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[994] Histopathologic Prognostic Factors in Stage I Uterine Leiomyosarcomas (Ut-LMS); a Clinicopathologic Study of 28 Cases
WL Wang, RA Soslow, M Hensley, H Asad, GF Zannoni, M de Nictolis, P Branton, E Oliva. Massachusetts General Hospital, Boston, MA; Memorial Sloan Kettering Cancer Center, New York, NY; Universita Cattolica, Rome, Italy; Istituto di Anatomia e Istologia Patologica, Ancona, Italy; Inova Fairfax Hospital, Church Falls, VA
Background: Ut-LMSs have an overall 5-year survival of 15-25%. However, stage I Ut-LMSs are reported to have a better prognosis with a 40-70% 5-year overall survival. The purpose of this study was to evaluate histopathologic parameters that may influence outcome in stage I Ut-LMSs.
Design: Twenty eight stage I Ut-LMSs were identified from the files of 5 tertiary care hospitals between 1974 and 2006. Tumors were primary staged based on pathologic information and supplemented with radiology (10 cases) and clinical records (1 case). Stage I tumors with no additional clinical or radiologic staging information were included in the study if no recurrence was documented >6 months from the initial staging operation (17 cases). Clinicopathologic parameters evaluated included: age, tumor size, cell type, mitotic activity (MA), cytologic atypia, tumor cell necrosis (TCN), and lymphovascular invasion (LVI). Follow-up was available for all patients. Poor outcome was defined as either dead from disease or alive with disease.
Results: Thirteen patients (46%) with stage I Ut-LMSs had poor outcome with a follow-up ranging from 10 to 97 (mean 33) months; 7 died of disease and 6 were alive with disease. Fifteen patients (54%) with stage I tumors were alive and well with follow- up ranging from 8 to 148 (mean 54) months. The findings are shown in Table 1.
Conclusions: Clinically aggresive Stage I Ut-LMSs have more MA, more often an epithelioid component, extensive TCN, and LVI as compared to clinically indolent Stage I Ut-LMSs. Histological factors may contribute to some degree to stratify stage I Ut-LMSs into indolent and aggressive categories.
Table 1. Summary of Histologic Findings by Outcome | Mean age (years) | Mean tumor size (cm) | Cell Type | Mean MA (range) | High grade atypia | TCN | LVI | | Poor Outcome (n=13) | 53 (37-73) | 10 (5-12) | | 30 (6-69) | 13 | 8 | 4 | | | | 6 S | | | | | | | | 4 E | | | | | | | | 1 E+S | | | | | | | | 2 M | | | | | | Alive and Well (n=15) | 55 (35-72) | 9 (5.5-13.5) | | 19 (4-66) | 12 | 4 | 2 | | | | 12 S | | | | | | | | 1 E | | | | | | | | 2 M | | | | | S= Spindled, E= Epithelioid, M= Myxoid, MA=Mitotic activity, TCN=Tumor cell necrosis, LVI=Lymphovascular invasion
Category: Gynecologic
Monday, March 26, 2007 11:30 AM
Platform Session: Section C, Monday Morning
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