Oncol Res Treat. 2018;41(11):680-686. doi: 10.1159/000494299. Epub 2018 Oct 16.
Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.
子宫平滑肌肉瘤（uLMS）是一种罕见的妇科恶性肿瘤，预后极差，绝经前和绝经后发病率最高。只有早期肿瘤才有可接受的预后，前提是患者在治疗过程中未损伤子宫。uLMS 通常是偶然诊断出来的，由于与更为常见的良性子宫肌瘤有相似的特征，因此正确诊断受到阻碍。手术是治疗的基础，应完整切除子宫。由于阴道、腹部和内镜手术-可能包括分碎术-是治疗子宫肌瘤的首选方法，因此术前通过病理检查发现未诊断出的平滑肌肉瘤会使预后恶化。辅助治疗中的全身治疗和放疗没有明确的价值。因此，迫切需要一种可靠的术前平滑肌肉瘤风险评分，以证明超出临床常规的诊断手段是合理的，并选择正确的手术途径。通过一个 30 岁未生育患者的病例报告来说明诊断平滑肌肉瘤和治疗中的临床问题。回顾了辅助和姑息治疗中的诊断工具以及治疗选择。
