scholarly journals Uterine Preservation Treatments in Sarcomas: Oncological Problems and Reproductive Results: A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (22) ◽  
pp. 5808
Author(s):  
Giulia Dondi ◽  
Eleonora Porcu ◽  
Alessandra De Palma ◽  
Giuseppe Damiano ◽  
Eugenia De Crescenzo ◽  
...  
Keyword(s):  
Systematic Review ◽  
Early Stage ◽  
Uterine Sarcoma ◽  
Low Grade ◽  
Cochrane Central Register ◽  
Childbearing Age ◽  
Uterine Sarcomas ◽  
Oncological Outcomes ◽  
Uterine Tumors ◽  
Fertility Sparing

Uterine sarcomas are rare cancers, sometimes diagnosed in women of childbearing age. Hysterectomy is the standard treatment in early stages. The option of lesion removal to save fertility is described in the literature, but it is still considered experimental. The objective of this systematic review is to report on the available evidence on the reproductive and oncological outcomes of fertility-sparing treatment in women with uterine sarcomas. PubMed, Scopus and Cochrane Central Register of Controlled Trials were searched between 1 January 2011 and 21 June 2021 for publications in English about women with uterine sarcoma treated with a fertility-sparing intervention. Thirty-seven studies were included for a total of 210 patients: 63 low-grade endometrial stromal sarcomas, 35 embryonal rhabdomyosarcomas of the cervix, 19 adenosarcomas, 7 leiomyosarcomas and 2 uterine tumors resembling an ovarian sex cord. Conservative treatment ensured pregnancy in 32% of cases. In terms of oncological outcomes, relapse was related to histology and the worst prognosis was reported for leiomyosarcoma, followed by low-grade endometrial stromal sarcoma, which relapsed in 71% and 54% of cases, respectively. The highest death rate was associated with leiomyosarcoma (57.1%). This study demonstrated that fertility-sparing treatments may be employed in selected cases of early stage uterine sarcoma.

scholarly journals Fertility-Sparing Surgery in Gynecologic Cancer: A Systematic Review

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1008
Author(s):  
Teska Schuurman ◽  
Sanne Zilver ◽  
Sanne Samuels ◽  
Winnie Schats ◽  
Frédéric Amant ◽  
...  
Keyword(s):  
Systematic Review ◽  
Endometrial Cancer ◽  
Early Stage ◽  
Gynecologic Cancer ◽  
Cochrane Library ◽  
Low Grade ◽  
Extensive Literature ◽  
Recurrence Rates ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

Fertility-sparing surgery (FSS) is increasingly being offered to women with a gynecological malignancy who wish to preserve fertility. In this systematic review, we evaluate the best evidence currently available on oncological and reproductive outcome after FSS for early stage cervical cancer, epithelial ovarian cancer, and endometrial cancer. An extensive literature search was conducted using the electronic databases Medline (OVID), Embase, and Cochrane Library to identify eligible studies published up to December 2020. In total, 153 studies were included with 7544, 3944, and 1229 patients who underwent FSS for cervical, ovarian, and endometrial cancer, respectively. We assessed the different FSS techniques that are available to preserve fertility, i.e., omitting removal of the uterine body and preserving at least one ovary. Overall, recurrence rates after FSS are reassuring and therefore, these conservative procedures seem oncologically safe in the current selection of patients with low-stage and low-grade disease. However, generalized conclusions should be made with caution due to the methodology of available studies, i.e., mostly retrospective cohort studies with a heterogeneous patient population, inducing selection bias. Moreover, about half of patients do not pursue pregnancy despite FSS and the reasons for these decisions have not yet been well studied. International collaboration will facilitate the collection of solid evidence on FSS and the related decision-making process to optimize patient selection and counseling.

Uterine Sarcomas: Histology and Its Implications on Therapy

2012 ◽  
pp. 356-361 ◽  
Author(s):  
Martee L. Hensley
Keyword(s):  
High Risk ◽  
Metastatic Disease ◽  
Objective Response ◽  
The United States ◽  
Good Prognosis ◽  
Uterine Sarcoma ◽  
Low Grade ◽  
High Grade ◽  
Limited Disease ◽  
Uterine Sarcomas

Overview: Uterine sarcomas are rare cancers, they comprise only 5% of all uterine malignancies. There are about 2,000 cases of uterine sarcoma diagnosed annually in the United States. Uterine sarcomas may be categorized as either favorable-risk, low-grade malignancies with a relatively good prognosis or as poor-risk, high-grade cancers that carry a high risk for tumor recurrence and disease progression. Expert histologic review is critical for appropriate diagnosis and management. Uterine sarcoma histologies considered to carry a more favorable prognosis include low-grade endometrial stromal sarcomas and adenosarcomas. The high-grade sarcomas include high-grade leiomyosarcomas, high-grade undifferentiated endometrial sarcomas, and adenosarcomas with sarcomatous overgrowth. The favorable histology, low-grade uterine sarcomas may be cured with surgical resection of uterus-limited disease. These tumors are often hormone-sensitive, and treatment with hormonal therapies may be efficacious for patients with advanced, unresectable disease. High-grade uterine leiomyosarcomas and undifferentiated endometrial sarcomas carry a high risk for recurrence, even after complete resection of uterus-limited disease. No adjuvant intervention has been shown to improve survival outcomes. Advanced, metastatic disease is generally treated with systemic cytotoxic therapies, which may result in objective response but is not curative. Selected patients with isolated metastatic disease and a long disease-free interval may benefit from metastatectomy.

Management of Ovarian Stromal Cell Tumors

2007 ◽  
Vol 25 (20) ◽  
pp. 2944-2951 ◽  
Author(s):  
Nicoletta Colombo ◽  
Gabriella Parma ◽  
Vanna Zanagnolo ◽  
Alessandra Insinga
Keyword(s):  
Clinical Management ◽  
Initial Treatment ◽  
Stromal Cell ◽  
Early Stage ◽  
Current Evidence ◽  
Late Relapse ◽  
Childbearing Age ◽  
Term Survival ◽  
Platinum Based Chemotherapy ◽  
Fertility Sparing

Purpose To describe the clinical management of ovarian stromal cell tumors, which are a heterogeneous group of neoplasms that develop from the sex cords and the ovarian stroma. Design We reviewed the current evidence on the clinical management of these relatively rare ovarian malignancies, which are typically detected at an early stage and may recur as late as 30 years following the initial treatment. The overall prognosis is favorable with a long-term survival ranging from 75% to 90% for all stages. Adult granulosa cell tumor (GCT) is the most common malignancy among these tumors. Results Surgery is the cornerstone of initial treatment. In women of childbearing age and with disease limited to one ovary, a fertility-sparing surgery can be a reasonable approach. Tumor stage represents the most important clinical parameter of prognostic relevance. The value of postoperative adjuvant therapy for high-risk patients has not been proven by prospective randomized studies. Platinum-based chemotherapy is used currently for patients with advanced stages or recurrent disease, with an overall response rate of 63% to 80%. Taxane and platinum combination chemotherapy seems to be a reasonable candidate for future trials. Little evidence exists for the use of radiation or hormonal therapy, and these modalities should be restricted to selected cases. Given the propensity of GCT for late relapse, prolonged follow-up is required. Conclusion Surgery remains the most effective treatment for ovarian stromal tumors and, whenever feasible, for relapsing disease. Platinum-based chemotherapy is currently used in metastatic or recurrent tumors.

scholarly journals Uterine sarcoma: a clinical case and a literature review

2019 ◽  
Vol 25 (4) ◽  
pp. 206-218
Author(s):  
Diana Bužinskienė ◽  
Saulius Mikėnas ◽  
Gražina Drąsutienė ◽  
Matas Mongirdas
Keyword(s):  
Clinical Case ◽  
Uterine Sarcoma ◽  
Imaging Modalities ◽  
Histological Evaluation ◽  
Low Grade ◽  
Undifferentiated Sarcoma ◽  
Uterine Sarcomas ◽  
Uterine Tumour ◽  
Presenting Symptoms ◽  
Power Morcellation

Background. Uterine sarcomas are rare gynaecologic tumours representing 3–7% of all uterine malignancies. The aetiology of sarcomas is still unclear: it is thought, that chromosomal translocations have influence on wide histological variety of sarcomas. Presenting symptoms are vague and nonspecific. Usually sarcoma causes abnormal vaginal bleeding, can cause abdominal or pelvic pain, or manifests as a rapidly growing uterine tumour. The diagnosis of sarcoma is often made retrospectively after surgical removal of a presumed benign uterine neoplasm, because imaging modalities such as ultrasound, computed tomography, or magnetic resonance imaging cannot yet accurately and reliably distinguish between benign leiomyoma and malignant pathology. If there are certain clinical features that raise a suspicion of malignancy in the uterus, it is recommended to avoid the use of power morcellation through laparoscopic surgery in order to prevent disease dissemination. Materials and methods. We present a clinical case of a 64-year-old patient, who was referred to hospital due to abdominal pain and tenesmus that lasted for two days. From a past medical history it was known that previously the patient had been diagnosed with uterine myoma. Transvaginal ultrasonography showed a 10.4 cm × 9.8 cm uterine tumour of nonhomogeneous structure with signs of necrosis and good vascularization. The patient refused urgent hysterectomy, that was advised to her. The patient was operated on one month later and total hysterectomy with bilateral salpingooforectomy was performed. Postoperative histological evaluation showed undifferentiated sarcoma uterus pT1b L/V0. Imaging modalities were made to evaluate possible dissemination of the disease. In the absence of signs of disease progression, the patient received radiotherapy and brachytherapy and was followed-up by doctors. Results and conclusions. Uterine sarcomas are highly malignant tumours that originate from smooth muscles and connective tissue elements of the uterus and make up 1% of all malignant gynaecological tumours and about 3–7% of all malignant uterine tumours. Imaging modalities cannot yet reliably distinguish benign myomas from malignant sarcomas. It is important not to damage the wholeness of uterus during operation in order to prevent dissemination of the disease in the abdominal cavity. The low-grade endometrial stromal sarcoma has the best survival prognosis, while carcinosarcoma and undifferentiated uterine sarcoma have the lowest survival rates.

Incidence of metastasis in circumflex iliac nodes in patients with cervical cancer: a systematic review

2021 ◽  
pp. ijgc-2021-003005
Author(s):  
David Viveros-Carreño ◽  
Juliana Rodriguez ◽  
Rene Pareja
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Lymph Node ◽  
English Language ◽  
Early Stage ◽  
Case Reports ◽  
Pelvic Lymphadenectomy ◽  
Positive Lymph Node ◽  
Cochrane Central Register ◽  
Early Stage Disease

ObjectiveThe circumflex iliac nodes distal to the external iliac nodes are frequently removed when bilateral pelvic lymphadenectomy is performed in patients with cervical cancer. The objective of this systematic review was to assess the incidence of metastasis in the circumflex iliac nodes in patients with cervical cancer.MethodsPubMed/Medline, ClinicalTrials, Embase, Cochrane Central Register of Controlled Trials, Scopus, and Ovid databases were searched from inception to May 2021. We included articles published in English language reporting all types of studies, except for case reports and commentaries. Abstracts and unpublished studies were excluded. The inclusion criteria were diagnosis of cervical cancer, FIGO 2009 stages IA–IIB, squamous cell carcinoma, adenocarcinoma or adenosquamous carcinoma, and primary surgery including pelvic lymph node dissection.ResultsA total of 3037 articles were identified. Overall, 1165 eligible patients from four studies were included in the analysis. A total of 696 (59.7%) patients had early-stage disease (FIGO 2009 stages IA, IB1, IIA1). The median number of extracted circumflex iliac nodes, which was reported in two studies, was one (range not reported) and three (range 1–13). The positive lymph node rate for the entire population and circumflex iliac node involvement were 26.9% and 3.1%, respectively. Isolated metastases were reported for 904 patients (three studies) and in one patient nodal spread was detected (0.11%).ConclusionThe rate of isolated metastases in circumflex iliac nodes is small and excision of these lymph nodes as part of routine lymphadenectomy should be avoided.

Oncological outcomes after fertility-sparing surgery for cervical cancer: a systematic review

2016 ◽  
Vol 17 (6) ◽  
pp. e240-e253 ◽  
Author(s):  
Enrica Bentivegna ◽  
Sebastien Gouy ◽  
Amandine Maulard ◽  
Cyrus Chargari ◽  
Alexandra Leary ◽  
...  
Keyword(s):  
Systematic Review ◽  
Cervical Cancer ◽  
Oncological Outcomes ◽  
Fertility Sparing Surgery ◽  
Fertility Sparing

scholarly journals Laparoscopic management of endometrial stromal sarcoma in young: a case report

2020 ◽  
Vol 9 (5) ◽  
pp. 2144
Author(s):  
Shailesh Puntambekar ◽  
Shetty Theertha Shankar ◽  
Arjun Goel ◽  
Shakti Panchal
Keyword(s):  
Clinical Course ◽  
Histopathological Examination ◽  
Endometrial Stromal Sarcoma ◽  
Initial Therapy ◽  
Uterine Sarcoma ◽  
Low Grade ◽  
Lower Abdomen ◽  
Uterine Sarcomas ◽  
Stromal Sarcoma ◽  
Locally Recurrent

Endometrial stromal sarcoma (ESS) is a case malignancy and accounts for 0.2% of all uterine malignancies and 10% of all uterine sarcomas. In the present case, an unmarried 27-year-old woman presented with complaints of on and off episodes of pain in the lower abdomen. On examination, a diffuse oval mass was felt occupying the hypogastrium, iliac and lumbar regions and extending up to the umbilicus. CT scan impression was given as? Complex retroperitoneal mass? solid cystic ovarian mass with grade I right hydro nephrosis. On laparoscopy, a huge mass measuring approximately 10×10 cm was noted arising from the uterus. Laparoscopic myomectomy was done and the specimen was retrieved in a bag and the tissue was sent for histopathological examination. The postoperative clinical course was uneventful. The patient was advised to undergo oocyte cryopreservation following which she was advised hysterectomy with bilateral salphingo-oophorectomy. Pelvic radiation was advised thereafter. ESS is a rare malignant tumor, which on histopathological examination reveals sheets of cells and endometrial stromal cell differentiation. Hysterectomy with bilateral salpingo-oophorectomy is optimum initial therapy. Radiotherapy is chosen when the tumour is inadequately excised or the pelvic disease is locally recurrent. Low grade ESS is a rare form of uterine sarcoma usually seen between 40-60 years of age with limited available data regarding the clinical course and management. Early diagnosis and management is associated with a favourable prognosis and outcome.

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