Leiomyosarcoma of the Uterus

In 34 patients treated for histologically documented leiomyosarcoma of the uterus, all available clinical and pathologic data were evaluated in relation to survival. The two most valuable indicators of prognosis were the menstrual status of the patient and the gross appearance of the tumor. Only two of 21 premenopausal patients are known to have died of their disease, while 10 of 13 postmenopausal women have succumbed. Among the 10 patients for whom a gross impression of sarcoma was rendered in the operating room, eight are dead and one is living despite known metastases. Tumors entirely confined within benign leiomyomas (7) and those without an obvious myomatous origin but with pushing margins (6) have all been associated with prolonged survival, but eight of 17 with infiltrating margins and all three with extension beyond the uterus have killed their hosts. Purely histologic criteria—grading of cellular atypia and counts of mitoses—were useful but less categoric. The prognosis is poor in premenopausal patients with vascular invasion and in all postmenopausal patients, and hormonal therapy is suggested as a possible adjunct to hysterectomy in these women.