Uterine sarcoma is one of the rare tumors originating from the uterine wall. These tumors make up 2-6% of all malignant tumors of the uterus. Radiation therapy applied to the pelvis for any reason increases the risk of uterine sarcoma. Uterine sarcomas have generally the worst prognosis among the malignant uterine tumors.
The most common three types are endometrial stromal sarcoma, leiomyosarcoma and malignant mixed mullerian tumor.
1) Endometrial Stromal Tumors:
They occur most frequently between the ages of 45-50. The most common symptom is abnormal vaginal bleeding, abdominal pain and pressure due to the tumor mass may also be felt. In the examination, regular or irregular enlargement of the uterus and sometimes rubbery stiffness around the uterus may be found. Diagnosis can be made with endometrial biopsy, but preoperative diagnosis in these patients is usually uterine fibroid.
Endometrial stromal tumors are subdivided into 3 types according to their mitotic activity, vascular spread and clinical course; endometrial stromal nodule, low-grade stromal sarcoma and high-grade stromal sarcoma.
The average age of the patients is between 43-53 years. Approximately 4% of patients have a history of radiotherapy. The risk of a benign tumor transforming into malignancy varies between 0.13% and 0.81%.
The first symptoms are usually vaginal bleeding, pelvic pain, or pressure sensation. The most prominent finding in examination is the presence of pelvic mass. If the uterus is rapidly enlarging in a postmenopausal patient, leiomyosarcoma.
3) Malignant mixed mullerian tumor
Almost all of these tumors are seen after menopause, and the average age of patients is 62. It can often be accompanied by other diseases such as obesity, diabetes and hypertension. In 7-37% of the patients, there is a history of previous radiotherapy.
The most common symptom is bleeding after menopause, occurring in 80-90% of patients. More rarely, vaginal discharge, pain and weight loss can be seen.
Treatment of Uterine Sarcomas
The standard treatment for sarcoma is surgery. According to the postoperative pathological findings, chemotherapy and/or radiotherapy may be required. In some cases, it may be recommended to reduce the tumor volume with preoperative chemotherapy and then operate it.