Leiomyosarcoma: Difference between revisions

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==[[Leiomyosarcoma differential diagnosis|Differentiating Leiomyosarcoma from other Diseases]]==
==[[Leiomyosarcoma differential diagnosis|Differentiating Leiomyosarcoma from other Diseases]]==
{| class="wikitable"
{| class="wikitable"
!Disease
|'''Disease'''
!Clinical Features
|Clinical Features
!Physical Examination
|Physical Examination
!Diagnostic findings
|Diagnosis
|-
|-
|'''Peptic Ulcer disease'''
!Peptic Ulcer Disease
|
!
|
!
|
!
|-
* xray chest if perforated.
|'''Endometrial Carcinoma'''
* Upper GI Endoscopy     
|
* Serum Gastrin level     
|
* Secretin Stimulation test
|
* Biopsy                           
|-
|-
|'''Gastric cancer'''
|'''Gastric cancer'''
|
|Abdominal pain, Weight loss, Heartburn, Belching,Nausea,Vomiting,Weight loss,Loss of Appetite,Dysphagia,Hemetemesis,Melena
|
|Pallor,Jaundice,Acanthosis Nigrans,Leasr-Trelat signs,Left supraclavicular Lypmph adenopathy,Abdominal mass and distension,Splenomegaly,Ascites,Hepattomegaly
|
|<small>'''Esophagogastroduodenoscopy'''</small>
|-
|-
|'''Leiomyoma'''
|'''Endometrial Cancer'''
|
|Abnormal Vaginal bleeding,Post coital bleeding,Fatigue,weight loss,Pelvic pain and dysparunia
|
|Tachycardia,Tachypnea,Pallor,Jaundice,Vaginal bleeding, Enlarged uterus,Pedal Edema,Hepatomegaly,Lymphadenopathy,Decreased breath sounds(depending upon the staging of the cancer)
|
|CBC,LFT,CA-125,CA,PFT,xray chest,CT,MRI,Ultrasound, Endometrial Curettage,D and C,Endometrial Biopsy and '''TruTest'''
|}
|}



Revision as of 11:55, 23 May 2018

Leiomyosarcoma Microchapters

Home

Patient Information

Overview

Historical Perspective

Classification

Pathophysiology

Causes

Differentiating Leiomyosarcoma from other Diseases

Epidemiology and Demographics

Risk Factors

Natural History, Complications and Prognosis

Diagnosis

History and Symptoms

Physical Examination

Laboratory Findings

Chest X Ray

CT

MRI

Ultrasound

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Secondary Prevention

Cost-Effectiveness of Therapy

Future or Investigational Therapies

Case Studies

Case #1

Leiomyosarcoma On the Web

Most recent articles

Most cited articles

Review articles

CME Programs

Powerpoint slides

Images

American Roentgen Ray Society Images of Leiomyosarcoma

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X-rays
Echo & Ultrasound
CT Images
MRI

Ongoing Trials at Clinical Trials.gov

US National Guidelines Clearinghouse

NICE Guidance

FDA on Leiomyosarcoma

CDC on Leiomyosarcoma

Leiomyosarcoma in the news

Blogs on Leiomyosarcoma

Directions to Hospitals Treating Leiomyosarcoma

Risk calculators and risk factors for Leiomyosarcoma

For patient information click here.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

Overview

Historical Perspective

Pathophysiology

  • The pathogenesis of leimyosarcoma is characterized by malignant smoth muscle neoplasm that can appear in any site in the body but most commonly found in the uterus,small intestine and retro peritoneum.
  • On gross pathology, leiomyosarcoma appears to be soft, large, yellow or tan solitary masses with fleshy cut surfaces and areas of hemorrhage and necrosis.
  • On microscopic histopathological analysis,prominent cellular atypia, abundant mitoses(15-30 per 10 high power field),and areas of coagulative necrosis are characteristic features of the leiomyosarcoma.

Causes

  • Exact cause of leiomyosarcoma is not clearly evident.
  • Although not proven but some reasearchers believes that it could be a malignant transformation of the fibroid( leiomyoma).
  • It may arise denovo or can be due to the genomic instabilty. However molecular mechanism of tumorgenesis driven by genomic and genetic aberration is yet to be elucidated.
  • Over expression of the protooncogene C-myc is seen in 50% of the cases.
  • Retinobalstoma gene discrepancies are also seen in 90% of cases.
  • P16 chromosomal deletion causes loss of tumor suppression and so is involved in the development of leiomyosarcoma.
  • P53 gene mutation is also frequently seen in uterine leiomyosarcoma.

Differentiating Leiomyosarcoma from other Diseases

Disease Clinical Features Physical Examination Diagnosis
Peptic Ulcer Disease
  • xray chest if perforated.
  • Upper GI Endoscopy
  • Serum Gastrin level
  • Secretin Stimulation test
  • Biopsy
Gastric cancer Abdominal pain, Weight loss, Heartburn, Belching,Nausea,Vomiting,Weight loss,Loss of Appetite,Dysphagia,Hemetemesis,Melena Pallor,Jaundice,Acanthosis Nigrans,Leasr-Trelat signs,Left supraclavicular Lypmph adenopathy,Abdominal mass and distension,Splenomegaly,Ascites,Hepattomegaly Esophagogastroduodenoscopy
Endometrial Cancer Abnormal Vaginal bleeding,Post coital bleeding,Fatigue,weight loss,Pelvic pain and dysparunia Tachycardia,Tachypnea,Pallor,Jaundice,Vaginal bleeding, Enlarged uterus,Pedal Edema,Hepatomegaly,Lymphadenopathy,Decreased breath sounds(depending upon the staging of the cancer) CBC,LFT,CA-125,CA,PFT,xray chest,CT,MRI,Ultrasound, Endometrial Curettage,D and C,Endometrial Biopsy and TruTest

Epidemiology and Demographics:

  • Leiomyosarcoma is one the most common types of soft tissue sarcoma, about 1 person in 100,000 gets diagnosed with LMS each year.Uterine sarcoma are extremely rare, with the incidence of 3 to 7 per 100,000 US population however rate of sarcoma appears to be rising as compared to early years.

Risk Factors: Following Risk Fcators found to be associated with the development of the Uterine leiomyosarcoma

  • Age: Leiomyosarcoma can be seen at 20 years of age but mean age at diagnosis is 50-60 years old.
  • Race:Black women have a higher incidence of development of the uterine leiomyosarcoma as compared to the white women.
  • Long term use of the tamoxifen: Prolonged use of the tamoxifen esp more than five years has been associated with the increased risk of development of leiomyosarcoma.
  • History of Pelvic radiations:Pelvic irradiation has been associated with the increased development of the leiomyosarcoma.
  • Certain Hereditary condition like Gardner syndrome, Li-Fraumeni syndrome,Werner syndrome and Neurofibromatosis are associated with the development of leiomyosarcoma.

Natural History, Complications and Prognosis

  • The majority of patients with leiomyosarcoma remain asymptomatic for decades.
  • Most leiomyosarcomas are diagnosed incidentally at an advanced stage.
  • They are invariably aggressive and associated with the poor prognosis.

Prognosis: The prognosis of leiomyosarcoma is poor and it depends on varying factors:

  • Tumor size
  • Tumor location
  • Tumor type/Grade
  • DNA content
  • Hormonal receptor status
  • cellular division and mitotic rate
  • local and distant extension

Survival Rate of Leiomyosarcoma by staging:

Stage Percentage
stage 1 60
stage 2 35
stage 3 28
stage 4 15

Diagnosis

History and Symptoms | Physical Examination | Laboratory Findings | Chest X Ray | CT | MRI | Ultrasound | Other Imaging Findings | Other Diagnostic Studies

Treatment

Leiomyosarcoma treatment consist of multi-disciplinary approach and is best carried out at the specialized hospital setting.

Medical Therapy | Surgery | Secondary Prevention | Cost-Effectiveness of Therapy | Future or Investigational Therapies

Case Studies

Case #1

Related Chapters

Uterine sarcoma


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