Uterýne Sarcoma Dýlemma: Unexpected or Expected? Does It Matter?

INTRODUCTION: We aim to identify clinical characteristics, outcome and prognosis of uterine sarcoma cases and compare clinical outcome of preoperatively or postoperatively (unexpected) diagnosed patients.
METHODS: In this retrospective study, medical records of patients with uterine sarcoma at the Zeynep Kamil Women and Children Education and Research Hospital, Department of Obstetrics and Gynecology, from January 2009 to December 2016. The age at diagnosis, gravidity, parity, menopausal status, complaints, comorbidity, tumor grade, tumor histology, stage of disease, postoperative adjuvant therapy, recurrence rate, location of recurrence, follow-up interval, and survival rate. Additionally, patients were divided into two groups: patients with diagnosed preoperatively and diagnosed postoperatively (unexpected). Two groups were compared regarding clinical characteristics.
RESULTS: Sixty-three patients were found to have uterine sarcoma. Mean age of patients was 51.8±11.7. Twenty-nine (46%) patients had leiomyosarcoma, 11 (17.5%) patients had endometrial stromal sarcoma and 13 (20.6%) had malign mixt mullerian tumor. Of 63 patients, 49 had pre-operative uterine sarcoma diagnosis and 14 patients had unexpected uterine sarcoma. The incidence of unexpected sarcoma was detected as 0.3%. The recurrence rate was significantly higher in patients with unexpected uterine sarcoma compared with patients had pre-operative uterine sarcoma diagnosis (42.8% vs 14.2%, respectively, p=0.002). All patients with recurrent disease in unexpected sarcoma group had local recurrence (100%). Regarding survival rates, there was no statistically difference between two groups (65.3% vs 57.1%).
DISCUSSION AND CONCLUSION: Uterine sarcoma is a rare tumor entity. Unexpected sarcoma cases found to have high recurrence rate and had totally local metastases. This finding may result from “myomectomy procedure” itself.