadenectomy,and 1 additionally underwent retroperitoneal tumor resection following relapse 8 months after hysterectomy and bilateral adnexectomy with pelvic tumor resection.6.All the patients were followed up after the operation.The shortest time to revisit was 3.5 months and the longest time was 8.5 years.Two patients with uterine SMTUMP exhibited relapse at 6.5 months and 11.5 months after the surgery;however,no malignant transformation or metastasis was noted in the 2 cases.Three patients with CUL exhibited relapse and the other patients were still alive.Among those with ULMS,2 patients died 6 months and 12 months after the surgery,and 1 other patient exhibited relapse.Three patients who received chemotherapy on time after the surgery did not exhibit relapse.Two patients were lost to follow-up,and the remaining 7 patients were still alive.7.A total of 9 patients with uterine SMTUMP underwent laparoscopic hysteromyomectomy with a laparoscopic morcellator,and no recurrence or local seeding was observed after follow-up for 6-39 months.Moreover,28 patients with CUL underwent laparoscopic hysteromyomectomy with a laparoscopic morcellator,and no recurrence or local seeding was observed after follow-up for 6-48 months.All the patients with ULMS underwent laparotomy.Conclusion:There was no specific clinical manifestation for uterine SMTUMP and CUL,and the findings were similar to those of a simple uterine leiomyoma.Preoperative ultrasonography also did not indicate any specific characteristics,and it was difficult to diagnose these tumors prior to surgery.Thus,the diagnosis still depends on the pathological method.The prognosis of patients with SMTUMP and CUL who underwent surgery is good.However,due to the tendency for recurrence and malignant change,the indications for hysterectomy can be broadened.Post-operative follow-up indicated that the use of laparoscopic tumor cracker can benefit patients with uterine STUMP or CUL,which still require long-term observation.Due to the high degree of malignancy and the rate of early recurrence,metastasis,and seeding,we should seek to enhance the preoperative examination of ULMS and avoid the use of a laparoscopic morcellator. |
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