Neobook — clinical reference

Leiomyosarcoma (and endometrial stromal sarcoma) staging

Choriocarcinoma

This tumor is related to gestational trophoblastic disease (Gestational Trophoblastic Disease). Chemotherapy is used. The tumor very rarely occurs as a primary ovarian malignancy & may be found incidentally on histology.

Uterine sarcoma

Whether leiomyosarcoma or Mixed Mesordermal Müllerian tumors (Triple MT/ MMMT), these are managed as for endometrial carcinoma if diagnosed preoperatively.

Occasionally, detection is only on histology after surgery for multifibroid uterus or ovarian mass.

When does a fibroid become a leiomyosarcoma? When there are 10 or more mitoses per 10 high power fields. Malignant transformation in fibroids is very rare.

All patients should be presented at the weekly oncology meeting for consideration of radiotherapy. Prognosis is generally poor, except for early stage. Staging is v simple, not unlike the old endometrial ca staging –

Leiomyosarcoma (and Endometrial Stromal Sarcoma) staging (FIGO 2018)

Stage 1a: Confined to uterus <5cm diameter
Stage 1b: Confined to uterus >5cm
Stage 2a: Pelvic spread – adnexa
Stage 2b: Pelvic spread – other structures
Stage 3a: Abdominal spread 1 site
Stage 3b: Abdominal spread >1 site
Stage 4: Mucosal involvement rectum or bladder

MMMT (now called ‘carcinosarcoma’) - staging is the same except Stage 1a – confined to endometrium or endocervix, Stage 1b – inner ½ myometrium, Stage 1c – outer ½ myometrium

Tumours in children

Children with germ cell tumors, sarcoma botryoides or other malignancies must be presented at the weekly oncology meeting, but will receive chemotherapy if indicated in the paediatric oncology unit. Appropriate referral must be arranged. If surgery is required, consult with paediatric surgeons & anaesthetists.