Lecture of uterine sarcoma

2021-03-21 12:00 AM

The prognosis of the disease depends on the extent of the spread of the disease: good prognosis if the damage is only localized in the uterus and very poor prognosis if the cancer damage crosses the uterus.

General perception

Uterine sarcomas are rare, accounting for only 1-3% of all uterine cancers, but the degree of danger and recurrence is high, even in the early stages, limited to the uterus. making it one of the most serious malignancies in gynaecology. Although the detection rate is low, it accounts for 15% of all uterine cancer deaths.

Commonage is 55.7 years old. Leiomyosarcoma (muscle cell and fibrous confusion) occurs in younger people than in other cases of uterine sarcoma.

In general, the disease is often diagnosed late, and is usually diagnosed after the cell results are obtained in women who have had a fibroid removed or a hysterectomy for fibroids.

The prognosis of the disease depends on the extent of the spread of the disease: a good prognosis if the damage is only localized in the uterus and a very poor prognosis if the cancer lesions pass through the uterus.

Reason

It is not known, but like uterine lining cancer, it is common in obese people (18%), high blood pressure (11%), diabetes (8%).

Some authors found that uterine sarcoma occurred after radiation treatment of cervical cancer.

Malignant transformation of fibroids is very rare. A study report of 13,000 cases of fibroids of the uterus of Johns Hopkins University (USA), only 38 cases changed into malignant (0.29%).

Anatomy - cytology

Leiomyosarcoma (smooth muscle connective cancer)

Common in women about 51 years old.

General:

This is a tumour completely located in the uterine muscle, it has a mixed uterine muscle and fibrosis composition, it may appear either on the normal uterine muscle or possibly on the uterine muscle fibrosis, leiomyosarcoma accounts for 70% of uterine sarcoma cases, the tumour forms a solid mass, without a clear boundary with the muscle layer. The cyst may also swell into polyps in the uterine cavity. The section is light grey and soft. The rate of uterine invasion is higher than that of leiomyomas

How:

Tumours include many spindle cells that can form bundles. When the tumour is highly differentiated, the cells are very similar to normal smooth muscle cells, so it is necessary to rely on the uneven nucleus with abnormal excellence and division, and structural disorder is not markedly bundled. The presence and number of abnormal kernels have high predictive and predictive value: on 10 microscopic fields with high magnification (x 100) and seeing 5 dividing nuclei, it can be concluded that smooth muscle cancer is not must have benign smooth muscle tumour. If the number of multipliers goes up to 10, the prognosis is very bad. The prognosis of the disease is still very vague, smooth muscle cancer penetrates the veins of the uterus contraction and rapidly metastasizes, especially into the liver and lungs. It can also spread to the peritoneum and organs in the pelvis.

Endometrial stromal sarcoma (glial stromal uterine cancer)

The cells of the tumour, called the stromal cell of the uterine lining, are divided into a high, low, and nodule on the basis of the number of dividing cells and tumour margins.

General:

Initially, the tumour is localized in the endometrium in the form of a soft, purulent, edematous, and easily bleeding polyp. Then the invasive uterine muscle diffuses or the cavity wall by a more or less necrotic pale-yellow tissue.

How:

Cancer cells are distributed into fragments of cells and separated by an interdisciplinary network.

Progression:

Glial uterine cancer grows rapidly into the small pelvic fossa. It has briefly spread to the lungs or liver, usually dying 2 years after diagnosis. Common in the elderly, about 60 years old.

A mixed mesodermal tumour (mulleroblastome)

Eucalyptus, common in postmenopausal women (60 years old), is a mixed tumour in the uterus, containing both sarcomatous and carcinomatous components. The sarcomatous portion is again classified as homogeneous or heterogeneous.

Carcinosarcoma is a special tumor with the malignant epithelial and malignant homogenous sarcomatous component, in prognosis, Norris and Taylor noted that homogenous type has a better prognosis than heterogeneous type, but this finding is Not confirmed by follow-up studies. Although this tumour is believed to have a fairly good prognosis, Barker et al. Showed a greyish picture of 5 out of 6 patients having relapses and often lung metastases (15%).

General :

Muller phase tumours grow from the uterine lining or erupt in the form of polyps into the uterine cavity regardless of the histological structure. Polyps can appear in the uterine cavity or even in the vagina. Most commonly seen in the base of the uterus in one or more sites of the uterine muscular layer is invaded in full-thickness. The uterus is enlarged and swollen, tender.

Micro :

Conjugated carcinoma: reminiscent of Muller system morphology should be called isomeric, like malignant carcinoma consisting of glandular, tubular and cord structure, with excellent, nucleus rhombohedral cells uneven, bizarre and sometimes like muscle type.

Muller fibroblasts: In contrast to connective carcinoma, it is composed of many tissue components that do not evoke types of Muller tubes, and are therefore called heterologous tumours.

Adenocarcinoma - Muller link: has two components of the gland and stroma. The glands are like the type in the reproductive phase of the menstrual cycle with hyperplasia. The morphology appears benign or has atypical and abnormal nuclei. The cancerous nature manifests itself mainly in the stroma but is difficult to determine. Hence it progresses more like a benign tumour than cancer. Recurrence or metastasis is usually slow.

Stage and image of infection :

Staging: there is no accepted staging system in uterine sarcoma.

The clinical staging of FIGO in endometrial cancer is most commonly used. The survival rate in stage 1 is very significant with 55-65% of patients diagnosed in stage I.

Infection: The treatment of uterine sarcoma has been greatly limited by the inability to accurately determine the stage of the disease, plus the way its metastasis is currently poorly known.

Uterine sarcoma often metastasized to sites outside the subframe: Salazar et al showed that 85% had ectopic metastases, of which 65% in embryos, abdomen above 60%, bones 24%, brain 4%. However, it is common in both distal and tendon metastases.

Diagnose

Clinical signs are usually poor, in which vaginal bleeding is most common (80%), vaginal bleeding is most common in sarcomas with the lining of the uterus (94%) than in leiomyosarcoma (58%). out more, recurrence.

Other symptoms may be abdominal pain or pelvic pain (16%), uterus enlargement (16%), gas discharge as much as water (9.5%). Examination of tumours in the abdomen and pelvis (9.5%).

Laboratory tests: due to frequent bleeding, papanicolaou cytology in the cervical canal and uterus is often done and also usually gives positive results in sarcoma of the uterine stromal mucosa (46%) than in leiomyosarcoma (22 %).

Take a lung scan before surgery to detect metastases.

Hysteroscopy: dilated uterine cavity, with defect, irregular shapes inside the uterine cavity.

Ultrasound: often uterus enlargement, thickened mucosa. A heterogeneous murmur can be seen inside the uterine muscle.

Biopsy: only allows diagnosis in 20-60% of cases.

Tomodensitometrie scan: only showed that there was a tumour in the subframe area, irregular margin, coming from the uterus in addition nothing special.

Treatment

A full hysterectomy and two appendages, can remove the lymph nodes and remove the vagina.

Radiation: in situ (curietherapie) is rarely used except in the case of homogeneous mulleroblastome (or carcinosarcoma). External radiation, although more commonly used, appears to have very little effect, especially with leiomyosarcoma. However, it can reduce the recurrence rate of the disease.

Chemical: commonly used as a complementary therapy, the best response is too heterogeneous leiomyosarcoma and muleroblastome. In contrast, there is absolutely no effect in recurrence and metastasis.

Overall, the prognosis is still very poor, although with treatment only 55% live after 2 years, 27% live after 5 years, because of the nature of the disease often: late diagnosis, difficult due to clinical symptoms and Subclinical has nothing specific, the progression of the disease is very fast.