Uterine sarcomas: A review
TL;DR: This review summarizes the available clinicopathological data on uterine sarcomas classified by the WHO diagnostic criteria and concludes that immunohistochemical studies of oncoproteins as well as molecular analysis of non-random translocations will lead to an accurate and prognostically relevant classification of these rare tumors.
About: This article is published in Gynecologic Oncology.The article was published on 2010-01-01. It has received 687 citations till now. The article focuses on the topics: Uterine sarcoma & Endometrial stromal sarcoma.
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TL;DR: Increasing evidence indicates that Ki67 may be an effective target in cancer therapy, and therefore merits further development, including testing in more sophisticated in vitro and appropriate in vivo models.
Abstract: The expression of Ki67 is strongly associated with tumor cell proliferation and growth, and is widely used in routine pathological investigation as a proliferation marker. The nuclear protein Ki67 (pKi67) is an established prognostic and predictive indicator for the assessment of biopsies from patients with cancer. Clinically, pKi67 has been shown to correlate with metastasis and the clinical stage of tumors. In addition, it has been shown that Ki67 expression is significantly higher malignant tissues with poorly differentiated tumor cells, as compared with normal tissue. According to its predictive role, pKi67 expression identifies subpopulations of patients who are more likely to respond to a given therapy. The Ki67 labeling index is an independent prognostic factor for survival rate, which includes all stages and grade categories. There is a correlation between the ratio of Ki67‑positive malignant cells and patient survival. It has been shown that blocking of Ki67 either by microinjection of antibodies or through the use of antisense oligonucleotides leads to the arrest of cell proliferation. Specifically, antisense oligonucleotides and antibodies against pKi67 have been shown to inhibit the progression of the cell cycle. The Ki67 protein is well characterized at the molecular level and is extensively used as a prognostic and predictive marker for cancer diagnosis and treatment. Increasing evidence indicates that Ki67 may be an effective target in cancer therapy. It therefore merits further development, including testing in more sophisticated in vitro and appropriate in vivo models. This review provides an overview of recent advances in this field.
505 citations
TL;DR: This article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.
Abstract: Uterine fibroids are a major cause of morbidity in women of a reproductive age (and sometimes even after menopause). There are several factors that are attributed to underlie the development and incidence of these common tumors, but this further corroborates their relatively unknown etiology. The most likely presentation of fibroids is by their effect on the woman's menstrual cycle or pelvic pressure symptoms. Leiomyosarcoma is a very rare entity that should be suspected in postmenopausal women with fibroid growth (and no concurrent hormone replacement therapy). The gold standard diagnostic modality for uterine fibroids appears to be gray-scale ultrasonography, with magnetic resonance imaging being a close second option in complex clinical circumstances. The management of uterine fibroids can be approached medically, surgically, and even by minimal access techniques. The recent introduction of selective progesterone receptor modulators (SPRMs) and aromatase inhibitors has added more armamentarium to the medical options of treatment. Uterine artery embolization (UAE) has now been well-recognized as a uterine-sparing (fertility-preserving) method of treating fibroids. More recently, the introduction of ultrasound waves (MRgFUS) or radiofrequency (VizAblate™ and Acessa™) for uterine fibroid ablation has added to the options of minimal access treatment. More definite surgery in the form of myomectomy or hysterectomy can be performed via the minimal access or open route methods. Our article seeks to review the already established information on uterine fibroids with added emphasis on contemporary knowledge.
278 citations
TL;DR: There are differences in survival between histological types of US, and tumor-free resection margins at primary surgery are the most important prognostic factor for survival, sarcoma surgery should be centralized.
Abstract: Background. The histopathological classification and staging system for uterine sarcoma (US) were revised in 2003 and 2009, respectively. However, there is currently no consensus on the significance of various prognostic factors. Therefore the available clinicopathological data on US are summarized in this review. Methods. Articles on uterine sarcoma published in English from 1970 to 2011 were identified systematically by computer-based searches in Medline and the Cochrane Library. Results. Prognosis of US is poor, with a five-year survival rate as low as 30%. The most common histological types are leiomyosarcoma (LMS, 63%), endometrial stromal sarcoma (ESS, 21%), adenosarcoma (6%), undifferentiated sarcoma (5%) and other types (5%). Carcinosarcoma is a mixed tumor, which is today regarded as a subset of endometrial carcinoma. Disease stage is the most important prognostic factor for all types of US. However, the prognosis of stage I LMS is also significantly related to tumor size and mitotic inde...
161 citations
TL;DR: Oophorectomy and lymphadenectomy may be safely omitted for clinically uterus-confined leiomyosarcoma and Chemotherapy increases survival of women with metastatic leIomyosARcoma.
145 citations
Cites background from "Uterine sarcomas: A review"
...high risk of recurrence even among women with early-stage disease [2,3]....
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TL;DR: A critical appraisal of the literature regarding the contemporary surgical and medical management of uterusine leiomyosarcoma, the role of targeted therapies, and the implications of uterine morcellation on gynecologic surgical practice is provided.
141 citations
Cites background from "Uterine sarcomas: A review"
...Symptoms of both uterine entities may be vague and include uterine bleeding (56%), an increase in abdominal girth or palpable uterine mass (52%) and pelvic pain and/or pressure (22%) [10]....
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...Additionally, LMS often expresses smooth muscle markers, including desmin, h-caldesmon, histone deacetylase 8 (HDCA8) and smooth muscle actin [10]....
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References
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01 Jan 2002
7,963 citations
"Uterine sarcomas: A review" refers background or methods in this paper
...Please cite this article as: D'Angelo E, Prat J, Uterine sarcomas: A review in most retrospective studies of uterine sarcomas, as well as in the 2003 World Health Organization (WHO) classification [3]....
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...Undifferentiated endometrial sarcomas lack immunoreaction for ER and PR, but a high proportion is EGFR immunoreactive [3]....
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...The diagnosis of STUMP, however, should be used most sparingly and every effort should be made to classify a smooth muscle tumor into a specific category [3,34]....
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...According to the latestWHO classification [3], the term endometrial stromal tumor is applied to neoplasms typically composed of cells that resemble endometrial stromal cells of the proliferative endometrium [3]....
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...The histological appearance of this tumor is more like the mesenchymal elements of a carcinosarcoma than a typical endometrial stromal tumor [3]....
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Book•
01 Jan 2003
2,911 citations
TL;DR: From a wide variety of light microscopic features assessed, the important predictors that emerged, using a variety of data exploratory techniques, were MI, the degree of cytologic atypia, and the presence or absence of coagulative tumor cell necrosis.
Abstract: A recent trend in the classification of uterine smooth muscle neoplasms (USMNs) into clinically benign and clinically malignant groups has been to move from exclusive reliance upon mitotic index (MI) to an approach that incorporates additional histopathologic characteristics. In furtherance of this goal, we assessed a variety of histopathologic features of 213 problematic smooth muscle neoplasms for which we had > or = 2 years of clinical follow-up data or for which there was an unfavorable outcome. One hundred and thirteen of these patients have had a minimum follow-up of 5 years, and 48 have been followed for > or = 10 years. Cases eliminated from the study group included USMNs with a significant myxoid or epithelioid component and cases of intravenous leiomyomatosis. USMNs, whether cellular or not, with no cytologic atypia and with a mitotic index (MI = number of mitotic figures [mf]/10 high-power fields [hpf]) of or = 10 mf/10 hpf, four of 10 failed.(ABSTRACT TRUNCATED AT 400 WORDS)
663 citations
"Uterine sarcomas: A review" refers background in this paper
..., necrosis, nuclear atypia, or mitoses), but do not meet all diagnostic criteria for leiomyosarcoma, fall into the category of STUMP (Table 3) [3,34]....
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...The diagnosis of STUMP, however, should be used most sparingly and every effort should be made to classify a smooth muscle tumor into a specific category [3,34]....
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01 Jan 1987
TL;DR: Purely mesenchymal tumors, such as those derived from smooth muscle and endometrial stroma, are considered, as are benign and malignant neoplasms in which there are mixtures of epithelium and connective tissue.
Abstract: This chapter deals with neoplasms of the uterus in which there is mesenchymal differentiation. Purely mesenchymal tumors, such as those derived from smooth muscle and endometrial stroma, are considered, as are benign and malignant neoplasms in which there are mixtures of epithelium and connective tissue.
611 citations
TL;DR: A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979–1988.
Abstract: Background. A clinicopathologic evaluation of clinical Stage I and II uterine sarcoma was done by the Gynecologic Oncology Group from 1979-1988. Methods. After all eligibility criteria were met, 453 cases were evaluable and analyzed for prognostic factors. Results. Of the 301 mixed mesodermal tumors (MMT), 167 were homologous (HO), and 134 were heterologous (HE). Fifty-nine tumors were leiomyosarcomas (LM). The remaining 93 sarcomas were predominantly stromal cell and adenosarcomas. For this study, only the MMT or LM tumors were analyzed
581 citations
"Uterine sarcomas: A review" refers background in this paper
...Uterine sarcomas are rare tumors that account for approximately 1% of female genital tract malignancies and 3% to 7% of uterine cancers [1]....
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...It has become apparent that tumors diagnosed according to the 2003 WHO criteria are associated with poor prognosis even when confined to the uterus [11,23] and even when diagnosed at an early stage; recurrence rate has ranged from 53% to 71% [1]....
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