Uterine sarcomas represent an unusual gynecologic malignancy accounting for approximately 3% of cancers involving the body of the uterus, and only about 0.1% of all myomas. Progressiveuterine enlargement occurring in the postmenopausal years should not be assumed to be the result of simple uterine leiomyomata, because appreciable endogenous ovarian estrogen secretion is absent, thereby minimizing the poten-tial for growth of benign myomas. Even postmenopausal women on low-dose hormone therapy are not at risk for stimulation of uterine enlargement. When progressive growth is present in postmenopausal women, uterine sar-coma should be considered. Other symptoms of uterine sarcoma include postmenopausal bleeding, unusual pelvic pain coupled with uterine enlargement, and an increase in unusual vaginal discharge. Surgical removal is the method of most reliable diagnosis. Accordingly, hysterectomy is usu-ally indicated in patients with documented, and especially progressive, uterine enlargement (Fig. 45-5).
The virulence of uterine sarcoma is directly related to the number of mitotic figures and degree of cellular atypia as defined histologically. These tumors are more likely to spread hematogenously than endometrial adenocarci-noma. When uterine sarcoma is suspected, patients should undergo a tumor survey to assess for distant metastatic dis-ease. At the time of hysterectomy, it is necessary to thor-oughly explore the abdomen and sample commonly affected node chains, including the iliac and periaortic areas. Thestaging for uterine sarcoma is surgical and identical to that for endometrial adenocarcinoma.
Unfortunately, the 5-year survival of patients with a uterine sarcoma is only 50%. Radiation and chemotherapy provide little benefit as adjuvant therapy to hysterectomy.