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6.1 Staging

Uterine Sarcomas 

These uncommon tumours usually arise in the uterus but can occasionally originate in the ovary or broad ligament.

The most common subtypes are:
  • Low grade endometrial stromal (ESS)
  • High grade endometrial stromal (HGESS)
  • Undifferentiated uterine sarcoma (UUS)
  • Uterine leiomyosarcoma (uLMS)

WHO/ISGP Classification of Uterine Mesenchymal and Mixed Epithelial and Mesenchymal Tumour

Mesenchymal Tumours

Endometrial Stromal Tumours 

  1. Endometrial stromal nodule     
  2. Low-grade endometrial stromal sarcoma    
  3. High-grade endometrial stromal sarcoma
  4. Undifferentiated uterine sarcoma
  5. Uterine tumor resembling ovarian sex cord tumor

Miscellaneous Mesenchymal Tumours 

    f. Rhabdomyosarcoma     

Perivascular epithelioid cell tumor

Smooth Muscle Tumors

  1. Leiomyoma and benign leiomyoma-variants
  2. Smooth muscle tumor of uncertain malignant potential
  3. Leiomyosarcomatypical
    epithelioid
    myxoid
  4. Other smooth muscle tumors

Mixed epithelial-nonepithelial tumors

  1. Adenosarcoma
  2. Carcinosarcoma
* Uterine carcinosarcoma is classified as a carcinoma rather than a  sarcoma, though they have stromal differentiation, and is treated as such. Adenosarcomas are considered sarcomas.

Evaluation

Most uterine sarcomas are diagnosed based on pathologic evaluation after hysterectomy, only a minority of the cases is diagnosed at the time of endometrial sampling.

The role of pre-operative imaging to evaluate for uterine sarcomas is not well defined as most have non-specific appearances.

  • Known uterine sarcoma prior to surgery: CT C/A/P +/- MRI for staging purposes 
  • Post-operative evaluation: CT C/A/P +/- MRI for staging purposes 

SOURCE: 6.1 Staging ( )
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