Maligne mesenchymale Uterustumoren

Mesenchymale Uterustumoren sind zum Großteil benigne. Die häufigsten Vertreter dieser Gruppe (ca. 90%) sind die uterinen Myome. Maligne mesenchymale Tumoren des Uterus gelten als Rarität und stellen aufgrund der spärlichen Studiendaten eine diagnostische und therapeutische Herausforderung dar. Dieser Artikel befasst sich mit der Diagnostik und der Therapie der seltenen malignen mesenchymalen Tumoren des Uterus.

Schlüsselwörter

uterines Sarkom - Leiomyosarkom - Low-Grade endometriales Stromasarkom - High-Grade endometriales Stromasarkom - undifferenziertes Stromasarkom

• Literatur

• 1 Benson C, Miah AB. Uterine sarcoma – current perspectives. Int J Womens Health 2017; 9: 597-606
• 2 Rizzo A, Pantaleo MA, Saponara M. et al. Current status of the adjuvant therapy in uterine sarcoma: A literature review. World J Clin Cases 2019; 7: 1753-1763
• 3 Choi JH, Ro JY. The 2020 WHO Classification of tumors of soft tissue: selected changes and new entities. Adv Anat Pathol 2021; 28: 44-58
• 4 Liu FW, Galvan-Turner VB, Pfaendler KS. et al. A critical assessment of morcellation and its impact on gynecologic surgery and the limitations of the existing literature. Am J Obstet Gynecol 2015; 212: 717-724
• 5 Denschlag D, Ackermann S, Battista MJ. et al. Uterine Sarkome. Leitlinie der DGGG und OEGGG (S2k-Level, AWMF-Register-Nummer 015/074, Februar 2019). Geburtshilfe Frauenheilkd 2019; 79: 1043-1060
• 6 Sun S, Bonaffini PA, Nougaret S. et al. How to differentiate uterine leiomyosarcoma from leiomyoma with imaging. Diagn Interv Imaging 2019; 100: 619-634
• 7 Kostov S, Kornovski Y, Ivanova V. et al. New Aspects of Sarcomas of Uterine Corpus-A Brief Narrative Review. Clin Pract 2021; 11: 878-900
• 8 Prat J. FIGO staging for uterine sarcomas. Int J Gynaecol Obstet 2009; 104: 177-178
• 9 Kostov S, Watrowski R, Kornovski Y. et al. Yordanov A Hereditary Gynecologic Cancer Syndromes – A Narrative Review. Onco Targets Ther 2022; 15: 381-405
• 10 Bogani G, Cliby WA, Aletti GD. Impact of morcellation on survival outcomes of patients with unexpected uterine leiomyosarcoma: a systematic review and meta-analysis. Gynecol Oncol 2015; 137: 167-172
• 11 Köhler G, Vollmer M, Nath N. et al. Benign uterine mass-discrimination from leiomyosarcoma by a preoperative risk score: a multicenter cohort study. Arch Gynecol Obstet 2019; 300: 1719-1727
• 12 Seagle B-LL, Sobecki-Rausch J, Strohl AE. et al. Prognosis and treatment of uterine leiomyosarcoma: A National Cancer Database study. Gynecol Oncol 2017; 145: 61-70
• 13 Sangle NA, Lele SM. Uterine mesenchymal tumors. Indian J Pathol Microbiol 2011; 54: 243-253
• 14 George S, Serrano C, Hensley ML. et al. Soft tissue and uterine leiomyosarcoma. J Clin Oncol 2018; 36: 144-150
• 15 Reed NS, Mangioni C, Malmström H. et al. Phase III randomised study to evaluate the role of adjuvant pelvic radiotherapy in the treatment of uterine sarcomas stages I and II: an European Organisation for Research and Treatment of Cancer Gynaecological Cancer Group Study (protocol 55874). Eur J Cancer 2008; 44: 808-818
• 16 Wright JD, Seshan VE, Shah M. et al. The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma. Am J Obstet Gynecol 2008; 199: 536.e1-536.e8
• 17 Omura GA, Blessing JA, Major F. et al. A randomized clinical trial of adjuvant adriamycin in uterine sarcomas: a Gynecologic Oncology Group Study. J Clin Oncol Off J Am Soc Clin Oncol 1985; 3: 1240-1245
• 18 Kushner DM, Webster KD, Belinson JL. et al. Safety and efficacy of adjuvant single-agent ifosfamide in uterine sarcoma. Gynecol Oncol 2000; 78: 221-227
• 19 Hensley ML, Ishill N, Soslow R. et al. Adjuvant gemcitabine plus docetaxel for completely resected stages I-IV high grade uterine leiomyosarcoma: Results of a prospective study. Gynecol Oncol 2009; 112: 563-567
• 20 Hensley ML, Wathen JK, Maki RG. et al. Adjuvant therapy for high-grade, uterus-limited leiomyosarcoma: results of a phase 2 trial (SARC 005). Cancer 2013; 119: 1555-1561
• 21 Seddon B, Strauss SJ, Whelan J. et al. Gemcitabine and docetaxel versus doxorubicin as first-line treatment in previously untreated advanced unresectable or metastatic soft-tissue sarcomas (GeDDiS): a randomised controlled phase 3 trial. Lancet Oncol 2017; 18: 1397-1410
• 22 Harter P, Sehouli J, Reuss A. et al. Phase II Study Evaluating PegLiposomal Doxorubicin and Carboplatin Combination Chemotherapy in Gynecologic Sarcomas and Mixed Epithelial-Mesenchymal Tumors A Phase II Protocol of the Arbeitsgemeinschaft Gynaekologische Onkologie Study Group (AGO-GYN 7). Int J Gynecol Cancer Off J Int Gynecol Cancer Soc 2016; 26: 1636-1641
• 23 Hensley ML, Patel SR, von Mehren M. et al. Efficacy and safety of trabectedin or dacarbazine in patients with advanced uterine leiomyosarcoma after failure of anthracycline-based chemotherapy: Subgroup analysis of a phase 3, randomized clinical trial. Gynecol Oncol 2017; 146: 531-537
• 24 Pautier P, Italiano A, Piperno-Neumann S. et al. LBA59 – LMS-04 study: A randomised, multicenter, phase III study comparing doxorubicin alone versus doxorubicin with trabectedin followed by trabectedin in non-progressive patients as first-line therapy, in patients with metastatic or unresectable leiomyosarcoma – A French Sarcoma Group study. Ann Oncol 2021; 32: S1283-S1346
• 25 van der Graaf WTA, Blay J-Y, Chawla SP. et al. Pazopanib for metastatic soft-tissue sarcoma (PALETTE): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet 2012; 379: 1879-1886
• 26 Akaev I, Yeoh CC, Rahimi S. Update on Endometrial Stromal Tumours of the Uterus. Diagnostics (Basel) 2021; 11: 429
• 27 Leath CA, Huh WK, Hyde J. et al. A multi-institutional review of outcomes of endometrial stromal sarcoma. Gynecol Oncol 2007; 105: 630-634
• 28 Seagle B-LL, Shilpi A, Buchanan S. et al. Low-grade and high grade endometrial stromal sarcoma: A National Cancer Database study. Gynecol Oncol 2017; 146: 254-262
• 29 Ray-Coquard I. et al. A randomized double-blind phase II study evaluating the role of maintenance therapy with cabozantinib in high-grade uterine sarcoma after stabilization or response to doxorubicin ± ifosfamide following surgery or in metastatic first line treatment (EORTC62113). Int J Gynecol Cancer 2020; 30: 1633-1637
• 30 Gadducci A, Zannoni GF. Perivascular epitheloid cell tumors (PEComa) of the female genital tract: A challenging question for gynaecologic oncologist and pathologist. Gynecol Oncol Rep 2020; 33: 100603