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Obstetrics and Gynegology2024№1
The problem of differential diagnosis...

The problem of differential diagnosis of leiomyosarcoma in patients planning surgical treatment for uterine fibroids

DOI
https://dx.doi.org/10.18565/aig.2023.207

Tskhay V.B., Pashov A.I., Rachkovskaya V.V.

1) Professor V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, Krasnoyarsk, Russia; 2) Immanuel Kant Baltic Federal University, Kaliningrad, Russia

Uterine leiomyosarcoma is known to have no clear diagnostic criteria due to its similarity to uterine fibroids. Therefore, clinicians tend to make the wrong diagnosis and/or administer the wrong treatment. This can lead to rapid progression of tumor growth and an increased tendency to metastasis. The article presents the main definitions, classifications, and statistical data on the prevalence of these diseases. A review of literature data on current methods of preoperative diagnosis of tumors was carried out, and special attention was paid to the differential diagnosis of these pathologies. The review covers the general principles of surgical treatment of pathology, as well as the possible extent of surgical intervention. Due to the active introduction and application of uterine artery embolization and intra-abdominal tumor morcellation in gynecological practice, there is a growing interest in preoperative differential diagnosis between leiomyosarcoma and uterine fibroids. These methods of treatment are inadequate if the diagnosis of uterine sarcoma is made in the postoperative period.
Conclusion: Preoperative differential diagnosis between uterine fibroids and sarcomas is extremely important in modern gynecological practice. It is associated not only with the progression of the disease, but also with a deterioration in the prognosis of the disease for the patient after surgical organ-preserving treatment.

Authors’ contributions: Tskhay V.B., Pashov A.I. – developing the idea and design of the study; Tskhay V.B., Pashov A.I., Rachkovskaya V.V. – collecting and processing the material; Pashov A.I. – editing the article.
Conflicts of interest: Authors declare lack of the possible conflicts of interests.
Funding: The study was conducted without sponsorship.
For citation: Tskhay V.B., Pashov A.I., Rachkovskaya V.V. The problem of differential diagnosis of leiomyosarcoma in patients planning surgical treatment for uterine fibroids.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2024; (1): 42-49 (in Russian)
https://dx.doi.org/10.18565/aig.2023.207

Keywords

leiomyosarcoma
uterine body cancer
tumor
uterine fibroids
organ-preserving treatment
Full text (in Russian)

References

  1. FIGO Commitee on Gynecologic Oncology. FIGO staging for uterine sarcomas. Int. J. Gynecol. Obstet. 2009;104(3):179. https://dx.doi.org/10.1016/j.ijgo.2008.12.009.
  2. Desai V.B., Wright J.D., Gross C.P., Lin H., Boscoe F.P., Hutchison L.M. et al. Prevalence, characteristics, and risk factors of occult uterine cancer in presumed benign hysterectomy. Am. J. Obstet. Gynecol. 2019;221(1):39.e1-39.e14. https://dx.doi.org/10.1016/j.ajog.2019.02.051.
  3. Valzacchi R.G.M., Rosas P., Uzal M., Gil S.J., Viglierchio V.T. Incidence of leiomyosarcoma at surgery for presumed uterine myomas in different age groups. J. Minim. Invasive Gynecol. 2019;27(4):926-9. https://dx.doi.org/10.1016/j.jmig.2019.06.013.
  4. Kurman R.J., Carcangiu M.L., Herrington S., Young R.H., ed. WHO classification of tumours of female reproductive organs. WHO classification of tumours, 4th edition, volume 6. Lyon: IARC; 2014.
  5. Министерство здравоохранения Российской Федерации. Клинические рекомендации «Рак тела матки и саркомы матки». 2021. [Ministry of Health of the Russian Federation. Clinical guidelines "Cancer of the uterine body and uterine sarcoma". 2021. (in Russian)].
  6. Цхай В.Б., Пашов А.И., Ашрафян Л.А., Рачковская В.В. Саркома матки и беременность: современный взгляд на проблему. Акушерство и гинекология. 2023;1:13-9. [Tskhai V.B., Pashov A.I., Ashrafyan L.A., Rachkovskaya V.V. Uterine sarcoma and pregnancy: a modern view of the problem. Obstetrics and gynecology. 2023;(1):13-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2022.231.
  7. Roberts M.E., Aynardi J.T., Chu C.S. Uterine leiomyosarcoma: a review of the literature and update on management options. Gynecol. Oncol. 2018;151(3): 562-72. https://dx.doi.org/10.1016/j.ygyno.2018.09.010.
  8. Juhasz-Böss I., Gabriel L., Bohle R.M., Horn L.C., Solomayer E.F., Breitbach G.P. Uterine leiomyosarcoma. Oncol. Res. Treat. 2018;41(11):680-6.https://dx.doi.org/10.1159/000494299.
  9. Sparić R., Andjić M., Babović I., Nejković L., Mitrović M., Štulić J. et al. Molecular insights in uterine leiomyosarcoma: a systematic review. Int. J. Mol. Sci. 2022;23(17):9728. https://dx.doi.org/10.3390/ijms23179728.
  10. Barral M., Placé V., Dautry R., Bendavid S., Cornelis F., Foucher R. et al. Magnetic resonance imaging features of uterine sarcoma and mimickers. Abdom. Imaging (NY). 2017;42(6):1762-72. https://dx.doi.org/10.1007/s00261-017-1076-9.
  11. Oh J., Bin Park S., Park H.J., Lee E.S. Ultrasound features of uterine sarcomas. Ultrasound Q. 2019; 35(4):376-84. https://dx.doi.org/10.1097/RUQ.0000000000000454.
  12. Sun S., Bonaffini P.A., Nougaret S., Fournier L., Dohan A., Chong J. et al. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn. Interv. Imaging. 2019;100(10):619-34. https://dx.doi.org/10.1016/j.diii.2019.07.007.
  13. Lieng M., Berner E., Busund B. Risk of morcellation of uterine leiomyosarcomas in laparoscopic supracervical hysterectomy and laparoscopic myomectomy, a retrospective trial including 4791 women. J. Minim. Invasive Gynecol. 2015;22(3):410-4. https://dx.doi.org/10.1016/j.jmig.2014.10.022.
  14. Raine-Bennett T., Tucker L.Y., Zaritsky E., Littell R.D., Palen T., Neugebauer R. et al. Occult uterine sarcoma and leiomyosarcoma: incidence of survival associated with morcellation. Obstet. Gynecol. 2016;127(1):29-39.https://dx.doi.org/10.1097/AOG.0000000000001187.
  15. Halaska M.J., Haidopoulos D., Guyon F., Morice P., Zapardiel I., Kesic V.; ESGO Council. European Society of Gynecological Oncology Statement on Fibroid and Uterine Morcellation. Int. J. Gynecol. Cancer. 2017;27:189-92.https://dx.doi.org/10.1097/IGC.0000000000000911.
  16. ACOG Committee Opinion No. 770. Summary: uterine morcellation for presumed leiomyomas. Obstet. Gynecol. 2019;133:604-5.https://dx.doi.org/10.1097/AOG.0000000000003127.
  17. Wang L., Li S., Zhang Z., Jia J., Shan B. Prevalence and occult rates of uterine leiomyosarcoma. Medicine (Baltimore). 2020;99(33):e21766.https://dx.doi.org/10.1097/MD.0000000000021766.
  18. Mettler L., Maass N., Abdusattarova K., Dempfle A., Alkatout I. Frequency of uterine sarcomas in patients admitted for uterine fibroid surgery. J. Turk. Ger. Gynecol. Assoc. 2017;18(2):62-6. https://dx.doi.org/10.4274/jtgga.2016.0248.
  19. Van den Haak L., de Kroon C.D., Warmerdam M.I., Siebers A.G., Rhemrev J.P., Nieboer T.E., Jansen F.W. Incidence and groups at risk for unexpected uterine leiomyosarcoma: a Dutch nationwide cohort study. Arch. Gynecol. Obstet. 2019;299(1):159-65. https://dx.doi.org/10.1007/s00404-018-4949-4.
  20. Multinu F., Casarin J., Tortorella L., Huang Y., Weaver A., Angioni S. et al. Incidence of sarcoma in patients undergoing hysterectomy for benign indications: a population-based study. Am. J. Obstet. Gynecol. 2019;220(2):179.e1-179.e10. https://dx.doi.org/10.1016/j.ajog.2018.11.1086.
  21. Skorstad M., Kent A., Lieng M. Uterine leiomyosarcoma - incidence, treatment, and the impact of morcellation. A nationwide cohort study. Acta Obstet. Gynecol. Scand. 2016; 95(9):984-90. https://dx.doi.org/10.1111/aogs.12930.
  22. Arezzo F., Cormio G., Putino C., Di Lillo N., Silvestris E., Kardhashi A. et al. Overlap of suspicious and non-suspicious features in the ultrasound evaluations of leiomyosarcoma: a single-center experience. Diagnostics (Basel). 2023;13(3):543. https://dx.doi.org/10.3390/diagnostics13030543.
  23. Russo C., Camilli S., Martire F.G., Di Giovanni A., Lazzeri L., Malzoni M. et al. Ultrasound features of highly vascularized uterine myomas (uterine smooth muscle tumors) and correlation with histopathology. Ultrasound Obstet. Gynecol. 2022;60(2):269-76. https://dx.doi.org/10.1002/uog.24855.
  24. Cotrino I., Carosso A., Macchi C., Baima Poma C., Cosma S., Ribotta M. et al. Ultrasound and clinical characteristics of uterine smooth muscle tumors of uncertain malignant potential (STUMPs). Eur. J. Obstet. Gynecol. Reprod. Biol. 2020;251: 167-72. https://dx.doi.org/10.1016/j.ejogrb.2020.05.040.
  25. Ambrosio M., Raimondo D., Savelli L., Salucci P., Arena A., Borghese G. et al. Transvaginal ultrasound and doppler features of intraligamental myomas. J. Ultrasound Med. 2020;39(7):1253-9. https://dx.doi.org/10.1002/jum.15213.
  26. Ludovisi M., Moro F., Pasciuto T., Di Noi S., Giunchi S., Savelli L. et al. Imaging in gynecological disease (15): clinical and ultrasound characteristics of uterine sarcoma. Ultrasound Obstet. Gynecol. 2019;54(5):676-87.https://dx.doi.org/10.1002/uog.20270.
  27. Najibi S., Gilani N.M., Zamani F., Akhavan S., Zamani N. Comparison of the diagnostic accuracy of contrast-enhanced/DWI MRI and ultrasonography in the differentiation between benign and malignant myometrial tumors. Ann. Med. Surg (Lond). 2021;70:102813. https://dx.doi.org/10.1016/j.amsu.2021.102813.
  28. Kim J., Heo S.H., Shin S.S., Jeong Y.Y. MRI findings and differential diagnosis of benign and malignant tumors of the uterine corpus. Taehan Yongsang Uihakhoe Chi. 2021;82(5):1103-23. https://dx.doi.org/10.3348/jksr.2021.0116.
  29. Camponovo C., Neumann S., Zosso L., Mueller M.D., Raio L. Sonographic and magnetic resonance characteristics of gynecological sarcoma. Diagnostics (Basel). 2023;13(7):1223. https://dx.doi.org/10.3390/diagnostics13071223.
  30. Li D., Yin N., Du G., Wang S., Xiao Z., Chen J., Chen W. A real-world study on diagnosis and treatment of uterine sarcoma in Western China. Int. J. Biol. Sci. 2020;16: 388-95. https://dx.doi.org/10.7150/ijbs.39773.
  31. Van den Bosch T., Dueholm M., Leone F.P., Valentin L., Rasmussen C.K., Votino A. Terms, definitions and measurements to describe sonographic features of myometrium and uterine masses: a consensus opinion from the Morphological Uterus Sonographic Assessment (MUSA) group. Ultrasound Obstet. Gynecol. 2015;46(3):284-98. https://dx.doi.org/10.1002/uog.14806.
  32. Kurjak A., Kupesic S., Shalan H., Jukic S., Kosuta D., Ilijas M. Uterine sarcoma: A report of 10 cases studied by transvaginal color and pulsed doppler sonography. Gynecol. Oncol. 1995;59(3):342-6. https://dx.doi.org/10.1006/gyno.1995.9965.
  33. Exacoustos C., Manganaro L., Zupi E. Imaging for the evaluation of endometriosis and adenomyosis. Best Pract. Res. Clin. Obstet. Gynaecol. 2014;28(5):655-81. https://dx.doi.org/10.1016/j.bpobgyn.2014.04.010.
  34. Wojtowicz K., Góra T., Guzik P., Harpula M., Chechliński P., Wolak E., Stryjkowska-Góra A. Uterine myomas and sarcomas - clinical and ultrasound characteristics and differential diagnosis using pulsed and color Doppler techniques. J. Ultrason. 2022;22(89):100-8. https://dx.doi.org/10.15557/JoU.2022.0017.
  35. Haugen G., Novakovic Z., Kirste U., Husby H., Dorenberg E. Uterine artery Doppler flow velocity waveform analysis following uterine fibroid embolisation. J. Obstet. Gynaecol. 2015;35(3):316-7. https://dx.doi.org/10.3109/01443615.2014.940298.
  36. Santos P., Cunha T.M. Uterine sarcomas: clinical presentation and MRI features. Diagn. Interv. Radiol. 2015;21(1):4-9. https://dx.doi.org/10.5152/dir.2014.14053.
  37. Sumi A., Terasaki H., Sanada S., Uchida M., Tomioka Y., Kamura T. et al. Assessment of MR imaging as a tool to differentiate between the major histological types of uterine sarcomas. Magn. Reson. Med. Sci. 2015;14(4):295-304. https://dx.doi.org/10.2463/mrms.2014-0023.
  38. Valdes-Devesa V., Jimenez M.D.M., Sanz-Rosa D., Espada Vaquero M., Alvarez Moreno E., Sainz de la Cuesta Abbad R. Preoperative diagnosis of atypical pelvic leiomyoma and sarcoma: the potential role of diffusion-weighted imaging. J. Obstet. Gynaecol. 2019;39(1):98-104. https://dx.doi.org/10.1080/01443615.2018.1466110.
  39. Lin Y., Wu R.-C., Huang Y.-L., Chen K., Tseng S.-C., Wang C.-J. et al. Uterine fibroid-like tumors: spectrum of MR imaging findings and their differential diagnosis. Abdom. Radiol. (NY). 2022;47(6):2197-208.https://dx.doi.org/10.1007/s00261-022-03431-6.
  40. Цхай В.Б., Каплунов В.А., Андреева А.А., Бадмаева С.Ж., Полстяная Г.Н.,Кузьмина С.В., Джунагова Э.Ш. Нарушение трофики и некроз миоматозного узла у беременных. Проблема сложного выбора для врача. Сибирское медицинское обозрение. 2021;4:110-6. [Tskhay V.B., Kaplunov V.A., Andreeva A.A., Badmaeva S.Zh., Polstyanaya G.N., Kuzmina S.V., Dzhunagova E.Sh. Trophicity decline and fi broid nodule necrosis in pregnant patients. The problem of physician’s difficult choice. Siberian Medical Review. 2021;(4):110-6. (in Russian)]. https://dx.doi.org/10.20333/25000136-2021-4-110-116.
  41. Stukan M., Rutkowski P., Smadja J., Bonvalot S. Ultrasound-guided trans-uterine cavity core needle biopsy of uterine myometrial tumors to differentiate sarcoma from a benign lesion - description of the method and review of the literature. Diagnostics (Basel). 2022;12(6):1348. https://dx.doi.org/10.3390/diagnostics12061348.
  42. Hinchcliff E., Esselen K.M., Watkins J.C., Oduyebo T., Rauh-Hain J.A., Del Carmen M.G. et al. The role of endometrial biopsy in the preoperative detection of uterine leiomyosarcoma. J. Minim. Invasive Gynecol. 2016;23(4):567-72. https://dx.doi.org/10.1016/j.jmig.2016.01.022.
  43. Kho R.M., Desai V.B., Schwartz P.E., Wright J.D., Gross C.P., Hutchison L.M.et al. Endometrial sampling for preoperative diagnosis of uterine leiomyosarcoma. J. Minim. Invasive Gynecol. 2022;29(1):119-27. https://dx.doi.org/10.1016/j.jmig.2021.07.004.
  44. Bansal N., Herzog T.J., Burke W., Cohen C.J., Wright J.D. The utility of preoperative endometrial sampling for the detection of uterine sarcomas. Gynecol. Oncol. 2008;110(1):43-8. https://dx.doi.org/10.1016/j.ygyno.2008.02.026.
  45. Epstein E., Van Calster B., Timmerman D., Nikman S. Subjective ultrasound assessment, the ADNEX model and ultrasound-guided tru-cut biopsy to differentiate disseminated primary ovarian cancer from metastatic non-ovarian cancer. Ultrasound Obstet. Gynecol. 2016;47(1):110-6.https://dx.doi.org/10.1002/uog.14892.
  46. Park J.J., Kim C.K., Park B.K. Ultrasound-guided transvaginal core biopsy of pelvic masses: feasibility, safety, and short-term follow-up. Am. J. Roentgenol. 2016;206(4):877-82. https://dx.doi.org/10.2214/AJR.15.15702.
  47. Gronchi A., Miah A.B., Dei Tos A., Abecassis N., Bajpai J., Bauer S. et al. Soft tissue and visceral sarcomas: ESMO-EURACAN-GENTURIS Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann. Oncol. 2021;32:1348-65. https://dx.doi.org/10.1016/j.annonc.2021.07.006.
  48. Kubik-Huch R.A., Weston M., Nougaret S., Leonhardt H., Thomassin-Naggara I., Horta M. et al. European Society of Urogenital Radiology (ESUR) Guidelines: MR imaging of leiomyomas. Eur. Radiol. 2018;28(8):3125-37.https://dx.doi.org/10.1007/s00330-017-5157-5.
  49. Bonvalot S., Gronchi A., Hohenberger P., Litiere S., Pollock R.E, Raut Ch.P. et al. Management of primary retroperitoneal sarcoma (RPS) in the adult: a consensus approach from the Trans-Atlantic RPS Working Group. Ann. Surg. Oncol. 2015;22(1):256-63. https://dx.doi.org/10.1245/s10434-014-3965-2.
  50. Skorstad M., Kent A., Lieng M. Preoperative evaluation in women with uterine leiomyosarcoma. A nationwide cohort study. Acta Obstet. Gynecol. Scand. 2016;95(11):1228-34. https://dx.doi.org/10.1111/aogs.13008.
  51. Zhang F., Liu Y., Quan Q., Meng Y., Mu X. Diagnostic value of preoperative CA125, LDH and HE4 for leiomyosarcoma of the female reproductive system. Cancer Manag. Res. 2021;13:4657-64. https://dx.doi.org/10.2147/CMAR.S302223.
  52. Miao P., Sheng S., Sun X., Liu J., Huang G. Lactate dehydrogenase a in cancer: a promising target for diagnosis and therapy. IUBMB Life. 2013;65(11):904-10. https://dx.doi.org/10.1002/iub.1216.
  53. Sheng S.L., Liu J.J., Dai Y.H., Sun X.G., Xiong X.P., Huang G. Knockdown of lactate dehydrogenase a suppresses tumor growth and metastasis of human hepatocellular carcinoma. FEBS J. 2012;279(20):3898-910.https://dx.doi.org/10.1111/j.1742-4658.2012.08748.x.
  54. Wang Z.-Y., Loo T.Y., Shen J.-G., Wang N., Wang D.-M., Yang D.-P. et al. LDH-A silencing suppresses breast cancer tumorigenicity through induction of oxidative stress mediated mitochondrial pathway apoptosis. Breast Cancer Res. Treat. 2012;131(3):791-800. https://dx.doi.org/10.1007/s10549-011-1466-6.
  55. Goto A., Takeuchi S., Sugimura K., Maruo T. Usefulness of Gd-DTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus. Int. J. Gynecol. Cancer. 2002;12(4):354-61. https://dx.doi.org/10.1046/j.1525-1438.2002.01086.x.
  56. Nagai T., Takai Y., Akahori T., Ishida H., Hanaoka T., Uotani T. et al. Novel uterine sarcoma preoperative diagnosis score predicts the need for surgery in patients presenting with a uterine mass. SpringerPlus. 2014;3:678.https://dx.doi.org/10.1186/2193-1801-3-678.
  57. Kusunoki S., Terao Y., Ujihira T., Fujino K., Kaneda H., Kimura M. et al. Efficacy of PET/CT to exclude leiomyoma in patients with lesions suspicious for uterine sarcoma on MRI. Taiwan J. Obstet. Gynecol. 2017;56(4):508-13.https://dx.doi.org/10.1016/j.tjog.2017.05.003.
  58. Nishigaya Y., Kobayashi Y., Matsuzawa Y., Hasegawa K., Fukasawa I., Watanabe Y. et al. Diagnostic value of combination serum assay of lactate dehydrogenase, D-dimer, and C-reactive protein for uterine leiomyosarcoma. J. Obstet. Gynaecol. Res. 2019;45(1):189-94. https://dx.doi.org/10.1111/jog.13792.
  59. Nagai T., Takai Y., Akahori T., Ishida H., Hanaoka T., Uotani T. et al. Highly improved accuracy of the revised preoperative sarcoma score (rPRESS) in the decision of performing surgery for patients presenting with a uterine mass. Springerplus. 2015;4:520. https://dx.doi.org/10.1186/s40064-015-1318-7.
  60. Zhang G., Yu X., Zhu L., Fan Q., Shi H., Lang J. Preoperative clinical characteristics scoring system for differentiating uterine leiomyosarcoma from fibroid. BMC Cancer. 2020;20(1):514. https://dx.doi.org/10.1186/s12885-020-07003-z.
  61. Denschlag D., Ackermann S., Battista M.J., Cremer W., Egerer G., Fehr M. et al. Sarcoma of the uterus. Guideline of the DGGG, OEGGG and SGGG (S2k-Level, AWMF registry No. 015/074, April 2021). Geburtshilfe Frauenheilkd. 2022;82(12):1337-67. https://dx.doi.org/10.1055/a-1897-5124.

Received 28.08.2023

Accepted 20.12.2023

About the Authors

Vitaly B. Tskhay, Dr. Med. Sci., Professor, Head of the Department of Perinatology, Obstetrics and Gynecology of the Medical Faculty, Prof. V.F. Voino-Yasenetsky Krasnoyarsk State Medical University, Ministry of Health of Russia, +7(923)287-21-34, tchai@yandex.ru, 660022, Russia, Krasnoyarsk, P. Zheleznyak str., 1.
Alexander I. Pashov, Dr. Med. Sci., Professor, Head of the Department of Obstetrics and Gynecology of the Medical Institute, I. Kant Baltic Federal University,
+7(911)461-49-98, pachov@mail.ru, 236016, Russia, Kaliningrad, A. Nevsky str., 14.
Valeria V. Rachkovskaya, postgraduate student of the Department of Obstetrics and Gynecology of the Medical Institute, I. Kant Baltic Federal University, +7(952)117-48-18, losevavaleria2104@mail.ru, 236016, Russia, Kaliningrad, A. Nevsky str., 14.
Corresponding author: Valeria V. Rachkovskaya, losevavaleria2104@mail.ru

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