S. Karger Verlag für Medien und Naturwissenschaften GmbH
Abstract
Uterine leiomyosarcoma (uLMS) is a rare entity among
malignant gynecologic tumors with a very unfavorable
prognosis and the highest prevalence in the pre- and
peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated
without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by
equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and
it should be done in order to remove the uterus intact. As
vaginal, abdominal, and endoscopic surgery – possibly
including morcellation – are the methods of choice for
the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment
and radiotherapy are of no proven value in the adjuvant
setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the
correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient.
Diagnostic tools as well as treatment options in adjuvant
and palliative situations are reviewed