Leiomyosarcomas: Clinical presentation

Objective: The ability to preoperatively distinguish benign from malignant myomas is increasingly important because of the availability of more conservative approaches to management of patients with benign uterine enlargement who wish to preserve fertility. Such therapies include observation, medical treatment with gonadotropin-releasing hormone analogs, and hysteroscopic resection of submucosal leiomyomas, in view of these options, this study was undertaken to identify characteristic features of leiomyosarcomas that may preoperatively distinguish benign from malignant myomas. Study Design: The 10-year experience with 21 patients with uterine leiomyosarcomas at Yale-New Haven Hospital was retrospectively reviewed. Results: Leiomyosarcomas were both broad-based and pedunculated and had no preferential uterine location. In 95% of the uterine specimens the leiomyosarcoma was either the largest or the only mass. The leiomyosarcoma was limited to one mass in all patients but one. Conclusion: We recommend that the largest myoma be monitored most closely during conservative management of a uterus containing leiomyomas.