Clinical Analysis Of 113 Cases Of Uterine Sarcoma

Objective:To investigate the clinical characteristics of uterine sarcoma,and explore the methods of preoperative diagnosis and treatment.Methods:Retrospective analysis of 113 cases with complete data of uterine sarcomas who were treated at Women's Hospital,School of Medicine Zhejiang University between 2008 and March in 2018.There are uterine leiomyosarcoma(ULMS)40 cases(35.4%),endometrial stromal sarcoma(ESS)(both low grade and high grade)57cases(50.4%),adenosarcoma 13 cases(11.5%),and undifferentiated uterine sarcoma(UUS)3 cases(2.7%).In accordance with 2009 FIGO staging for ULMSs,uterine ESS and adenosarcoma,there are 88 cases with stage I(77.9%),8 cases with stage ?(7.1%),8 cases with stage ?(7.1%),4 cases with stage IV(3.5%),and 5 cases(4.4%)done not surgery for staging.Results:The average age of the 113 cases is 47.95 years old,and the average age of onset with the different histological type of uterine sarcomas has statistical differences,the average age of the undifferentiated uterine sarcoma(UUS)was 64.6±14.154,and compared with the average age of uterine leiomyosarcoma(ULMS)49.95±10.013,endometrial stromal sarcoma(ESS)43.72±8.819,and adenosarcoma54.92±10.634,there was significant different(P<0.05).In the cases there were 66 of 113 cases with a history of leiomyoma,and about 31 cases obvious increased in one year.Presenting symptoms can be vague and nonspecific,most commonly,abnormal vaginal bleeding 46.9%(53/113),then increased menstrual flow 35.4%(40/113),followed by lower abdominal or pelvic pain 31.0%(34/113),abdominal distension 11.5%(13/113),and symptoms of oppression of lower abdominal or pelvic 9.7%(11/113).Preoperative diagnosis of uterine sarcoma was 31.0%(35/113),the rate of uterine leiomyosarcoma(ULMS)was 17.1%,endometrial stromal sarcoma(ESS)51.4%,adenosarcoma 22.9%,undifferentiated uterine sarcoma(UUS)8.6%?Conclusion:Soft tissue sarcoma arising from the uterus is a rare and varied group of neoplasm,the prognosis was poor.There is a higher incidence rate for those aged 40-50 years compared to younger patients,and the onset age of uterine leiomyosarcoma(ULMS)and endometrial stromal sarcoma(ESS)is lower than undifferentiated uterine sarcoma(UUS).B-ultrasound as the basic method,most showed internal echoes uneven and rich blood flow.When it indicates malignant or leiomyoma degeneration,we should do CT scan or magnetic resonance imaging(MRI)to increase preoperative diagnosis rate.Preoperatively,we can do hysteroscope or curettage to increase the diagnosis rate.Surgery is the first choice of the treatment for uterine sarcoma,and total abdominal hysterectomy and bilateral salpingo-oophorectomy are the standards surgery of care.Increasingly,gynecologists are taking a minimally invasive surgical approach to myomectomy and hysterectomy,and using a power morcellator device to extract large fibroids through small abdominal incisions,however it increase the spread of an occult sarcoma,witch worsen the prognosis.So,it is important to increase the rate of preoperative diagnosis to avoid using power morcellator device during surgery.