Endometrial sarcoma can cause such symptoms

Endometrial sarcoma is a tumor of endometrial cells, which is generally divided into two types, low-grade malignant tumors or high-grade malignant endometrial sarcoma. The disease progresses rapidly and is prone to vaginal bleeding or increased menstrual flow. It can also easily lead to severe abdominal pain and blood stasis.

Clinical manifestations

1. Irregular vaginal bleeding, increased menstruation, vaginal discharge, anemia, lower abdominal pain, etc.

2. The uterus is enlarged, and early pelvic examination findings are similar to those of intramural uterine fibroids.

3. Soft, brittle, and easily bleeding polyp-like tumors are found in the cervix or vagina.

4. If the tumor ruptures and becomes infected, there may be extremely smelly vaginal discharge.

examine

1. Microscopic characteristics

The endometrial glands are dispersed, reduced, or even disappear completely.

The tumor cells are uniformly dense and spindle-shaped, round or polygonal, with large nuclei, rare giant cells, many nuclear divisions, and variable amount of cytoplasm. In rare cases, they resemble decidual cells and may show glandular differentiation.

Sarcoma cell atypia varies: small atypia, invasive growth of tumor cells and nuclear division are the main basis for diagnosing sarcoma. When the tumor cells are highly atypical, malformed nuclei, giant nuclei and multiple nuclei may appear. When silver-ophilic staining is performed, each tumor cell is within the silver-ophilic fibers.

The cytoplasm of the tumor cells resembles that of early proliferative endometrial stromal cells.

2. Preoperative curettage

It has certain value in treating endometrial stromal sarcoma, but the base of its polypoid lesions is wide and curettage has certain limitations.

3. Color Doppler measurement

Detect the blood flow signals and blood flow resistance of the uterus and tumors. For patients with low-resistance blood flow, uterine sarcoma should be highly suspected.

4.B-ultrasound examination

The uterus is significantly enlarged, the tumor boundary is irregular, and the boundary with the myometrium is unclear. Its echo is uniform low echo, or grid-like honeycomb-like uneven echo, similar to hydatidiform mole.

treat

1. Surgery

For patients who have been diagnosed with uterine sarcoma, timely surgical treatment should be considered.

(1) Scope of surgery for low-grade endometrial stromal sarcoma: total hysterectomy and bilateral salpingo-oophorectomy, and ovarian preservation is not recommended. Even if extensive metastasis occurs, the lesion should be removed as completely as possible. Patients with lung metastases underwent lobectomy.

(2) Highly malignant endometrial stromal sarcoma is prone to recurrence after surgery. For patients in the advanced stage, palliative surgery can be performed to relieve symptoms, followed by postoperative adjuvant radiotherapy and chemotherapy.

2. Chemotherapy

(1) Low-grade endometrial stromal sarcoma is treated with a regimen based on cisplatin (DDP) or ifosfamide once every 3 weeks.

(2) IAP regimen (ifosfamide + ADM + cisplatin) is used for high-grade malignant endometrial stromal sarcoma.

3. Radiotherapy

Indications: patients with residual lesions after surgery, patients with stage I or above, and highly malignant endometrial stromal sarcoma.

(1) The treatment plan for postoperative external irradiation should be formulated according to the situation of residual tumor and metastasis after surgery. The field setting of postoperative external irradiation is roughly the same as that of postoperative preventive pelvic irradiation.

For example, if there is residual sarcoma in the central part of the pelvis, the irradiation dose to the whole pelvis is increased to 40 Gy, and the central lead-blocking four-field irradiation is still 15 Gy.

For large pelvic wall masses: after completing the whole pelvis and four-field irradiation, a reduced-field irradiation of 10 to 15 Gy can be performed.

Positive para-aortic lymph nodes: set up another field, with an irradiation dose of 45-55 Gy, 8.5 Gy per week, completed within 4-6 weeks.

When the range of the lesion exceeds the pelvic cavity, an additional field can be added in the upper abdomen. The irradiation field area is determined according to the range of the lesion, and the liver and kidneys need to be covered with lead shielding. If the range of lung metastases is small, external irradiation can be performed on the lung metastases.