Leiomyosarcoma of the uterus: clinicopathologic study.

A clinicopathologic study of 32 consecutive patients with leiomyosarcoma of the uterus seen over a 12-year period has been evaluated and the literature has been reviewed. The mean age was 55.5 years, the youngest patient was 38, and the oldest was 86. The mean interval from menopause to diagnosis was 6.7 years. The predominant symptoms were abnormal vaginal bleeding, pain or abdominal discomfort, or enlarged pelvic mass. The preoperative dilatation and curettage established the correct diagnosis in 5 of 24 patients (20.8%). The predominant method of treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophorectomy (BSO). Three patients had adjuvant chemotherapy and 11 had adjuvant radiation therapy. The single most important factor in treatment was TAH and BSO. Of the total group, 25% survived 5 years or more and 43.8% died within the first 3 years following diagnosis. Age at time of diagnosis is an important prognostic indicator. When the diagnosis was made in the premenopausal and postmenopausal patients, the 5-year survival rates were 63.6 and 5.5%, respectively. Four of the 11 patients under the age of 50 (premenopausal) died from the effect of the disease, while only 1 of the 18 patients over the age of 50 (postmenopausal) lived. It is concluded that the best chance of cure lies in the early removal of the uterus when the leiomyosarcoma is still confined within a leiomyoma.