Diagnostics and treatment of uterine sarcomas: challenges of a low-volume tertiary centre

Uterine sarcomas are rare diseases with no specific characteristics on imaging, so preoperative diagnosis remains challenging. The diagnostics is usually performed before treatment of what is supposed to be a benign tumour and therefore not at referral centres. We performed a retrospective study of patients with uterine sarcoma treated at our centre between 2012 and 2022. We aimed to analyse the preoperative management and clinical characteristics of the tumours, and to propose appropriate clinical pathways for these patients in small countries with a low number of inhabitants. We identified 21 women with the average age of 59 ± 11 years. The most common clinical symptom was vaginal bleeding (61.9% of patients). Uterine sarcoma was confirmed in 42.9% of patients prior to primary surgery. Tumours were classified as leiomyosarcomas (38.1%), as low-grade endometrial stromal sarcomas (ESS) (23.8%), as high-grade or undifferentiated ESS (19%), as liposarcomas (4.8%), and as adenosarcomas (14.3%). 81% of patients were operated as having uterine tumour, of which 14.3% had either enucleation or morcellation of the tumour/uterus due to presumed uterine fibroma. 33.3% of all patients had a primary metastatic disease when presented at our centre, and 28.6% had a recurrent disease. In patients with a follow-up period of 5 years or more, the overall survival (OS) was 46.2%. Our results confirmed that the clinical and histopathological characteristics of uterine sarcomas are very diverse. As their incidence is extremely rare when compared to benign fibroids, the main challenge remains in defining the criteria to select which patients should be referred for further diagnostics and treatment to tertiary centres before surgical procedure. Specifically in small countries, an additional challenge is the fact that even a single referral centre is still a low volume centre.

Uterine sarcoma; Uterine sarcoma treatment; Low-volume centre

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