Abstract
Purpose
To review a single-center experience over a 27-year period in the management of endometrial stromal sarcoma (ESS) and undifferentiated endometrial sarcoma (UES) for insight into clinical characteristics, pathological diagnosis, surgical practice, adjuvant therapy and clinical outcome.
Materials and methods
This was a retrospective study of women with histologically proven ESS and UES who were treated at the Department of Obstetrics and Gynecology, University of Tuebingen, Germany, between 1983 and 2010. Available tumor tissue, as well as inpatient and ambulatory records were reviewed; follow-up and survival data were ascertained.
Results
The study sample comprised ten patients with ESS and seven patients with UES. Primary surgical treatment consisted of total hysterectomy in nine patients (90.0 %) with ESS and six patients (85.7 %) with UES; one patient (10.0 %) with ESS and one patient (14.3 %) with UES underwent debulking surgery. All patients (100 %) from the ESS group and six patients (85.7 %) from the UES group underwent bilateral salpingo-oophorectomy. Seven women (70.0 %) with ESS and six women (85.7 %) with UES underwent lymphadenectomy. Median DFS was 83.8 months (95 % CI 80.6–87.0) and median OS was 232.6 (95 % CI 49.3–415.9) for patients with ESS; median DFS was 12.9 months (95 % CI 0–284.1) and median OS was 17.6 (95 % CI 0–37.0) for patients with UES. There was no significant difference in DFS between patients with ESS as compared with patients with UES. However, patients with ESS had a significantly better OS when compared to patients with UES (p = 0.011).
Conclusion
ESS and UES are very rare uterine neoplasms. Surgery consisting of total hysterectomy with or without bilateral salpingo-oophorectomy is the most important treatment-element in patients with ESS or UES.
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References
D’Angelo E, Prat J (2010) Uterine sarcomas: a review. Gynecol Oncol 116(1):131–139
Rauh-Hain JA, del Carmen MG (2013) Endometrial stromal sarcoma: a systematic review. Obstet Gynecol 122(3):676–683
World Health Organization classification of tumors (2003) Mesenchamyl tumors and related lesions. In: Tavassoli FA, Devilee P (eds) Pathology and genetics of tumors of the breast and female organs. IARC Press, Lyon, pp 233–236
Amant F, Coosemans A, Debiec-Rychter M, Timmerman D, Vergote I (2009) Clinical management of uterine sarcomas. Lancet Oncol 10(12):1188–1198
Chang KL, Crabtree GS, Lim-Tan SK, Kempson RL, Hendrickson MR (1990) Primary uterine endometrial stromal neoplasms. A clinicopathologic study of 117 cases. Am J Surg Pathol 14(5):415–438
Dionigi A, Oliva E, Clement PB, Young RH (2002) Endometrial stromal nodules and endometrial stromal tumors with limited infiltration: a clinicopathologic study of 50 cases. Am J Surg Pathol 26(5):567–581
Gadducci A (2011) Prognostic factors in uterine sarcoma. Best Pract Res Clin Obstet Gynaecol. 25(6):783–795
He L, Li JD, Xiong Y, Huang X, Huang L, Lin JX, Zhou Y, Zheng M (2014) Clinicopathological and molecular markers associated with prognosis and treatment effectiveness of endometrial stromal sarcoma: a retrospective study in China. Arch Gynecol Obstet 289(2):383–391
Goff BA, Rice LW, Fleischhacker D, Muntz HG, Falkenberry SS, Nikrui N, Fuller AF Jr (1993) Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence. Gynecol Oncol 50(1):105–109
García-Martínez E, Egea Prefasi L, García-Donas J, Escolar-Pérez PP, Pastor F, González-Martín A (2011) Current management of uterine sarcomas. Clin Transl Oncol 13(5):307–314
Biswas A, Patel F, Kumar P, Srinivasan R, Bera A, Sharma SC, Rajwanshi A (2013) Uterine sarcoma-current management and experience from a regional cancer centre in North India. Arch Gynecol Obstet 288(4):873–882
Iwasaki S, Sudo T, Miwa M, Ukita M, Morimoto A, Tamada M, Ueno S, Wakahashi S, Yamaguchi S, Fujiwara K, Sakuma Y, Mikami Y, Nishimura R (2013) Endometrial stromal sarcoma: clinicopathological and immunophenotypic study of 16 cases. Arch Gynecol Obstet 288(2):385–391
FIGO Committee on Gynecologic Oncology (2009) FIGO staging for uterine sarcomas. Int J Gynaecol Obstet 104:179
Nordal RR, Kristensen GB, Kaern J, Stenwig AE, Pettersen EO, Tropé CG (1996) The prognostic significance of surgery, tumor size, malignancy grade, menopausal status, and DNA ploidy in endometrial stromal sarcoma. Gynecol Oncol 62(2):254–259
Chan JK, Kawar NM, Shin JY, Osann K, Chen LM, Powell CB, Kapp DS (2008) Endometrial stromal sarcoma: a population-based analysis. Br J Cancer 99(8):1210–1215
Garg G, Shah JP, Toy EP, Bryant CS, Kumar S, Morris RT (2010) Stage IA vs. IB endometrial stromal sarcoma: does the new staging system predict survival? Gynecol Oncol 118(1):8–13
Gadducci A, Cosio S, Romanini A, Genazzani AR (2008) The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 65(2):129–142
Evans HL (1982) Endometrial stromal sarcoma and poorly differentiated endometrial sarcoma. Cancer 50(10):2170–2182
Yoon A, Park JY, Park JY, Lee YY, Kim TJ, Choi CH, Bae DS, Kim BG, Lee JW, Nam JH (2014) Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: a multicenter review of 114 cases. Gynecol Oncol 132(1):70–75
Chu MC, Mor G, Lim C, Zheng W, Parkash V, Schwartz PE (2003) Low-grade endometrial stromal sarcoma: hormonal aspects. Gynecol Oncol 90(1):170–176
Amant F, De Knijf A, Van Calster B, Leunen K, Neven P, Berteloot P, Vergote I, Van Huffel S, Moerman P (2007) Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma. Br J Cancer 97(9):1194–1199
Li AJ, Giuntoli RL 2nd, Drake R, Byun SY, Rojas F, Barbuto D, Klipfel N, Edmonds P, Miller DS, Karlan BY (2005) Ovarian preservation in stage I low-grade endometrial stromal sarcomas. Obstet Gynecol 106(6):1304–1308
Kim WY, Lee JW, Choi CH, Kang H, Kim TJ, Kim BG, Lee JH, Bae DS (2008) Low-grade endometrial stromal sarcoma: a single center’s experience with 22 cases. Int J Gynecol Cancer 18(5):1084–1089
Shah JP, Bryant CS, Kumar S, Ali-Fehmi R, Malone JM Jr, Morris RT (2008) Lymphadenectomy and ovarian preservation in low-grade endometrial stromal sarcoma. Obstet Gynecol 112(5):1102–1108
Leath CA 3rd, Huh WK, Hyde J Jr, Cohn DE, Resnick KE, Taylor NP, Powell MA, Mutch DG, Bradley WH, Geller MA, Argenta PA, Gold MA (2007) A multi-institutional review of outcomes of endometrial stromal sarcoma. Gynecol Oncol 105(3):630–634
Riopel J, Plante M, Renaud MC, Roy M, Têtu B (2005) Lymph node metastases in low-grade endometrial stromal sarcoma. Gynecol Oncol 96(2):402–406
Dos Santos LA, Garg K, Diaz JP, Soslow RA, Hensley ML, Alektiar KM, Barakat RR, Leitao MM Jr (2011) Incidence of lymph node and adnexal metastasis in endometrial stromal sarcoma. Gynecol Oncol 121(2):319–322
Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH (2011) The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus. Ann Surg Oncol 18(12):3453–3461
Maluf FC, Sabbatini P, Schwartz L, Xia J, Aghajanian C (2001) Endometrial stromal sarcoma: objective response to letrozole. Gynecol Oncol 82(2):384–388
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We acknowledge the assistance of Brigit Trilling in obtaining patient follow-up data.
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A. Staebler and F. A. Taran have contributed equally to this work.
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Rothmund, R., Hartkopf, A., Joachim, C. et al. Clinical characteristics, pathological reevaluation, surgical management and adjuvant therapy of patients with endometrial stromal tumors. Arch Gynecol Obstet 290, 1195–1200 (2014). https://doi.org/10.1007/s00404-014-3320-7
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DOI: https://doi.org/10.1007/s00404-014-3320-7