Uterine Mesenchymal Neoplasia - Clinical Considerations

What Is Uterine Mesenchymal Neoplasia?

The spectrum of uterine tumors (cancerous or noncancerous) has shown a remarkable increase in number. These tumors tend to originate from the mesenchymal tissue (supporting tissues of the organ) of the uterus. Mesenchymal tumors are usually divided based on tumor phenotype and morphology. This article discusses the classification, clinical features, diagnosis, and symptoms of uterine mesenchymal tumors.

What Is the Incidence of Uterine Mesenchymal Neoplasia?

Uterine mesenchymal neoplasia commonly affects women in the age group of 15 to 80 years. Around 30 percent of the total population of females in the reproductive age group are affected by uterine tumors. It also affects the females who are in the postmenopausal phase.

What Is the Prevalence of Uterine Mesenchymal Neoplasia?

The metastatic uterine mesenchymal cancers comprise around three percent of the total uterine malignancies.

How Are Uterine Mesenchymal Tumors Classified as per World Health Organization?

The World Health Organization (WHO) has classified mesenchymal tumors into

1. Smooth Muscle Tumors:

• Uterine leiomyoma or fibroids arise from the smooth muscles of the uterus and are non-cancerous in nature.

• STUMP - smooth muscle tumor of uncertain malignant potential.

• Metastasizing (spreading) leiomyoma.

• Uterine leiomyosarcoma - It is an aggressive tumor with the potential to metastasize.

• Intravenous leiomyomatosis (a rare benign tumor with intraluminal growth of smooth muscle).

2. Endometrial Stromal Tumors: These tumors arise from the endometrial stromal cells. ESS (endometrial stromal sarcoma) is a rare tumor affecting the endometrium (inner lining) of the uterus and is malignant (cancerous).

• Low-grade endometrial stromal sarcoma (these tumors spread at a slower rate).

• High-grade endometrial stromal sarcoma (these tumors are quite aggressive and spread quickly to the surrounding tissues and organs).

• Endometrial stromal nodule.

• Undifferentiated uterine sarcoma.

3. Other Mesenchymal Uterine Neoplasms

• Perivascular epithelioid cell tumor (PeComa).

• Ovarian sex cord tumor (ovarian tumor).

• Myofibroblastic tumor (tumor containing myofibroblastic spindle cells).

• Nerve sheath tumors (rare tumor of nerve sheath).

• Giant cell tumor (non-cancerous tumor of giant cells).

4. Mixed Epithelial and Mesenchymal Tumor

• Adenosarcoma of the uterus exhibits a combination of epithelial and stromal components.

• Adenomyoma (non-cancerous tumor of uterus).

• Polypoid adenomyoma (uterine endometrial tumor of mixed cells).

What Are the Clinical Features of Uterine Mesenchymal Neoplasia?

The signs and symptoms associated with uterine mesenchymal neoplasia:

• Abnormal bleeding from the uterine.

• Pain in the pelvic and abdominal region.

• Palpable mass in the abdomen or pelvic region.

• Post-menopausal bleeding (bleeding after cessation of menopause).

• Bleeding abnormally in between the periods.

• Increased frequency of urination.

How Is Uterine Mesenchymal Neoplasia Diagnosed?

The diagnostic approaches of mesenchymal neoplasia involve a combination of clinical examination, radiographic examination, and histopathological analysis. The diagnostic modalities involve:

• Clinical Examination: The specialist performs a thorough physical examination, along with recording the presenting symptoms. The doctor usually palpates for the presence of swelling in the abdominal region.

• Radiographic Examination: Variable radiographic modalities used to diagnose uterine mesenchymal tumors are CT (computed tomography) scans, magnetic resonance imaging (MRI), and transvaginal ultrasound. These radiographic examinations help to detect the location, size, and extent of the tumor.

• Histopathological Examination: The technique of collecting tissue samples from the tumor site, also known as biopsy, is performed surgically, and the sample is forwarded to the laboratory for examination to rule out the exact diagnosis of the tumor. Excisional biopsy is usually performed in cases when a large sample of tissue is needed. A hysteroscopy (a thin, flexible tube with an attached camera placed inside the cervix) procedure is used to perform the biopsy.

• Genetic Screening: Mesenchymal uterine tumors have specific genetic characteristics. These tests are usually performed in cases of aggressive uterine cancers or for tumors that remain undiagnosed.

How Is Uterine Mesenchymal Neoplasia Managed?

The uterine mesenchymal neoplasm is managed by:

• Pharmacological Intervention: Various chemotherapeutic agents are used for the management of uterine mesenchymal tumors.

• Hormonal Therapies: Different hormonal therapies, such as gonadotropin-releasing hormone agonists, may be prescribed to alleviate symptoms like heavy menstrual bleeding or pelvic pain.

• Chemotherapy: Chemotherapy utilizes chemotherapeutic agents that help to restrict the spread of the tumor and prevent its metastasis.

• Radiation Therapy: The radiation therapy is given in two sessions, one prior to the surgery to shrink the size of the tumor and the second session after the surgical therapy to remove any remnants of the tumor present. It also helps to prevent the risk of recurrence of the tumor.

• Surgical Therapy: Surgical resection is the primary management for undifferentiated uterine sarcomas. However, due to the aggressive nature of these tumors, achieving complete resection can be challenging. Other tumors can be surgically removed along with the normal margins of the tissue lining to prevent the risk of recurrence. The type of surgical technique followed depends on the location, extent, and site of the tumor.

What Is the Prognosis of Uterine Mesenchymal Neoplasm?

The prognosis of uterine mesenchymal neoplasia varies for different cases as it depends on various factors such as:

• The clinical outcome after the surgical therapy.

• The stage at which the tumor is diagnosed.

• The extent of the tumor spread (aggressive tumor has poor prognosis). Low-grade tumors that have not metastasized (spread to different sites) have a fair prognosis and better clinical outcomes as compared to high-grade tumors that have metastasized to surrounding tissue and organs. Such tumors have quite poor prognosis and poor clinical outcomes. Uterine mesenchymal neoplasms that are diagnosed in the early stages have a fairer prognosis than those that are diagnosed in the advanced stages.

Conclusion

While non-cancerous tumors may be managed conservatively, cancerous variants such as leiomyosarcomas require a more aggressive approach. Advancements in imaging techniques and histopathological analysis have improved accuracy in diagnosing mesenchymal uterine tumors. The management landscape continues to evolve, with surgical interventions, radiation therapy, hormonal therapy, and chemotherapy playing pivotal roles. Personalized treatment strategies are becoming increasingly important considering the specific subtype and individual patient factors.

However, ongoing research is crucial to refine the diagnostic criteria and explore novel biomarkers to enhance the early detection of these cancers for early intervention. The understanding of mesenchymal uterine tumors has evolved, allowing for more precise diagnosis and tailored treatment plans. Collaborative efforts between clinicians and researchers are crucial to unraveling the complexities of uterine mesenchymal neoplasia. Continued research endeavors will contribute to improved diagnostic accuracy, refined treatment modalities, and, ultimately, better outcomes for individuals affected by these tumors.