Uterine sarcoma and pregnancy: modern view on the problem
The scientific review considers a gynecological disease, such as uterine sarcoma. The paper presents the main definitions of the gynecological disease, provides statistical data on the prevalence of this disease, describes its current classifications, and touches upon the etiological and pathogenetic aspects of uterine sarcoma. It reviews the current foreign and Russian sources of literature data on the incidence of uterine sarcoma during pregnancy and analyzes the outcomes of pregnancies. The authors also discuss the general principles of surgical treatment for this type of cancer, give an account of the possible volumes of surgical intervention, and highlight the expediency and principles of radiation therapy and adjuvant chemotherapy. They detail clinical outcomes and survival rates in women after surgical intervention of varying complexity and volume. Much attention is paid to the incidence of uterine sarcoma in women of childbearing age who are interested in maintaining their reproductive function in the future. The paper describes treatment options for uterine sarcoma (presents clinical cases), by preserving further female reproductive function, namely organ-sparing operations.Tskhay V.B., Pashov A.I., Ashrafyan L.A., Rachkovskaya V.V.
Conclusion: Organ-sparing operations in women of childbearing age with detected uterine sarcoma are an experimental procedure. However, the data on survival rates are more encouraging in patients with low- and moderate-grade endometrial stromal sarcoma (LMGESS) after organ-sparing surgery. From this it is inferred that organ-sparing surgery can be proposed and performed in women who are interested in maintaining their reproductive function.
Authors’ contributions: Tskhay V.B., Pashov A.I., Ashrafyan L.A. – concept and design of the investigation; Pashov A.I.,
Tskhay V.B., Rachkovskaya V.V. – material collection and processing; Rachkovskaya V.V. – statistical data processing;
Ashrafyan L.A., Pashov A.I., Tskhay V.B. – writing the text; Rachkovskaya V.V., Pashov A.I. – editing.
Conflicts of interest: The authors declare that there are no conflicts of interest.
Funding: There are no funding sources.
For citation: Tskhay V.B., Pashov A.I., Ashrafyan L.A., Rachkovskaya V.V.
Uterine sarcoma and pregnancy: modern view on the problem.
Akusherstvo i Ginekologiya/Obstetrics and Gynecology. 2023; 1: 13-19 (in Russian)
https://dx.doi.org/10.18565/aig.2022.231
Keywords
uterine sarcoma
corpus uteri cancer
pregnancy
tumor
delivery
References
- Amant F., Coosemans A., Debiec-Rychter M., Timmerman D., Vergote I. Clinical management of uterine sarcomas. Lancet Oncol. 2009; 10(12): 1188-98. https://dx.doi.org/10.1016/S1470-2045(09)70226-8.
- Francis M., Dennis N.L., Hirschowitz L., Grimer R., Poole J., Lawrence G., Nordin A. Incidence and survival of gynecologic sarcomas in England. Int. J. Gynecol. Cancer. 2015; 25(5): 850-7. https://dx.doi.org/10.1097/IGC.0000000000000443.
- National Cancer Intelligence Network. Gynaecological sarcoma surgical treatment. 2014. Available at: http://www.ncin.org.uk/view?rid=2755
- Yadav G., Rao M., Goyal S.B., Singh P., Kathuria P., Gothwal M. Risk of incidental genital tract malignancies at the time of myomectomy and hysterectomy for benign conditions. Obstet. Gynecol. Sci. 2021; 64(2): 209-15. https://dx.doi.org/10.5468/ogs.20199.
- Hendrickson M.R., Tavassoli F.A., Kempson R.L. Mesenchymal tumors and related lesions. In: Tavassoli F.A., Devilee P., eds. World Health Organization classification of tumors: pathology and genetics of tumors of the breast and female genital organs. Lyon: IARC Press; 2003; vol.2: 236-43.
- Libertini M., Hallin M., Thway K., Noujaim J., Benson C., van der Graaf W., Jones R.L. Gynecological sarcomas: molecular characteristics, behavior, and histology-driven therapy. Int. J. Surg. Pathol. 2021; 29(1): 4-20. https://dx.doi.org/10.1177/1066896920958120.
- Vilos G.A., Marks J., Ettler H.C. Uterine smooth muscle tumors of uncertain malignant potential: diagnostic challenges ad therapeutic dilemmas. Report of 2 cases and review of the literature. J. Minim. Invasive Gynecol. 2012; 19(3): 288-95. https://dx.doi.org/10.1016/j.jmig.2011.12.025.
- Micci F., Heim S., Panagopoulos I. Molecular pathogenesis and prognostication of "low‐grade'' and "high‐grade" endometrial stromal sarcoma. Genes Chromosomes Cancer. 2021; 60(3): 160-7. https://dx.doi.org/10.1002/gcc.22907.
- 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. https://dx.doi.org/10.1016/j.ajog.2018.11.1086.
- Koh W.J., Abu-Rustum N.R., Bean S., Bradley K., Campos S.M., Cho K.R. et al. Uterine neoplasms, version 1. 2018, NCCN clinical practice guidelines in oncology. J. Natl. Compr. Canc. Netw. 2018; 16(2): 170-99. https://dx.doi.org/10.6004/jnccn.2018.0006.
- Gojnic M., Likic I., Pervulov M., Petkovic S., Fazlagic A., Vasiljevic B. The significance of Doppler flow in early detection of uterine sarcoma in older primigravida pregnancies. Eur. J. Gynaecol. Oncol. 2005; 26(3): 291-3.
- Akaev I., Yeoh C.C., Rahimi S. Update on endometrial stromal tumours of the uterus. Diagnostics (Basel). 2021; 11(3): 429. https://dx.doi.org/10.3390/diagnostics11030429.
- Ricci S., Stone R.L., Fader A.N. Uterine leiomyosarcoma: epidemiology, contemporary treatment strategies and the impact of uterine morcellation. Gynecol. Oncol. 2017; 145(1): 208-16. https://dx.doi.org/10.1016/j.ygyno.2017.02.019.
- Friedrich M., Riffel B., Schillinger H., Schweizer J., Mink D., Reitnauer K. et al. Uterine leiomyosarcoma with subsequent pregnancy. Zentralbl. Gynakol. 1998; 120(7): 341-6.
- Cheung V.Y., Pun T.C. Contained morcellation for laparoscopic myomectomy within a specially designed bag. J. Minim. Invasive Gynecol. 2016; 23(1): 139-40. https://dx.doi.org/10.1016/j.jmig.2015.08.004.
- Буянова С.Н., Логутова Л.С., Щукина Н.А., Волощук И.Н., Бабунашвили Е.Л., Барто Р.А., Юдина Н.В., Гукасян С.А. Паразитарные миомы и аденомиомы после миомэктомии. Акушерство и гинекология. 2020; 9: 241-7. https://dx.doi.org/10.18565/aig.2020.9.241-247. [Buyanova S.N., Logutova L.S., Shchukinа N.A., Voloshchuk I.N., Babunashvili E.L., Barto R.A., Yudinа N.V., Gukasyan S.A. Parasitic myomas and adenomyomas after myomectomy. Obstetrics and Gynecology. 2020; 9: 241-7. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.9.241-247.
- Cui R.R., Wright J.D. Risk of occult uterine sarcoma in presumed uterine fibroids. Clin. Obstet. Gynecol. 2016; 59(1): 103-18. https://dx.doi.org/10.1097/GRF.0000000000000163.
- Lieng M., Berner E., Busund B.J. 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.
- Matsuo K., Eno M.L., Im D.D., Rosenshein N.B. Pregnancy and genital sarcoma: a systematic review of the literature. Am. J. Perinatol. 2009; 26(7): 507-18. https://dx.doi.org/10.1055/s-0029-1215428.
- Gu Y.Z., Duan N.Y., Cheng H.X., Xu L.Q., Meng J.L. Fertility-sparing surgeries without adjuvant therapy through term pregnancies in a patient with low-grade endometrial stromal sarcoma: A case report. World J. Clin. Cases. 2021; 9(4): 983-91. https://dx.doi.org/10.12998/wjcc.v9.i4.983.
- Campbell J.E., Knudtson J.F., Valente P.T., Robinson R.D., Kost E.R. Successful pregnancy following myomectomy for uterine smooth muscle tumor of uncertain malignant potential: A case report and review of the literature. Gynecol. Oncol. Rep. 2016; 15: 1-3. https://dx.doi.org/10.1016/j.gore.2015.07.005.
- Hand L.C., Gimovsky A.C., Chan J.S.Y., Rosenblum N.G., Kim C.H. Incidental leiomyosarcoma found at the time of cesarean hysterectomy for morbidly adherent placenta. Gynecol. Oncol. Rep. 2017; 20: 127-30. https://dx.doi.org/10.1016/j.gore.2017.04.007.
- Bodner-Adler B., Lozano P., Bodner K., Zeisler H. Primary uterine leiomyosarcoma and primary atypical meningioma diagnosed during pregnancy. Anticancer Res. 2008; 28(5B): 3083-5.
- Younis J.S., Okon E., Anteby S.O. Uterine leiomyosarcoma in pregnancy. Arch. Gynecol. Obstet. 1990; 247(3): 155-60.
- Ghirardi V., Bizzarri N., Francesco Guida F., Vascone C., Costantini B., Scambia G., Fagotti A. Role of surgery in gynaecological sarcomas. Oncotarget. 2019; 10(26): 2561-75. https://dx.doi.org/10.1016/0006-2944(75)90147-7.
- Benson C., Miah A.B. Uterine sarcoma - current perspectives. Int. J. Womens Health. 2017; 9: 597-606. https://dx.doi.org/10.2147/IJWH.S117754.
- Barney B., Tward J.D., Skidmore T., Gaffney D.K. Does radiotherapy or lymphadenectomy improve survival in endometrial stromal sarcoma? Int. J. Gynecol. Cancer. 2009; 19(7): 1232-8. https://dx.doi.org/10.1111/IGC.0b013e3181b33c9a.
- Capozzi V.A., Monfardini L., Ceni V., Cianciolo A., Butera D., Gaiano M., Berretta R. Endometrial stromal sarcoma: A review of rare mesenchymal uterine neoplasm. J. Obstet. Gynaecol. Res. 2020; 46(11): 2221-36. https://dx.doi.org/10.1111/jog.14436.
- Chan J.K., Kawar N.M., Shin J.Y., Osann K., Chen L.M., Powell C.B., Kapp D.S. Endometrial stromal sarcoma: a population-based analysis. Br. J. Cancer. 2018; 99(8): 1210-5. https://dx.doi.org/10.1038/sj.bjc.6604527.
- 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): 757-63. https://dx.doi.org/10.1016/j.ijrobp.2011.11.005.
- Кириллова А.О., Буняева Е.С., Ковальская Е.В., Камалетдинов Н.С., Хабас Г.Н., Фармаковская М.Д., Сироткина Е.А., Мишиева Н.Г., Назаренко Т.А., Абубакиров А.Н. Сохранение фертильности у пациенток с диагностированным во время беременности онкологическим заболеванием. Акушерство и гинекология. 2020; 4: 59-64. https://dx.doi.org/10.18565/aig.2020.4.59-64. [Kirillova A.O., Bunyaeva E.S., Koval’skaya E.V., Kamaletdinov N.S., Khabas G.N., Farmakovskaya M.D, Sirotkina E.A., Mishieva N.G., Nazarenko T.A., Abubakirov A.N. Fertility preservation in patients diagnosed with cancer during pregnancy. Obstetrics and Gynecology. 2020; 4: 59-64. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.4.59-64.
- Назаренко Т.А., Ашрафян Л.А., Бирюкова А.М., Кириллова А.О., Мартиросян Я.О., Джанашвили Л.Г., Буняева Е.С. Характеристика и тактика ведения онкологических больных, нуждающихся в сохранении репродуктивного материала. Акушерство и гинекология. 2020; 11: 93-9. https://dx.doi.org/10.18565/aig.2020.11.93-99. [Nazarenko T.A., Ashrafyan L.A., Biryukova A.M., Kirillova A.O., Martirosyan Ya.O., Dzhanashvili L.G., Bunyaeva E.S. Characteristics and management of cancer patients who wish to preserve their reproductive capacity. Obstetrics and Gynecology. 2020; 11: 93-9. (in Russian)]. https://dx.doi.org/10.18565/aig.2020.11.93-99.
- Delaney A.A., Gubbels A.L., Remmenga S., Tomich P., Molpus K. Successful pregnancy after fertility-sparing local resection and uterine reconstruction for low-grade endometrial stromal sarcoma. Obstet. Gynecol. 2012; 120(2, Pt 2): 486-9. https://dx.doi.org/10.1097/AOG.0b013e31825a7397.
- Yan L., Tian Y., Fu Y., Zhao X. Successful pregnancy after fertility-preserving surgery for endometrial stromal sarcoma. Fertil. Steril. 2010; 93(1): 269.e1-e3. https://dx.doi.org/10.1016/j.fertnstert.2009.09.024.
- Jin Y., Li Y., Deng C.Y., Tian Q.J., Chen H., Pan L.Y. Fertility-sparing treatment of low-grade endometrial stromal sarcoma. Int. J. Clin. Exp. Med. 2015; 8(4): 5818-21.
- Dong R., Pang Y., Mao H., Yang N., Liu P. Successful pregnancy following conservative management of low-grade endometrial stromal sarcoma: A case report. Oncol. Lett. 2014; 7(4): 1039-42. https://dx.doi.org/10.3892/ol.2014.1858.
- Koskas M., Morice P., Yazbeck C., Duvillard P., Walker F., Madelenat P. Conservative management of low-grade endometrial stromal sarcoma followed by pregnancy and severe recurrence. Anticancer Res. 2009; 29(10): 4147-50.
- Li N., Wu L.Y., Zhang H.T., An J.S., Li X.G., Ma S.K. Treatment options in stage I endometrial stromal sarcoma: a retrospective analysis of 53 cases. Gynecol. Oncol. 2008; 108(2): 306-11. https://dx.doi.org/1016/j.ygyno.2007.10.023.
- Dai Q., Xu B., Wu H., You Y., Wu M., Li L. The prognosis of recurrent low-grade endometrial stromal sarcoma: a retrospective cohort study. Orphanet J. Rare Dis. 2021; 16(1): 160. https://dx.doi.org/10.1186/s13023-021-01802-8.
- Xie W., Cao D., Yang J., Jiang X., Shen K., Pan L. et al. Fertility-sparing surgery for patients with low-grade endometrial stromal sarcoma. Oncotarget. 2017; 8(6): 10602-8. https://dx.doi.org/10.18632/oncotarget.12491.
- Stadsvold J.L., Molpus K.L., Baker J.J., Michael K., Remmenga S.W. Conservative management of a myxoid endometrial stromal sarcoma in a 16-year-old nulliparous woman. Gynecol. Oncol. 2005; 99(1): 243-5. https://dx.doi.org/10.1016/j.ygyno.2005.06.039.
- Roque D.R., Taylor K.N., Palisoul M., Wysham W.Z., Milam B., Robison K. 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(3): 505-11. https://dx.doi.org/10.1097/IGC.0000000000000634.
- Şahin H., Karatas F., Coban G., Özen Ö., Erdem Ö., Onan M.A., Ayhan A. Uterine smooth muscle tumor of uncertain malignant potential: fertility and clinical outcomes. J. Gynecol. Oncol. 2019; 30(4): e54. https://dx.doi.org/10.3802/jgo.2019.30.e54.
- Hyman D.M., Grisham R.N., Hensley M.L. Management of advanced uterine leiomyosarcoma. Curr. Opin. Oncol. 2014; 26(4): 422-7. https://dx.doi.org/10.1097/CCO.0000000000000094.
Received 04.10.2022
Accepted 01.12.2022
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, Ministyr 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.
Lev A. Ashrafyan, Academician of the RAS, Dr. Med. Sci., Professor, Deputy Director, V.I. Kulakov National Medical Research Center of Obstetrics, Gynecology, and Perinatology, Ministry of Health of Russia, Director of the Institute of Oncogynecology and Mammology, +7(495)531-44-44, levaa2004@yahoo.com,
117997, Russia, Moscow, Akademika Oparina str., 4.
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