Unexpected Histopathological Diagnosis of Undifferentiated Uterine Sarcoma after Simple Hysterectomy: Extrapolating Limited Evidence.

Uterine sarcomas are a rare malignancy, often retrospectively diagnosed after myomectomy or hysterectomy. Undifferentiated uterine sarcomas (UUS) are a particularly aggressive variant of this condition. Little evidence exists regarding the postoperative management of undifferentiated sarcomas diagnosed after hysterectomy performed for presumed benign conditions. We describe the case of a 33-year-old woman who presented with heavy bleeding and subsequently underwent hysterectomy on an emergency basis after failed medical management. Cut-section of the uterus revealed a grossly benign-looking sub-mucosal fibroid. However, the final histopathology report revealed undifferentiated uterine sarcoma. We worked up the patient postoperatively with MRI to rule out metastasis and performed bilateral salpingo-oophorectomy based on hormone receptivity status. We followed this with single-agent chemotherapy with adriamycin, which was followed by continuous therapy with oral letrozole (aromatase inhibitor). The patient was found doing well at the two-year follow-up, with no evidence of relapse. Postoperative diagnosis of UUS should include imaging to rule out metastasis, consideration for completion of surgery based on hormone receptivity of tumour, and lymphadenectomy based on the subtype of tumour.

Uterine Arterial Embolization for Uterine Leiomyoma: Efficacy and Clinical Outcome

PURPOSE: To determine the efficacy and clinical outcome of uterine arterial embolization as a new approach to the management of uterine leiomyomas MATERIALS AND METHODS: Uterine arterial embolization was performed in 21 patients aged 26-62(mean, 42) years. Twenty of these had menorrhagia, dysmenorrhea, and mass-related symptoms (low abdorminal discomfort, backache, urinary frequency, etc.) and one was diagnesed incidentally. Bilateral uterine arteries were selected individually and polyvinyl alcohol and/or gelfoam was used as an embolic material. RESULTS: Nineteen patients were followed up after embolization. Seventeen (89.5 %) reported satisfactory myoma volume. In 17 patients (89.5 %), the menstrual cycle returned to normal. All patients experienced pain after the procedure and other complications were vaginal bleeding (26.3%) and fever (23.8%). CONCLUSION: Uterine arterial embolization represents a new approach to the management of uterine leiomyoma-related symptoms. Further investigations and long-term follow-up are, however, equired.

Locally Advanced Squamous Cell Carcinoma of the Uterine Cervix: MR Evaluation of Effect of Combined Biologic (13-cis-Retinoic Acid plus Interferon alpha-2a) and Radiation Therapy

PURPOSE: To evaluate the effectiveness of MR imaging in assessing the response of carcinomas of the uterinecervix to the combined therapy of interferon alpha-2a, 13-cis-retinoic acid and radiation. MATERIALS AND METHODS: Thirteen patients with untreated, locally advanced squamous cell cervical carcinoma were treated for eight weeks with 13-cis-retinoic acid plus interferon alpha-2a and radiotherapy. Axial and sagittal T1-weighted spin echo and fast spin echo MR images were obtained before and after treatment, using a 1.5-T MR scanner. MR images were correlated with biopsy findings. In each patient, pre- and post-treatment images were prospectively analyzed andcompared. RESULTS: In all patients, tumor volume could be calculated by three dimensional measurement on MR images. Initial response to the combined therapy was complete in eight patients, partial in four and progressivein one. Evidence of tumor recurrence was noted in two patients during the follow-up period. MR images correlated well with biopsy findings. CONCLUSION: MR imaging is useful in the evaluation of tumor response to the combined biologic and radiation therapy, which can be an effective first-line therapy against locally advanced squamouscell carcinoma of the cervix.