Avoiding intra operative unexpected Leiomyosarcoma: Does age, menopausal status or clinical presentation assist risk stratification? (#C6)
In gynaecological text books leiomyosarcoma is referred to as a rare form of malignancy encountered in the reproductive system. Traditional risk factors for the development of leiomyosarcoma include age greater than 60, post menopausal status, African/American background, irradiation and childhood retinoblastoma. Furthermore, clinical presentation of a rapidly increasing fibroid is also thought to be associated with leiomyosarcoma.
With the advances of laparoscopic surgical techniques, large benign fibroids are managed laparoscopically with the use of electromechanical morcellator. However the recent Food and Drug Administration (FDA) statement has put this device and leiomyosarcoma, a once rare malignancy into the spot light. Therefore we retrospectively evaluate our patient cohort to better understand the patient demographics, clinical presentation and disease progress in leiomyosarcoma to guide and inform future surgical decision making.
Methods: All patient's with primary uterine leiomyosarcoma from Royal Women's hospital histopathology and gynaeoncology databases from December 1996 to December 2013 were included. Medical and electronic records were accessed to collect relevant data.
Results: A total of 42 patients matched the audit inclusion criteria. The average age of diagnosis was 52 years with an alarming 20 patients diagnosed before the age of 50. Around 60% of the patients diagnosed with primary leiomyosarcoma were pre menopausal. There was also a wide variety of clinical presentations that resulted in unexpected finding of leiomyosarcoma on final histopathology. A total of 40 patients had surgical management for leiomyosarcoma. This resulted in 23 patients being diagnosed as stage 1 whilst 10 were classified as stage 3 and above at the time of primary diagnosis. Adjuvant therapy was utilised in 29 patients. The most common surgical finding in these patient's was the finding of a large fibroid 10 cm in size or greater.
Conclusion: Based on the above observations, demographics such as younger age and pre menopausal status may not predict the low risk patient. A wide variety of clinical presentations were also observed in leiomyosarcoma. The presence of a large fibroid was a common surgical finding, however given majority of myomectomies are performed for symptomatic large fibroids this finding does not differentiate benign from malignant disease.