UTERINE LEIOMYOSARCOMA: DIAGNOSIS PATTERN, TREATMENT AND PROGNOSIS

• Grant number: 22/16607-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Effective date (Start): April 01, 2023
• Effective date (End): March 31, 2024
• Field of knowledge: Health Sciences - Medicine
• Principal Investigator: Júlio César Teixeira
• Grantee: Helena da Cunha Lopes de Lima
• Host Institution: Centro de Atenção Integral à Saúde da Mulher (CAISM). Hospital da Mulher Professor Doutor José Aristodemo Pinotti. Universidade Estadual de Campinas (UNICAMP). Campinas , SP, Brazil

Abstract

Malignant neoplasms of the uterine body have a high prevalence among females, and have been suffering a significant increase, with 95% of endometrial carcinomas and 5% of sarcomas. The main types of uterine sarcomas are leiomyosarcoma, endometrial stromal sarcoma (ESS) and adenosarcoma. Uterine leiomyosarcomas make up 2.3% of uterine body neoplasms, originating in the myometrium and have an aggressive behavior, with rapid growth and early metastases. With thispattern of presentation, the diagnosis predominates in advanced stages and with a worse prognosis, with 26% affecting women under 50 years of age. Diagnostic confusion with leiomyomas is not infrequent, whether degenerated or not, and a surgical approach for benign leiomyomas inadvertently applied to unsuspected sarcomas can be catastrophic. Cases in this situation have been recently reported in some countries and, in order to avoid this risk, the recommendations contraindicate manipulation procedures or fragmentation of supposed leiomyomas. On the other hand, since uterine leiomyosarcomas are relatively rare, there is little consistent information about the situation of women with this pathology in Brazilian locations. Unicamp's Women's Hospital is a reference oncology center for gynecological cancer care, maintaining a good level of follow-up and information recording. This scenario allowed local researchers to recently publish the largest series of uterine sarcomas in Brazilian women, with 122 cases treated between 2001-2016, and this group continues to study these neoplasms. Thus, there are conditions to update the follow-up of the series of cases of uterine leiomyosarcomas already studied, to add the cases treated after 2016, allowing a detailed analysis of the subgroup of women under 50 years of age, including the diagnostic methods and immunohistochemical markers under analysis of some cases in a FAPESP project. In the end, it is expected to obtain a series of cases of leimyosarcomas with a significant number that will allow the expansion of knowledge about this pathology in Brazilian women and gather information about the cases that affect younger women. The results may help in the development of new diagnostic strategies and therapeutic guidelines, with the possibility of having a positive impact on the prognosis of the disease.