Re-evaluation of preoperative endometrial smears for the cytodiagnosis of uterine leiomyosarcoma

Introduction: Uterine leiomyosarcoma (ULS) is a highly aggressive and lethal tumor. The absence of specific symptoms and diagnostic imaging findings makes the diagnosis of ULS challenging. Endometrial sampling reportedly has a significantly lower predictive value in diagnosing ULS compared with epithelial uterine malignancies. Materials and Methods: The authors retrospectively reviewed the preoperative endometrial cytology findings in seven of the 12 patients with ULS who were treated in this institution between 2008 and 2017. The other five patients did not have preoperative samples obtained for cytology. Results: Only one of the seven patients was originally diagnosed with a malignant tumor, with preoperative cytology showing rounded tumor cells with enlarged, irregular, hyperchromatic, and sometimes multiple nuclei, with conspicuous nucleoli in a necrotic background. After re-evaluation of the preoperative specimens, atypical cells were detected in four of the six patients who were initially deemed to have negative findings. A monomorphic population of spindle cells with slightly hyperchromatic, elongated nuclei was detected in two patients. Another two patients had rounded tumor cells with a moderate amount of basophilic cytoplasm and round or oval nuclei with minimal atypia. Conclusion: Novel diagnostic techniques are needed to accurately identify ULS in the preoperative period. Careful microscopic observation of the entire cytological specimen, together with detailed patient medical information, are essential to making a correct preoperative diagnosis of ULS.

Uterine neoplasms; Leiomyosarcoma; Cytodiagnosis.

[1] D’Angelo E., Prat J.: “Uterine sarcomas: a review”. Gynecol. Oncol., 2010, 116, 131.

[2] Brown L.: “Pathology of uterine malignancies”. Clin. Oncol. (R. Colll. Radiol.), 2008, 20, 433.

[3] Kapp D.S., Shin J.Y., Chan J.K.: “Prognostic factors and survival in 1396 patients with uterine leiomyosarcomas: emphasis on impact of lymphadenectomy and oophorectomy”. Cancer, 2008, 112, 820.

[4] Goto A., Takeuchi S., Sugimura K., Maruo T.: “Usefulness of GdDTPA contrast-enhanced dynamic MRI and serum determination of LDH and its isozymes in the differential diagnosis of leiomyosarcoma from degenerated leiomyoma of the uterus”. Int. J. Gynecol. Cancer, 2002, 12, 354.

[5] Bansal N., Herzog T.J., Burke W., Cohen C.J., Wright J.D.: “The utility of preoperative endometrial sampling for the detection of uterine sarcomas”. Gynecol. Oncol., 2008, 110, 43.

[6] Ueoka Y., Kobayashi H., Wake N.: “Carcinoma of the endometrium surveillance counterpoint: Japan”. In: Johnson F.E., Maehara Y., Browman G.P., Margenthaler J.A., Audisio R.A., Thompson J.F., et al. (eds). Patient surveillance after cancer treatment. New York: Humana Press, 2013, 311.

[7] Oda K., Okada S., Nei T., Shirai T., Takahashi M., Sano Y., et al.: “Cytodiagnostic problems in uterine sarcoma. Analysis according to a novel classification of tumor growth types”. Acta. Cytol., 2004, 48,181.

[8] An-Foraker S.H., Kawada C.Y.: “Cytodiagnosis of endometrial malignant mixed mesodermal tumor”. Acta. Cytol., 1985, 29, 137.

[9] Massoni E.A., Hajdu S.I.: “Cytology of primary and metastatic uterine sarcomas”. Acta. Cytol., 1984, 28, 93.

[10] Pappa L., Zagorianakou N., Kitsiou E., Sintou-Mantela E., Bafa M., Malamnou-Mitsi V.: “Breast metastasis from uterine leiomyosarcoma diagnosed by fine needle aspiration: a case report”. Acta. Cytol., 2008, 52, 485.

[11] Ito E., Saito T., Suzuki T., Fujii M., Kudo R.: “Cytology of vaginal and uterine sarcomas”. Acta. Cytol., 2004, 48, 601.

[12] Barbazza R., Chiarelli S., Quintarelli G.F., Manconi R.: “Role of fine-needle aspiration cytology in the preoperative evaluation of smooth muscle tumors”. Diagn. Cytopathol., 1997, 16, 326.

[13] Kawamura N., Ichimura T., Ito F., Shibata S., Takahashi K., Tsujimura A., et al.: “Transcervical needle biopsy for the differential diagnosis between uterine sarcoma and leiomyoma”. Cancer, 2002, 94, 1713.

[14] Shveiky D., Revel A., Rojansky N., Benshushan A., Shushan A.: “Diagnosis of malignant mesenchymal uterine tumors by hysteroscopic excisional biopsy”. J. Minim. Invasive. Gynecol., 2005, 12, 29.

[15] Sonoda K.: “Uterine leiomyosarcoma: An aggressive and challenging malignant tumor”. Fukuoka. Acta. Med., 2017, 108, 24.