CURRENT PROBLEMS OF MODERN ONCOGYNECOLOGY: UTERINE SARCOMAS
https://doi.org/10.17749/2313-7347.2017.11.3.070-081
Abstract
The aim of this study was to review and analyze the medical reports on the current aspects of etiology, pathogenesis, diagnosis and treatment of uterine sarcomas. Here, we attempt to summarize the available information concerning the patient management and the many issues related to the diagnosis and treatment of this disease. In this study, the updated classification of uterine sarcomas is presented together with the current concepts on staging of the disease. Although «epidemiologically» rare, this group of diseases represents a serious oncological problem because of its severity and high mortality rate, and the lack of complete understanding of its pathogenesis.
About the Authors
A. G. SolopovaRussian Federation
Solopova Antonina Grigorievna – MD, Professor, Department of Obstetrics and Gynecology, Faculty of Preventive Medicine.
Ul. Trubetskaya, 8, str. 2, Moscow, 119991
A. D. Makatsariya
Russian Federation
Makatsariya Alexander Davidovich – MD, corresponding member of RAS, Professor, Head of Department of Obstetrics and Gynecology, Faculty of Preventive Medicine.
Ul. Trubetskaya, 8, str. 2, Moscow, 119991
A. E. Solopova
Russian Federation
Solopova Alina Evgenievna – PhD, Assistant Professor, Department of Radiation Diagnostics and Radiation Therapy, Faculty of Internal Diseases.
Ul. Trubetskaya, 8, str. 2, Moscow, 119991
I. A. Rozanov
Russian Federation
Rozanov Ivan Andreevich – 6th year student, Faculty of Preventive Medicine.
Ul. Trubetskaya, 8, str. 2, Moscow, 119991
E. K. Titova
Russian Federation
Titova Ekaterina Konstantinovna – 5th year student, Pediatric Faculty.
Ul. Trubetskaya, 8, str. 2, Moscow, 119991
References
1. Savkova R.F., Yudina L.F., Dzasokhov A.S., Gerashchenko M.A. Hyperbaric oxygenation in the treatment of chemo-resistant recurrences of sarcoma and uterine body cancer [Giperbaricheskaya oksigenaciya v lechenii himiorezistentnyh recidivov sarkomy i raka tela matki]. Vestnik novyh medicinskih tekhnologij. 2008; ХV (3): 41-2 (in Russian).
2. Wu T.I., Yen T.C., Lai C.H. Clinical presentation and diagnosis of uterine sarcoma, including imaging. Best Pract Res Clin Obstet Gynaecol.
3. ; 25 (6): 681-9. 3. Rong H., Hilakivi-Clarke L., Clarke R. Molecular mechanisms of tamoxifen-associated endometrial cancer (review). Oncol Lett. 2015; 9: 1495-501.
4. Schick U., Bolukbasi Y., Thariat J., Abdah-Bortnyak R., Kuten A., Igdem S. et al. Outcome and prognostic factors in endometrial stromal tumors: a rare cancer network study. Int J Radiat Oncol Biol Phys. 2012; 82 (5): e757-63.
5. Ostashevsky V.A., Barkov E.S., Gerasimov A.V., Krasilnikov S.E., Gulyaeva L.F. Epidemiological analysis of 167 cases of uterine sarcoma in the Novosibirsk region [Epidemiologicheskij analiz 167 sluchaev sarkomy matki v Novosibirskoj oblasti]. Vestnik NGU. Seriya: Biologiya, klinicheskaya medicina. 2006; 4 (2): 3-8 (in Russian).
6. Strukov A.I., Serov V.V. Pathological anatomy: a textbook. 5th ed [Patologicheskaya anatomiya: uchebnik. 5-e izd.]. Moskva: Litterra. 2010: 880 s (in Russian).
7. Berrington de Gonzalez A., Kutsenko A., Rajaraman P. Sarcoma risk after radiation exposure. Clin Sarcoma Research. 2012; 2 (1): 18.
8. Cuppens T., Tuyaerts S., Amant F. Potential therapeutic targets in uterine sarcomas. Sarcoma. 2015; 2015: 243298.
9. Felix A.S., Cook L.S., Gaudet M.M., Rohan T.E., Schouten L.J., Setiawan V.W. et al. The Etiology of Uterine Sarcomas: A Pooled Analysis of the Epidemiology of Endometrial Cancer Consortium. Br J Cancer. 2013; 108 (3): 727-34.
10. Lin L.L., Brown J.C., Segal S, Schmitz K.H. Quality of Life, Body Mass Index, and Physical Activity among Uterine Cancer Patients. Int J Gynecol Cancer. 2014; 24 (6): 1027-32.
11. Makinen N., Aavikko M., Heikkinen T., Taipale M., Taipale J., Koivisto-Korander R. et al. Exome Sequencing of Uterine Leiomyosarcomas Identifies Frequent Mutations in TP53, ATRX, and MED12. PLoS Genet. 2016; 12 (2): e1005850.
12. Arora P., Rao S., Khurana N., Talwar D., Tanwar R. Malignant mixed Mullerian tumor of broad ligament with synchronous ovarian and endometrial carcinoma: a rare association. J Cancer Res Ther. 2011; 7 (1): 88-91.
13. Shang W., Huang L., Li L., Li X., Zeng R., Ge S., Xu G. et al. Cancer Risk in Patients Receiving Renal Replacement Therapy: A Meta-Analysis of Cohort Studies. Mol Clin Oncol. 2016; 5 (3): 315-25.
14. Zwierzchowska A., Panek G., Gajewska M. Postradiation carcinosarcoma of the corpus uteri – a case report . Eur J Gynaecol Oncol. 2015; 36 (6): 746-9.
15. Szubert M., Suzin J., Stawerski P., Kowalczyk-Amico K., Duechler M. Endometriosis and carcinosarcoma – a hypothetical correlation or a proven pathogenetic pathway? Colon carcinosarcoma with origin in endometriotic foci – a case report. Ginekol Pol. 2015; 86 (7): 547-50.
16. Purdie D.M., Green A.C. Epidemiology of endometrial cancer. Best Pract Res Clin Obstet Gynaecol. 2001; 15 (3): 341-54.
17. Brooks S.E., Zhan M., Cote T., Baquet C.R. Surveillance, epidemiology and end results analysis of 2677 cases of uterine sarcoma 1989-1999. Gynecol Oncol. 2004; 93: 204-8.
18. Choi Y.J., Jung S.H., Kim M.S., Baek I.P., Rhee J.K., Lee S.H., Hur S.Y., Kim T.M., Chung Y.J., Lee S.H. Genomic landscape of endometrial stromal sarcoma of uterus. Oncotarget. 2015; 6 (32): 33319-28.
19. International Union Against Cancer (UICC). TNM Classification of Malignant Tumours [Eds. L.H. Sobin, M.K. Gospodarowicz, Ch. Wittekind]. 7th ed. NY: Wiley-Blackwell. 2009.
20. Sivakumari S., Rajaraman R., Subbiah S. Uterine Sarcoma: The Indian Scenario. Indian J Surg Oncol. 2015; 6 (3): 232-6.
21. Oliva E., Carcangiu M.L., Carinelli S.G., Ip P., Loening T., Longacre T.A. et al. Tumours of the uterine corpus [Eds. R.J. Kurman, M.L. Carcangiu, C.S. Herrington, R.H. Young]. WHO classification of tumours of female reproductive organs. 4th ed. Lyons, France: IARC Press. 2014: 135-47.
22. Prat J., Mbatani N. Uterine sarcomas. Int J Gynecol Obstet. 2015; 131 (Suppl 2): S105-10.
23. Denoix P.F. Nomtnclature des cancers. Bull Inst Nat Hyg (Paris). 1944: 69-73; 1945: 82-84; 1952: 743-748.
24. FIGO Committee on Gynecologic Oncology. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet. 2009; 104 (3): 179.
25. Oliva E. Practical issues in uterine pathology from banal to bewildering: the remarkable spectrum of smooth muscle neoplasia. Mod Pathol. 2016; 29 (Suppl 1): S104-20.
26. Klimashevsky V.F., Turkevich E.A. Morphological classification of sarcomas of the uterus body [Morfologicheskaya klassifikaciya sarkom tela matki]. Prakticheskaya onkologiya. 2008; 9 (3): 125-31 (in Russian).
27. Savostikov M.V., Levchenko N.E., Laktionov K.P., Krasnoshchekova G.I., Mushtenko S.V. Mesenchymal tumors of the uterus body [Mezenhimal'nye opuholi tela matki]. Onkoginekologiya. 2014; 3: 11-22 (in Russian).
28. Naaman Y.I., Shveiky D., Ben-Shachar I., Shushan A., Mejia-Gomez J., Benshushan A. Uterine sarcoma: prognostic factors and treatment evaluation. Isr Med Assoc J. 2011; 13 (2): 76-9.
29. Takahama J., Takahashi A., Marugami N. et al. New FIGO Staging of Uterine malignancies with MR Imaging: Correlation with Surgical and Histopathologic Findings. Congress ECR. 2011: 1548.
30. Lange S.S., Novetsky A.P., Powell M.A. Recent advances in the treatment of sarcomas in gynecology. Discov Med. 2014; 18 (98): 133-40.
31. Zacharie S., Fouelifack F.Y., Fouogue J.T., Fouedjio J.H., Anoudem C.E., Nangue С. Carcinosarcoma of the Corpus Uteri (Malignant Müllerian Mixed Tumor): A Case Report in Yaoundé (Cameroon). Pan African Medical Journal. 2013; 16: 145.
32. Taga S., Sawada M., Nagai A., Yamamoto D., Hayase R. A Case of Adenosarcoma of the Uterus. Case Rep Obstet Gynecol. 2014; 2014: 342187.
33. Nathenson M.J., Ravi V., Fleming N., Wang W.L., Conley A. Uterine Adenosarcoma: a Review. Curr Oncol Rep. 2016; 18 (11): 68.
34. Cárdenas-Serrano Ó.E., Villalón-López J.S., Ruiz-Mar G., Daza-Benítez L. Diagnostic of uterine sarcoma, review of 11 cases. Ginecol Obstet Mex. 2015; 83 (9): 515-21.
35. Hong Liu, Yi Zhu, Guo-Nan Zhang, Chang Wang, Chao Li, Yu Shi. Laparoscopic surgery on broken points for uterine sarcoma in the early stage decrease prognosis. Sci Rep. 2016; 6: 31229.
36. Jung-Yun Lee, Hyun Soo Kim, Eun Ji Nam, Sang Wun Kim, Sunghoon Kim, Young Tae Kim Lee et al. Outcomes of uterine sarcoma found incidentally after uterus-preserving surgery for presumed benign disease. BMC Cancer. 2016; 16: 675.
37. Monappa V., Kudva R., Hasan R. Uterine malignant mixed müllerian tumor camouflaging as pelvic sarcoma. J Cancer Res Ther. 2015; 11 (4): 997-9.
38. Van de Rijn M., Guo X., Sweeney R.T., Beck A.H., West R.B. Molecular Pathological Analysis of Sarcomas Using ParaffinEmbedded Tissue: Current Limitations and Future Possibilities. Histopathology. 2014; 64 (1): 163-70.
39. Lee C.H., Marino-Enriquez A., Ou W., Zhu M., Ali R.H., Chiang S. et al. Cyclin D1 as a Diagnostic Immunomarker for Endometrial Stromal Sarcoma with YWHAE-FAM22 Rearrangement. Am J Surg Pathol. 2012; 36 (10): 1562-70.
40. Park Ga Eun, Rha Sung Eun, Oh Soon Nam, Lee Ahwon, Lee Keun Ho, Kim Mee-Ran. Ultrasonographic Findings of Low-Grade Endometrial Stromal Sarcoma of the Uterus with a Focus on Cystic Degeneration. Ultrasonography (Seoul, Korea). 2016; 35 (2): 124-30.
41. Santos P., Cunha T.M. Uterine sarcomas: clinical presentation and MRI features. Diagn Interv Radiol. 2015; 21 (1): 4-9.
42. Ucar М., Guryildirim М. Granulocytic Sarcoma of the Uterus: A Rare Presentation of Extramedullary Relapse of AML and Importance of MRI. Case Rep Radiol. 2014; 2014: 501342. DOI: 10.1155/2014/501342.
43. Malayeri A.A., El Khouli R.H., Zaheer А., Jacobs M.A., Corona-Villalobos C.P., Kamel I.R., Macura K.J. Principles and applications of diffusion-weighted Imaging in cancer detection, staging, treatment and follow-up. Radiographics. 2013; 31 (6): 1773-91.
44. Manoharan D., Das C.J., Aggarwal A., Gupta A.K. Diffusion weighted imaging in gynecological malignancies – present and future. World J Radiol. 2016; 8 (3): 288-97. DOI: 10.4329/wjr.v8.i3.288.
45. Yonglan H., Ding N., Xue H.D., Jin Z., Hao S., Cao J. Cyclic changes of the uterus and cervix in young and middle-aged women during the menstrual cycle: an initial 3T MR functional imaging study based on T2 mapping and diffusion tensor imaging (DTI) sequences. Congress ECR. 2014: C-0498. DOI: 10.1594/ece2014/C-0498.
46. Bozkurt K.D., Bozkurt M., Nazli M.A., Mutlu I.N., Kilickesmez O. Diffusion-weighted and diffusion-tensor imaging of normal and diseased uterus. World J Radiol. 2015; 7 (7): 149-56.
47. Lee C.H., Marino-Enriquez A., Ou W., Zhu M., Ali R.H., Chiang S. et al. The clinicopathologic features of YWHAE-FAM22 endometrial stromal sarcomas: a histologically high-grade and clinically aggressive tumor. Am J Surg Pathol. 2012; 36 (5): 641-53.
48. Si M., Jia L., Song K., Zhang Q., Kong B. Role of Lymphadenectomy for Uterine Sarcoma: A Meta-Analysis. Int J Gynecol Cancer. 2016; 27 (1): 109-16.
49. Vrzic-Petronijevic S., Likic-Ladjevic I., Petronijevic M., Argirovic R., Ladjevic N. Diagnosis and surgical therapy of uterine sarcoma. Acta Chir Iugosl. 2006; 53 (3): 67-72.
50. Thomassin-Naggara I., Siles P., Balvay D., Cuenod C.A., Carette M.F., Bazot M. Diagnostic and Interventional Imaging. Éditions françaises de radiologie. 2013; 94 (12): 1291-8.
51. Hensley M.L., Wathen K., Maki R.G. et al. 3-year follow up ot SARC005: adjuvant treatment of high risk primary uterine leiomyosarcoma with gemcitabine/docetaxel, followed by doxorubicin. Connective Tissue Oncology Society Annual Meeting. Chicago. 2011: poster № 78.
52. Ho H.L., Meng M.B., Chen X.L., Zhao L.J., Shu L., Zhang B.L. et al. The prognosis factor of adjuvant radiation therapy after surgery in uterine sarcomas. Onco Targets Ther. 2015; 8: 2339-44.
53. Roque D.R., Taylor K.N., Palisoul M., Wysham W.Z., Milam B., Robison K. et al. Gemcitabine and docetaxel compared with observation, radiation, or other chemotherapy regimens as adjuvant treatment for Stage I-to-IV uterine leiomyosarcoma. Int J Gynecol Cancer. 2016; 26: 505-11.
54. Yu T., Kim H.J., Wu H.G., Ha S.W., Song Y.S., Park N.H. et al. Outcome analysis in patients with uterine sarcoma. Radiat Oncol J. 2015; 33: 29-35.
55. Zhu J., Wen H., Bi R., Wu X. Clinicopathological Characteristics, Treatment and Outcomes in Uterine Carcinosarcoma and Grade 3 Endometrial Cancer Patients: A Comparative Study. J Gynecol Oncol. 2016; 27 (2): e18.
56. Ryu H., Choi Y.S., Song I.C., Yun H.J., Jo D.Y., Kim S. et al. Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature. Oncol Lett. 2015; 10: 3310-4.
57. Duhan N. Current and emerging treatments for uterine myoma – an update. Int J Women’s Health. 2011; 3: 231-41.
58. Pautier P., Floquet A., Gladieff L., Bompas E., Ray-Coquard I., Piperno-Neumann S. et al. A randomized clinical trial of adjuvant chemotherapy with doxorubicin, ifosfamide, and cisplatin followed by radiotherapy versus radiotherapy alone in patients with localized uterine sarcomas (SARCGYN study). A study of the French Sarcoma Group. Ann Oncol. 2013; 24: 1099-104.
59. Denschlag D., Thiel F.C., Ackermann S., Harter P., Juhasz-Boess I., Mallmann P. et al. Sarcoma of the uterus. Guideline of the DGGG (S2k-Level, AWMF Registry No. 015/074, August 2015). Geburtshilfe Frauenheilkd. 2015; 75 (10): 1028-42.
60. Olah K.S., Gee H., Blunt S., Dunn J.A., Kelly K., Chan K.K. Retrospective analysis of 318 cases of uterine sarcoma. Eur J Cancer. 1991; 27 (9): 1095-9.
61. Wang P.H., Wen K.C., Yen M.S. Challenges in the management of recurrent endometrial cancer. J Chin Med Assoc. 2016; 79 (24): 171-3.
62. Tanner E.J., Garg K., Leitao M.M., Soslow R.A., Hensley M.L. High grade undifferentiated uterine sarcoma: surgery, treatment, and survival outcomes. Gynecol Oncol. 2012; 127 (1): 27-31.
63. Visnovsky J., Kudela E., Slavik P., Krkoska M., Buocik P., Szepe P., Danko J. Survival and risk factors associated with sarcomas and carcinosarcomas in stage I and II. NeuroEndocrinolLett. 2015; 36 (8): 750-7.
Review
For citations:
Solopova A.G., Makatsariya A.D., Solopova A.E., Rozanov I.A., Titova E.K. CURRENT PROBLEMS OF MODERN ONCOGYNECOLOGY: UTERINE SARCOMAS. Obstetrics, Gynecology and Reproduction. 2017;11(3):70-81. (In Russ.) https://doi.org/10.17749/2313-7347.2017.11.3.070-081

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