Primary uterine sarcoma is rare, and cervical sarcoma is even less common than uterine corpus sarcoma. Secondary uterine sarcoma arises from malignant transformation of uterine fibroids. The histological classification of primary uterine sarcoma is complex, but can be broadly categorized into uterine leiomyosarcoma, uterine endometrial stromal sarcoma, malignant mixed Müllerian tumor (also known as malignant mesodermal mixed tumor or carcinosarcoma), adenosarcoma, and other sarcoma types (including sarcomas derived from heterologous components such as rhabdomyosarcoma, osteosarcoma, chondrosarcoma, liposarcoma, as well as sarcomas of vascular or lymphatic origin).

bubble_chart Diagnosis

1. Can occur at any age, most commonly seen in women around menopause, while cervical grape-like fleshy tumors are more common in young girls.
2. Abnormal menstruation or irregular vaginal bleeding or postmenopausal bleeding.
3. Abnormal vaginal discharge, which may be serous or bloody, and purulent with a foul odor if infection is present.
4. Abdominal pain, caused by the rapid growth of fleshy tumors.
5. Due to uterine masses growing rapidly, a lump can be felt in the lower abdomen.
6. There may be symptoms of bladder or rectal compression.
7. Gynecological examination: The uterus is enlarged to varying degrees with an irregular shape, and primary fleshy tumors tend to be soft. Protruding masses may be seen outside the cervical os, appearing dark red, accompanied by purulent discharge and necrotic tissue in cases of secondary infection. Advanced-stage uterine fleshy tumors may present as a frozen pelvis.
8. Biopsy of the protruding mass outside the cervical os or pathological examination via diagnostic curettage aids in diagnosis.
9. If a pre-existing uterine fibroid grows rapidly recently, the possibility of transformation into a fleshy tumor should be highly suspected. During surgery for uterine fibroids, careful examination is necessary, and if malignancy is suspected, frozen section pathology should be performed for confirmation.
10. If necessary, seasonal epidemic chest/X-ray examination should be conducted to check for lung metastasis.
11. Staging: Clinical staging is as follows—Stage I: Tumor confined to the uterine body; Stage II: Tumor infiltrates the uterine cervix; Stage III: Tumor infiltrates pelvic organs outside the uterus; Stage IV: Tumor infiltrates intra-abdominal organs or distant metastasis.

bubble_chart Treatment Measures

Surgery is the main treatment, supplemented by radiotherapy or chemotherapy.

1. Surgery: Stage I: Perform total hysterectomy and bilateral salpingo-oophorectomy, explore the pelvic and para-aortic lymph nodes, and remove any enlarged nodes. Stage II (involving the cervix): Perform radical hysterectomy, bilateral salpingo-oophorectomy, and pelvic and para-aortic lymphadenectomy.
2. Radiotherapy: Mostly used as adjuvant therapy before or after surgery, or for advanced-stage or recurrent patients. Endometrial stromal sarcoma and malignant mixed Müllerian tumor are more sensitive to radiotherapy than leiomyosarcoma.
3. Chemotherapy: As one of the comprehensive treatment measures. It is generally believed that uterine leiomyosarcoma is more sensitive to chemotherapy than endometrial stromal sarcoma and malignant mixed Müllerian tumor. The chemotherapy regimens and usage are detailed in the "Chemotherapy for Gynecological Malignant Tumors" section.
4. Hormonal therapy: As an adjuvant treatment, mainly used for low-grade malignant endometrial stromal sarcoma, which often tests positive for estrogen and progesterone receptors. It shows good efficacy with progesterone or progesterone plus tamoxifen.