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Croce S, Devouassoux-Shisheboran M, Pautier P, Ray-Coquard I, Treilleux I, Neuville A, Arnould L, Just PA, Le Frere Belda MA, Averous G, Leroux A, Bataillon G, Mery E, Loussouarn D, Weinbreck N, Le Guellec S, Mishellany F, Morice P, Guyon F, Genestie C. [Diagnosis of uterine sarcomas and rare uterine mesenchymal tumours with malignant potential. Guidelines of the French Sarcoma Group and Rare Gynaecological Tumours]. Bull Cancer 2024; 111:97-116. [PMID: 37806863 DOI: 10.1016/j.bulcan.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Revised: 08/02/2023] [Accepted: 08/04/2023] [Indexed: 10/10/2023]
Abstract
The landscape of uterine sarcomas is becoming more complex with the description of new entities associated with recurrent driver molecular alterations. Uterine sarcomas, in analogy with soft tissue sarcomas, are distinguished into complex genomic and simple genomic sarcomas. Leiomyosarcomas and undifferentiated uterine sarcomas belong to complex genomic sarcomas group. Low-grade and high-grade endometrial stromal sarcomas, other rare tumors associated with fusion transcripts (such as NTRK, PDGFB, ALK, RET ROS1) and SMARCA4-deficient uterine sarcoma are considered simple genomic sarcomas. The most common uterine sarcoma are first leiomyosarcoma and secondly endometrial stromal sarcomas. Three different histological subtypes of leiomyosarcoma (fusiform, myxoid, epithelioid) are identified, myxoid and epithelioid leiomyosarcoma being more aggressive than fusiform leiomyosarcoma. The distinction between low-grade and high-grade endometrial stromal sarcoma is primarily morphological and immunohistochemical and the detection of fusion transcripts can help the diagnosis. Uterine PEComa is a rare tumor, which is distinguished into borderline and malignant, according to a risk assessment algorithm. Embryonal rhabdomyosarcoma of the uterine cervix is more common in children but can also occur in adult women. Embryonal rhabdomyosarcoma of the uterine cervix is almost always DICER1 mutated, unlike that of the vagina which is wild-type DICER1, and adenosarcoma which can be DICER1 mutated but with less frequency. Among the emerging entities, sarcomas associated with fusion transcripts involving the NTRK, ALK, PDGFB genes benefit from targeted therapy. The integration of molecular data with histology and clinical data allows better identification of uterine sarcomas in order to better treat them.
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Affiliation(s)
- Sabrina Croce
- Anticancer Center, Institut Bergonié, Department of BioPathology, Bordeaux, France; Unité Inserm U1312, Bordeaux, France; Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France.
| | - Mojgan Devouassoux-Shisheboran
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; CHU de Lyon, Department of Pathology, Lyon, France
| | - Patricia Pautier
- Institut Gustave-Roussy, Department of Medical Oncology, Villejuif, France
| | - Isabelle Ray-Coquard
- Centre Leon-Berard, Department of Medical Oncology, Lyon, France; University Claude-Bernard Lyon I, Laboratoire RESHAPE U1290, Lyon, France
| | - Isabelle Treilleux
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Centre Leon-Berard, Department of Pathology, Lyon, France
| | - Agnès Neuville
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Institut de Pathologie de Haut de France, Amiens, France
| | - Laurent Arnould
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Centre G.-F.-Leclerc, Biology and Tumor Pathology Department, Dijon, France
| | - Pierre-Alexandre Just
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; AP-HP, Hôpital Cochin, Department of Pathology, Paris, France
| | - Marie Aude Le Frere Belda
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; AP-HP. Centre, European Georges-Pompidou Hospital, Department of Pathology, Paris, France
| | - Gerlinde Averous
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; CHRU de Strasbourg, Department of Pathology, Strasbourg, France
| | - Agnès Leroux
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Institut de Cancérologie de Lorraine, Department of Pathology, Nancy, France
| | - Guillaume Bataillon
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; CHRU de Strasbourg, Department of Pathology, Strasbourg, France
| | - Eliane Mery
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; IUCT Oncopole, Department of Pathology, Toulouse, France
| | - Delphine Loussouarn
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; CHU de Nantes, Department of Pathology, Nantes, France
| | - Nicolas Weinbreck
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Medipath, Fréjus, France
| | - Sophie Le Guellec
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Medipath-Les Feuillants, Toulouse, France
| | - Florence Mishellany
- Gynecological pathology group of RRePS (Réseau de Référence en Pathologie des Sarcomes) Network, France; Centre de Lutte contre le Cancer Jean-Perrin, Department of Pathology, Clermont-Ferrand, France
| | - Philippe Morice
- Gustave-Roussy, Department of Gynecological Surgery, Villejuif, Île-de-France, France
| | - Frédéric Guyon
- Institut Bergonié, Department of surgery, Bordeaux, France
| | - Catherine Genestie
- Gustave-Roussy, Département de Biopathologie, Unité 981, Villejuif, France
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Karabajakian A, Genestie C, Meeus P, Guyon F, Llacer Moscardo C, Croce S, Taieb S, Duffaud F, Pautier P, Ray-Coquard I, Blay JY. [Uterin adenosarcoma: French Guidelines of the French Sarcoma Group and the Rare Gynecologic Tumor Group]. Bull Cancer 2023; 110:836-843. [PMID: 37202293 DOI: 10.1016/j.bulcan.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Uterine adenosarcoma is a very rare malignancy defined as a biphasic tumor composed of both benign epithelial component and a malignant sarcoma component. The stage of the disease is determined by the presence of myometrial invasion and the extent of extra-uterine disease. The most important histopronostic factors are the existence of a sarcomatous overgrowth defined by a sarcomatous contingent occupying more than 25 % of the volume of the tumor (directly correlated to the grade of the disease), the presence of a heterologous and/or a high-grade component. Stage I adenosarcomas without sarcomatous overgrowth have a good prognosis, with an overall 5-year survival of up to 80 %. In localized disease, complete surgical removal is recommended. The role of hormone therapy, chemotherapy and adjuvant radiotherapy is not established. If possible, relapses should be re-treated surgically, with the aim of achieving complete resection. In the advanced inoperable or metastatic setting, hormone therapy is an option for low-grade adenosarcomas with estrogen receptor (ER) and progesterone receptor (PR) overexpression. For high-grade tumors, the standard chemotherapies are doxorubicin-based combinations, although an integrated approach of surgery and medical treatment should also be considered in this setting.
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Affiliation(s)
- Andy Karabajakian
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Catherine Genestie
- Gustave-Roussy cancer campus, service de biopathologie, 94805 Villejuif, France
| | - Pierre Meeus
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Centre Léon-Bérard, département de chirurgie oncologique, 69008 Lyon, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie oncologique, 33076 Bordeaux, France
| | - Carmen Llacer Moscardo
- Institut du cancer de Montpellier (ICM), département de radiothérapie oncologique, 208, avenue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 5, France
| | - Sabrina Croce
- Institut Bergonié, département de biopathologie, 33076 Bordeaux, France
| | - Sophie Taieb
- Centre Oscar Lambret, département de radiologie, 59000 Lille, France
| | - Florence Duffaud
- AP-HM, hôpitaux universitaires de Marseille Timone, département d'oncologie médicale, 13005 Marseille, France
| | - Patricia Pautier
- Gustave-Roussy Cancer Campus, département d'oncologie médicale, 94805 Villejuif, France.
| | - Isabelle Ray-Coquard
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
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Roussel-Simonin C, Croce S, Guyon F, Llacer C, Ray-Coquard I, Meeus P, Genestie C, Taieb S, Malhaire C, Duffaud F, Pautier P. [Uterin sarcoma, high-grade stroma, indifferenciated, referential]. Bull Cancer 2023:S0007-4551(23)00161-3. [PMID: 37062646 DOI: 10.1016/j.bulcan.2023.03.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 03/17/2023] [Accepted: 03/20/2023] [Indexed: 04/18/2023]
Abstract
High-grade endometrial stromal sarcoma (HGESS) and uterine undifferentiated sarcoma (UUS) are rare uterine malignancies arising from mesenchymal endometrial cells. They are characterized by aggressive behavior and poor prognosis. Median age of diagnostic is 55years. The most common symptoms are vaginal bleeding, abdominal pain, and pelvic mass. Approximately 65 % are diagnosed witch advance disease stage III or IV according to the International Federation of Gynecology and Obstetrics classification. Median overall survival is around 20months. The management of the disease must be discussed in multidisciplinary staff meetings. The standard management of HGESS and UUS is total hysterectomy with bilateral oophorectomy. Systematic lymphadenectomy is not recommended. Adjuvant therapies, such as chemotherapy and radiotherapy must be discussed. In case of oligo-metastasic disease, surgery of the primary tumor and metastasis must be discussed and if not operable the standard management is doxorubine-based chemotherapy.
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Affiliation(s)
| | - Sabrina Croce
- Institut Bergonié, département de pathologie, Bordeaux, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie, Bordeaux, France
| | - Carmen Llacer
- Institut du Cancer de Montpellier, département de radiothérapie, Montpellier, France
| | | | - Pierre Meeus
- Centre Léon-Bérard, département de chirurgie, Lyon, France
| | | | - Sophie Taieb
- Centre Oscar-Lambret, département de radiologie, Lille, France
| | | | - Florence Duffaud
- Gustave-Roussy, département d'oncologie médicale, Villejuif, France
| | - Patricia Pautier
- Gustave-Roussy, département d'oncologie médicale, Villejuif, France
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Chene G, Delacroix C, Lebail Carval K, Chabert P, Mellier G, Lamblin G. [How I do… laparoscopic in-bag morcellation of myomas?]. ACTA ACUST UNITED AC 2017; 45:566-570. [PMID: 28967600 DOI: 10.1016/j.gofs.2017.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Indexed: 12/28/2022]
Affiliation(s)
- G Chene
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France; Université Claude-Bernard-Lyon 1, EMR 3738, 69000 Lyon, France.
| | - C Delacroix
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France
| | - K Lebail Carval
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France
| | - P Chabert
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France
| | - G Mellier
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France
| | - G Lamblin
- Département de gynécologie, hôpital Femme-Mère-Enfant (HFME), hospices civils de Lyon, CHU de Lyon, 69000 Lyon, France
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Kerbage Y, Azaïs H, Estevez JP, Merlot B, Collinet P. [Current controversies regarding power morcellation and future directions]. ACTA ACUST UNITED AC 2016; 44:417-23. [PMID: 27363612 DOI: 10.1016/j.gyobfe.2016.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Accepted: 05/23/2016] [Indexed: 12/29/2022]
Abstract
Modern surgery tends to the improvement of minimally invasive strategies. Laparoscopy, rooted in practices for years, supplanted laparotomy in many directions. Regarding the extraction of large uterus, morcellation is currently the only way to externalize surgical specimens (myomas, uterine), without increasing the skin opening while allowing to reduce postoperative complications compared to laparotomy. However, in 2014, the Food and Drug Administration (FDA) discourages the use of uterine morcellation because of oncological risk. This recommendation has been challenged by a part of the profession. Our review has sought to identify the evidence for and against the use of morcellation. We also tried to quantify surgical risk and the current means of prevention. The incidence of uterine sarcomas is still poorly identified and preoperative diagnostic facilities remain inadequate. The small number of retrospective studies currently available could not enable any recommendation. The evaluation of morcellation devices and the improvement of preoperative diagnosis modalities (imaging, preoperative biopsy) are to continue to minimize the oncological risk.
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Affiliation(s)
- Y Kerbage
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France.
| | - H Azaïs
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - J P Estevez
- Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - B Merlot
- Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
| | - P Collinet
- Faculté de médecine, université de Lille, CHU de Lille, 59000 Lille, France; Service de gynécologie-obstétrique, CHU de Lille, 59000 Lille, France
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Guyon F, Cordeiro Vidal G, Babin G, Stoeckle E, Querleu D. [A critical assessment of morcellation in case of uterine malignancies and its impact on gynecologic surgery: From "precautionary principle" to "realism"]. Bull Cancer 2015; 103:96-103. [PMID: 26657189 DOI: 10.1016/j.bulcan.2015.10.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2015] [Accepted: 10/12/2015] [Indexed: 12/26/2022]
Abstract
Minimally invasive surgery has demonstrated benefits that include improved pain control, decreased infection risk, and faster surgical recovery and return to work. Morcellation is an integral part of making laparoscopic surgery possible for the removal of large uterine leiomyomata, and the development of power morcellation has increased efficiency during these procedures. Morcellation may expose patients to increased morbidity in certain circumstances. This is particularly true in cases of unrecognized malignancy, where intra-abdominal dissemination of cancer may worsen the prognosis (overall survival and disease free survival). A critical review of published data supports that tissue morcellation can be performed safely in screened and selected patients.
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Affiliation(s)
- Frédéric Guyon
- Centre regional de lutte contre le cancer Bordeaux-Aquitaine, institut Bergonié, département de chirurgie oncogynécologique, 229, cours de l'Argonne, 33076 Bordeaux cedex, France.
| | - Gloria Cordeiro Vidal
- Centre regional de lutte contre le cancer Bordeaux-Aquitaine, institut Bergonié, département de chirurgie oncogynécologique, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - Guillaume Babin
- Centre regional de lutte contre le cancer Bordeaux-Aquitaine, institut Bergonié, département de chirurgie oncogynécologique, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - Eberhard Stoeckle
- Centre regional de lutte contre le cancer Bordeaux-Aquitaine, institut Bergonié, département de chirurgie oncogynécologique, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
| | - Denis Querleu
- Centre regional de lutte contre le cancer Bordeaux-Aquitaine, institut Bergonié, département de chirurgie oncogynécologique, 229, cours de l'Argonne, 33076 Bordeaux cedex, France
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