EPV141/#627 Total hysterectomy for unexpected uterine leiomyosarcoma: impact of surgery on oncological outcomes

Background: Uterine leiomyosarcoma (uLMS) is a rare tumor that accounts for 1% of all uterine malignancies. In spite of adequate surgical resection of uLMS, even in the early stage, patients remain at high risk for local and distant recurrence. Therefore, the treatment of advanced uLMS represents a considerable challenge. Methods: We report the case of a 47-year-old woman who presented with uLMS with abnormal vaginal bleeding. Results: The patient underwent a total hysterectomy and bilateral adnexectomy, which was followed by 1 year progression-free survival without adjuvant therapy. Thereafter, new lung metastases and local progression at the vaginal stump were observed. Chemotherapy with ifosfamide and doxorubicin was administered. However, after 4 cycles, a CT scan revealed disease progression in the lung metastases. Subsequently, the patient was treated with trabectedin at a dose of 1.5 mg/m2 for 6 cycles resulting in complete remission of the lung metastases as well as partial remission of the mass in the vaginal stump after 9 cycles of trabectedin. The patient is currently on maintenance therapy with trabectedin and has no recurrence. Conclusion: Trabectedin seems to be an efficient option for patients with uLMS as demonstrated by a long-lasting response in a pretreated patient with an acceptable safety profile with no signs of cumulative toxicity.

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Cytoreduction as a remedial procedure improves disease-free survival of patients with occult uterine sarcoma undergoing morcellation——a retrospective study

10.21203/rs.3.rs-35753/v1 ◽

2020 ◽

Author(s):

Chao Ding ◽

Jianqing Zhu

Keyword(s):

Disease Free Survival ◽

Endometrial Stromal Sarcoma ◽

Uterine Sarcoma ◽

Uterine Leiomyosarcoma ◽

Uterine Sarcomas ◽

Free Survival ◽

Total Hysterectomy ◽

Stromal Sarcoma ◽

Significant Difference ◽

Disease Free

Abstract Background：Tumor morcellation happened to facilitate iatrogenic metastasis for patients with occult uterine sarcoma. The optimal remedial procedure for these patients needed to be established. Methods：Data were retrospectively collected and analyzed from patients with occult uterine sarcoma undergoing morcellation. Results：23 consecutive patients with uterine sarcomas undergoing morcellation were accessed between Jan 2008 and Dec 2018, including 15 patients with uterine leiomyosarcoma and 8 with endometrial stromal sarcoma. Cytoreduction as a remedial procedure was significantly associated with better disease-free survival (P=0.031), and none of 7 patients undergoing cytoreduction suffered recurrence, while total hysterectomy (P=0.194) and adjuvant therapy (P=0.159) had no such benefit. There was no significant difference in disease-free survival between laparoscopic and open surgery (p=0.321). Conclusion：Cytoreduction was considered as the optimal remedial procedure for patients with occult uterine sarcoma undergoing morcellation.

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Uterine stump leiomyosarcoma after sub-total hysterectomy: a case report

Obstetrics & Gynecology International Journal ◽

10.15406/ogij.2021.12.00588 ◽

2021 ◽

Vol 12 (4) ◽

Author(s):

Haitham Abdel Wahab ◽

Mohamed Ayaty ◽

Mohamed Abdallah ◽

Ahmed Elghandor

Keyword(s):

Case Report ◽

Abdominal Circumference ◽

Ca 125 ◽

Abdominal Pressure ◽

Uterine Leiomyosarcoma ◽

Rare Tumor ◽

Uterine Sarcomas ◽

Total Hysterectomy ◽

Subtotal Hysterectomy ◽

One Year

Introduction: Uterine sarcomas considered as one of the aggressive tumors of uterine malignancies. It is one of the mesenchymal tumors that originate from smooth muscle of the uterus which is a rare tumor that accounts for 2% to 5% of all uterine malignancies. Very few cases are reported in the literature. Our patient has a unique history of Pelvic-Abdominal swelling reaching xiphisternum level after subtotal hysterectomy one year ago. Abnormal genital bleeding not responding to medical treatment is the usual presentation in uterine sarcoma like in our patient. We report an original case report of an abnormal sequence of this rare tumor arising from the uterine stump after subtotal hysterectomy. Case presentation: A 42-year-old nulliparous woman presented to our gyne-oncology unit in El-Galaa Maternity Teaching Hospital in June 2020 with a significant rapid increase in abdominal circumference, symptoms caused by abdominal pressure (vomiting and constipation) and abnormal genital bleeding after laparotomic sub-total hysterectomy one year ago. Tumor marker CA-125 was raised, LDH was raised and a MRI scan showed a huge mass arising from the pelvis. An exploratory laparotomy was performed and the histopathology report confirmed the diagnosis of uterine leiomyosarcoma weighing around 22kg. Conclusion: Because of their rarity, uterine sarcomas are not suitable for screening. Diagnosis by histopathologic examination and surgery is the only treatment. Pre-operative MRI with contrast for abdomen and pelvis is highly recommended to exclude abdomen metastatic sarcoma if the tumor is confined to the pelvis only.

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Outcome of adjuvant radiotherapy after total hysterectomy in patients with uterine leiomyosarcoma or carcinosarcoma: a SEER-based study

BMC Cancer ◽

10.1186/s12885-019-5879-7 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 6

Author(s):

Yuan Li ◽

Haitao Ren ◽

Junmei Wang

Keyword(s):

Adjuvant Radiotherapy ◽

Uterine Leiomyosarcoma ◽

Total Hysterectomy

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Uterine Leiomyosarcoma: Does the Primary Surgical Procedure Matter?

International Journal of Gynecological Cancer ◽

10.1111/igc.0b013e31819a1f8f ◽

2009 ◽

Vol 19 (2) ◽

pp. 257-260 ◽

Cited By ~ 97

Author(s):

Tamar Perri ◽

Jacob Korach ◽

Siegal Sadetzki ◽

Bernice Oberman ◽

Eddie Fridman ◽

...

Keyword(s):

Surgical Procedure ◽

Menopausal Status ◽

Survival Rates ◽

Stage I ◽

Age At Diagnosis ◽

Uterine Leiomyosarcoma ◽

Total Hysterectomy ◽

Group A ◽

Group B

Background:Uterine leiomyosarcoma (LMS) has a poor prognosis even after early-stage diagnosis. Because there are no accurate diagnostic tools for preoperatively distinguishing LMS from uterine leiomyoma, surgeons might opt for partial surgical procedures such as myomectomy or subtotal hysterectomy. We sought to determine whether a surgical procedure that cuts through the tumor influences prognosis.Materials and Methods:Demographic and clinical data of consecutive patients with stage I LMS treated between 1969 and 2005 were reviewed. The study population was divided into group A: patients whose first surgical intervention was total hysterectomy (n = 21); and group B: patients who underwent procedures involving tumor injury, for example, myomectomy, laparoscopic hysterectomy with a morcellator knife, or hysteroscopic myomectomy (n = 16). Survival rates were analyzed and compared. A Cox proportional hazards model was used to assess the association between variables of interest and prognosis.Results:The median age at diagnosis was 50 years (range, 30-74 years). Median follow-up duration was 44 months. The 2 groups did not differ significantly in age at diagnosis, menopausal status, gravidity, parity, postoperative radiotherapy, or time to last follow-up. Kaplan-Meier curves showed significantly better survival rates (P = 0.04) and a significant advantage in recurrence rate (P = 0.03) for group A compared with group B. Survival in group A was 2.8-fold better than that in group B (95% confidence interval, 1.02-7.67). These estimates remained stable after adjustment for age, menopausal status, and radiotherapy.Conclusions:In patients with stage I LMS, primary surgery involving tumor injury seems to be associated with a worse prognosis than total hysterectomy as a primary intervention.

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559: Impact of Fellowship Training on Oncological Outcomes after Radical Prostatectomy

The Journal of Urology ◽

10.1016/s0022-5347(18)30799-7 ◽

2007 ◽

Vol 177 (4S) ◽

pp. 186-186

Author(s):

Fernando J. Bianco ◽

Andrew J. Vickers ◽

Angel M. Serio ◽

James A. Eastham ◽

Eric A. Klein ◽

...

Keyword(s):

Radical Prostatectomy ◽

Fellowship Training ◽

Oncological Outcomes

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Unicornuate Uterus with NonCommunicating Non-Cavitated Rudimentary Uterine Horn: An Unusual Case with Adenomyosis Managed with Total Hysterectomy

Medical & Clinical Research ◽

10.33140/mcr.01.01.04 ◽

2015 ◽

Vol 1 (1) ◽

Keyword(s):

Medical Treatment ◽

Unusual Case ◽

Uterine Bleeding ◽

Uterine Horn ◽

Rudimentary Horn ◽

Total Hysterectomy ◽

Unicornuate Uterus ◽

Ultrasound Evaluation ◽

Rudimentary Uterine Horn

A 45-year-old woman admitted to our hospital complaining of perimenopausal uterine bleeding not responding to medical treatment. Ultrasound evaluation revealed unicornuate uterus with adenomyosis and it was so difficult to see the distant small left rudimentary horn on ultrasound. The patient underwent laparotomy with total hysterectomy for both horns and was sent to pathologist that indicated adenomyosis and non-communicating non-cavitated left rudimentary horn.

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