WordNet

a usually malignant tumor arising from connective tissue (bone or muscle etc.); one of the four major types of cancer
of or involving the uterus; "uterine cancer"

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肉腫(にくしゅ)
子宮の / 同母異父の

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出典(authority):フリー百科事典『ウィキペディア（Wikipedia）』「2015/02/07 09:43:05」(JST)

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The uterine sarcomas form a group of malignant tumors that arises from the smooth muscle or connective tissue of the uterus.

Histology

Tumoral entities include leiomyosarcomas, endometrial stromal sarcomas, carcinosarcomas and "other" sarcomas.^[1]

If the lesion originates from the stroma of the uterine lining it is an endometrial stromal sarcoma.
If the uterine muscle cell is the originator the tumor is a uterine leiomyosarcoma.
Carcinosarcomas comprise both malignant epithelial and malignant sarcomatous components.

Classification

Leiomyosarcomas are now staged using the 2009 FIGO staging system^[2] (previously they were staged like endometrial carcinomas) at time of surgery.

Stage I: tumor is limited to the uterus

IA: ≤5 cm in greatest dimension

IB: >5 cm

Stage II: tumor extends beyond the uterus, but within the pelvis

IIA: involves adnexa of uterus

IIB: involves other pelvic tissues

Stage III: tumor infiltrates abdominal tissues

IIIA: 1 site

IIIB: >1 site

IIIC: regional lymph node metastasis

Stage IVA: invades bladder or rectum
Stage IVB: distant metastasis (including intraabdominal or inguinal lymph nodes; excluding adnexa, pelvic and abdominal tissues)

Endometrial stromal sarcomas and uterine adenosarcomas are classified as above, with the exception of different classifications for Stage I tumors.

Stage I: tumor is limited to the uterus

IA: limited to endometrium/endocervix

IB: invades <½ myometrium

IC: invades ≥½ myometrium

Finally, malignant mixed Müllerian tumors, a type of carcinosarcoma, are staged similarly to endometrial carcinomas.^[3]

Stage I: tumor is limited to the uterus

IA: invades <½ myometrium

IB: invades ≥½ myometrium

Stage II: invades cervical stroma, but no extension beyond the uterus
Stage III: local and/or regional spread

IIIA: invades uterine serosa and/or adnexa

IIIB: vaginal and/or parametrial involvement

IIIC: metastases to pelvic and/or paraaortic lymph nodes

IIIC1: positive pelvic nodes

IIIC2: positive para-aortic lymph nodes

Stage IVA: invades bladder and/or bowel mucosa
Stage IVB: distant metastases (including intra-abdominal metastases and/or inguinal lymph nodes)

Signs and Symptoms

Unusual or postmenopausal bleeding may be a sign of a malignancy including uterine sarcoma and needs to be investigated. Other signs include pelvic pain, pressure, and unusual discharge. A nonpregnant uterus that enlarges quickly is suspicious. However, none of the signs are specific. Specific screening test have not been developed; a Pap smear is a screening test for cervical cancer and not designed to detect uterine sarcoma.

Diagnosis

Investigations by the physician include imaging (ultrasound, CAT scan, MRI) and, if possible, obtaining a tissue diagnosis by biopsy, hysteroscopy, or D&C. Ultimately the diagnosis is established by the histologic examination of the specimen. Typically malignant lesions have >10 mitosis per high power field. In contrast a uterine leiomyoma as a benign lesion would have < 5 mitosis per high power field.

Management

Therapy is based on staging and patient condition and utilizes one or more of the following approaches. Surgery is the mainstay of therapy if feasible involving total abdominal hysterectomy with bilateral salpingo-oophorectomy. Other approaches include radiation therapy, chemotherapy, and hormonal therapy.

Prognosis is relatively poor.^[4]

Epidemiology

Uterine sarcoma are rare, out of all malignancies of the uterine body only about 4% will be uterine sarcomas.^[5] Generally, the cause of the lesion is not known, however patients with a history of pelvic radiation are at higher risk. Most tumors occur after menopause. Women who take long-term tamoxifen are at higher risk.^[6]

References

^ Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA (2009). "Treatment of early uterine sarcomas: disentangling adjuvant modalities". World J Surg Oncol 7: 38. doi:10.1186/1477-7819-7-38. PMC 2674046. PMID 19356236.
^ http://www.ijgo.org/article/S0020-7292%2809%2900202-1/fulltext
^ http://www.cancer.gov/cancertopics/pdq/treatment/endometrial/HealthProfessional/page3
^ Gadducci A, Cosio S, Romanini A, Genazzani AR (February 2008). "The management of patients with uterine sarcoma: a debated clinical challenge". Crit. Rev. Oncol. Hematol. 65 (2): 129–42. doi:10.1016/j.critrevonc.2007.06.011. PMID 17706430.
^ [1] American Cancer Society information, accessed 03-11-2006
^ [2] National Cancer Institute information, accessed 03-11-2006

External links

Leiomyosarcoma of the Uterus: A Review
Uni-Bonn site with detailed information
Leiomyosarcoma Direct Research Foundation

UpToDate Contents

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1. 子宮肉腫：分類、臨床症状、および診断 uterine sarcoma classification clinical manifestations and diagnosis
2. 子宮内膜間質肉腫および子宮腺肉腫の分類および治療 classification and treatment of endometrial stromal sarcoma and uterine adenosarcoma
3. 子宮筋腫と子宮肉腫の識別 differentiating uterine leiomyomas fibroids from uterine sarcomas
4. 子宮平滑筋肉腫の治療および予後 treatment and prognosis of uterine leiomyosarcoma
5. 子宮癌肉腫の臨床的特徴、診断、病期分類、および治療 clinical features diagnosis staging and treatment of uterine carcinosarcoma

English Journal

Recurrent cerebral infarction synchronous with menorrhagia caused by endometrial stromal sarcoma.

Akaishi T1, Kuroda H2, Tateyama M1, Yoshida Y3, Otsuki T3, Watanabe M4, Yaegashi N3, Aoki M1.
Journal of the neurological sciences.J Neurol Sci.2015 Nov 15;358(1-2):509-11. doi: 10.1016/j.jns.2015.09.367. Epub 2015 Sep 28.
PMID 26432578

Assessment of MR Imaging as a Tool to Differentiate between the Major Histological Types of Uterine Sarcomas.

Sumi A1, Terasaki H, Sanada S, Uchida M, Tomioka Y, Kamura T, Yano H, Abe T.
Magnetic resonance in medical sciences : MRMS : an official journal of Japan Society of Magnetic Resonance in Medicine.Magn Reson Med Sci.2015 Nov 13;14(4):295-304. doi: 10.2463/mrms.2014-0023. Epub 2015 Jun 23.
OBJECTIVES: We retrospectively compared and quantified magnetic resonance (MR) images to distinguish major histological types of uterine sarcomas and malignant and benign tumors.METHODS: MR images were obtained from patients who underwent preoperative examinations. We compared 25 pathologically conf
PMID 26104072

Cytoreductive Surgery and HIPEC as a Treatment Option for Laparoscopic Resection of Uterine Leiomyosarcoma with Morcellation: Early Results.

Sugarbaker P1, Ihemelandu C2, Bijelic L3.
Annals of surgical oncology.Ann Surg Oncol.2015 Nov 6. [Epub ahead of print]
BACKGROUND: A new and frequently utilized treatment option for symptomatic uterine leiomyoma is laparoscopic resection with morcellation so the specimen can be extracted through a small abdominal incision or through the vagina. Some of these tumors (approximately 0.2 %) have malignant foci of uteri
PMID 26545375