Leiomyosarcoma
Diagnostyka i diagnoza

Leiomyosarcoma (LMS) to rzadki, agresywny mięsak wywodzący się z komórek mięśni gładkich, występujący w różnych lokalizacjach, m.in. w macicy, przewodzie pokarmowym czy naczyniach krwionośnych. Diagnostyka LMS opiera się na kompleksowej ocenie klinicznej, badaniach obrazowych (MRI, CT, PET/CT, USG, angiografia) oraz biopsji, która stanowi złoty standard potwierdzenia rozpoznania. W diagnostyce różnicowej szczególną uwagę zwraca się na odróżnienie LMS od łagodnych mięśniaków (leiomyoma) i innych mięsaków, co jest szczególnie trudne w przypadku zmian macicznych. Kryteria histopatologiczne obejmują obecność atypii cytologicznej, martwicy koagulacyjnej oraz wysokiej aktywności mitotycznej (>10 mitoz na 10 pól widzenia). Stopień złośliwości ocenia się na podstawie tych cech, a rozmiar guza powyżej 5 cm oraz obecność przerzutów pogarszają rokowanie. Badania immunohistochemiczne (SMA, ER, PR, p53, p16) oraz molekularne (analiza cytogenetyczna, sekwencjonowanie, badania ekspresji genów, płynna biopsja ctDNA) wspomagają klasyfikację i prognozę choroby, a także identyfikację potencjalnych celów terapeutycznych, np. wrażliwości na inhibitory PARP.

  1. Diagnostyka Leiomyosarcoma
    1. Badanie kliniczne i wywiad
    2. Badania obrazowe
    3. Biopsja
    4. Badania laboratoryjne
  2. Zaawansowane metody diagnostyczne
    1. Badania genetyczne i molekularne
    2. Badania immunohistochemiczne
  3. Kryteria diagnostyczne i różnicowanie
    1. Kryteria diagnostyczne
    2. Różnicowanie
  4. Staging i ocena zaawansowania
  5. Wyzwania diagnostyczne
  6. Nowe perspektywy w diagnostyce
  7. Znaczenie wczesnej i dokładnej diagnostyki
  8. Aspekty praktyczne procesu diagnostycznego
  9. Podsumowanie
    1. Kolejne rozdziały

Diagnostyka Leiomyosarcoma

Leiomyosarcoma (LMS) to rzadki, agresywny nowotwór wywodzący się z komórek mięśni gładkich, który może rozwijać się w różnych narządach ciała, takich jak macica, żołądek, jelita, pęcherz moczowy czy naczynia krwionośne. Prawidłowa diagnostyka tego nowotworu jest kluczowa dla skutecznego leczenia i rokowania pacjenta.12

Badanie kliniczne i wywiad

Diagnostyka leiomyosarcoma rozpoczyna się zazwyczaj od dokładnego badania klinicznego i wywiadu z pacjentem. Lekarz przeprowadza szczegółowy wywiad dotyczący objawów, czasu ich trwania, tempa wzrostu guza oraz czynników ryzyka, takich jak wcześniejsza ekspozycja na promieniowanie jonizujące, przewlekła immunosupresja czy występowanie łagodnych guzów mięśni gładkich w przeszłości.1

Podczas badania fizykalnego lekarz ocenia obecność guzów lub innych nieprawidłowości. W przypadku podejrzenia leiomyosarcoma macicy przeprowadza się badanie ginekologiczne, które obejmuje ocenę pochwy, szyjki macicy, macicy, jajowodów, jajników i odbytnicy.1

Badania obrazowe

Badania obrazowe stanowią istotny element diagnostyki leiomyosarcoma. Pozwalają określić lokalizację i rozmiar guza, jego stosunek do otaczających struktur oraz potencjalne miejsca biopsji.2

Do najczęściej wykorzystywanych metod obrazowania w diagnostyce LMS należą:

  • Rezonans magnetyczny (MRI) – jest najbardziej wartościowym badaniem w ocenie mięsaków tkanek miękkich, dostarczającym szczegółowych informacji na temat rozmiaru guza, jego zasięgu i stosunku do sąsiadujących struktur. MRI może również pomóc w określeniu, czy guz wykazuje cechy złośliwości.34
  • Tomografia komputerowa (CT) – jest przydatna do oceny struktury guza oraz do wykrywania przerzutów odległych, szczególnie w płucach, wątrobie i innych narządach.12
  • Pozytonowa tomografia emisyjna (PET) – często stosowana w połączeniu z CT (PET/CT), może być przydatna u pacjentów z leiomyosarcoma, gdy podejrzewa się rozsiew nowotworu, ale nie wiadomo dokładnie gdzie.3
  • Ultrasonografia (USG) – jest często pierwszym badaniem wykonywanym u pacjentów z podejrzeniem guza, szczególnie w przypadku leiomyosarcoma macicy. Badanie to ma jednak ograniczoną wartość w różnicowaniu łagodnych i złośliwych zmian.1
  • Angiografia – może być wykorzystana do oceny naczyń krwionośnych w obrębie i wokół guza.5

Warto jednak podkreślić, że żadna z metod obrazowania nie pozwala na jednoznaczne rozpoznanie leiomyosarcoma. Na przykład, w przypadku leiomyosarcoma macicy, badania obrazowe często nie pozwalają na odróżnienie go od łagodnych mięśniaków.1

Biopsja

Biopsja jest najważniejszym i ostatecznym krokiem w diagnostyce leiomyosarcoma. Jest to jedyne badanie, które może definitywnie potwierdzić diagnozę.2

W przypadku leiomyosarcoma najczęściej wykonuje się:

  • Biopsję gruboigłową – polegającą na pobraniu próbki tkanki za pomocą specjalnej igły. Jest to preferowana metoda biopsji w przypadku podejrzenia leiomyosarcoma, ponieważ dostarcza większej ilości materiału do badania niż biopsja cienkoigłowa.1
  • Biopsję chirurgiczną – wykonuje się ją, gdy biopsja igłowa jest niemożliwa lub nie daje jednoznacznych wyników.1

Próbka pobrana podczas biopsji jest następnie badana przez patomorfologa, który ocenia komórki pod mikroskopem w celu potwierdzenia diagnozy leiomyosarcoma i określenia stopnia złośliwości nowotworu.1

Ważne jest, aby biopsja była wykonywana w ośrodku specjalizującym się w diagnostyce i leczeniu mięsaków, przez zespół z dużym doświadczeniem. Ponadto biopsja musi być przeprowadzona w sposób, który nie wpłynie negatywnie na przyszłe leczenie chirurgiczne.1

Badania laboratoryjne

Badania laboratoryjne, choć nie są specyficzne dla leiomyosarcoma, mogą być pomocne w ocenie ogólnego stanu zdrowia pacjenta oraz w różnicowaniu z innymi schorzeniami. Obejmują one:

Zaawansowane metody diagnostyczne

Badania genetyczne i molekularne

Badania genetyczne i molekularne stają się coraz ważniejszym elementem diagnostyki leiomyosarcoma. Mogą pomóc w potwierdzeniu diagnozy, określeniu podtypu nowotworu, a także w identyfikacji potencjalnych celów terapeutycznych.1

Do najważniejszych badań w tym zakresie należą:

  • Analiza cytogenetyczna – badanie chromosomów komórek nowotworowych w celu wykrycia specyficznych aberracji chromosomowych.1
  • Sekwencjonowanie genetyczne – metoda ta może zidentyfikować mutacje genetyczne charakterystyczne dla leiomyosarcoma.1
  • Badania ekspresji genów – ocena ekspresji określonych genów może pomóc w klasyfikacji podtypów leiomyosarcoma i prognozowaniu przebiegu choroby. Niedawne badania wykazały, że leiomyosarcoma można podzielić na trzy podtypy genetyczne, które różnią się rokowaniem i potencjalną odpowiedzią na leczenie.12
  • Badania płynnej biopsji – analiza krążącego DNA guza (ctDNA) we krwi może być przydatna do monitorowania odpowiedzi na leczenie i wczesnego wykrywania nawrotów choroby.1

Badania molekularne mogą również zidentyfikować specyficzne sygnatury mutacyjne związane z niedoborem naprawy rekombinacyjnej DNA, co może sugerować potencjalną wrażliwość na inhibitory PARP.3

Badania immunohistochemiczne

Badania immunohistochemiczne są kluczowe w diagnostyce i różnicowaniu leiomyosarcoma od innych nowotworów. Polegają one na wykorzystaniu przeciwciał do wykrywania specyficznych białek w próbce tkanki.1

W przypadku leiomyosarcoma, badania immunohistochemiczne mogą obejmować:

  • Markery mięśni gładkich – takie jak aktyna mięśni gładkich (SMA), które są zwykle dodatnie w leiomyosarcoma.2
  • Receptory hormonalne – takie jak receptory estrogenowe (ER) i progesteronowe (PR), które mogą być obecne w niektórych przypadkach leiomyosarcoma macicy i mogą wpływać na odpowiedź na leczenie hormonalne.1
  • Markery proliferacji – takie jak PCNA (proliferating cell nuclear antigen), które mogą pomóc w ocenie aktywności proliferacyjnej guza.3
  • Białko p53 – mutacje genu TP53 są częste w leiomyosarcoma i mogą być wykryte za pomocą badań immunohistochemicznych.4
  • Białko p16 – nadekspresja p16 jest obserwowana w leiomyosarcoma macicy w porównaniu z łagodnymi mięśniakami.1

Kryteria diagnostyczne i różnicowanie

Kryteria diagnostyczne

Diagnoza leiomyosarcoma opiera się na kilku kryteriach histopatologicznych. W przypadku leiomyosarcoma macicy, diagnozę stawia się na podstawie obecności przynajmniej dwóch z następujących cech:1

  • Atypia cytologiczna – nieprawidłowości w wyglądzie komórek nowotworowych.1
  • Martwica koagulacyjna – obszary martwicy w guzie.2
  • Wysoka aktywność mitotyczna – duża liczba figur mitotycznych (>10 na 10 pól widzenia w dużym powiększeniu).3

Stopień złośliwości leiomyosarcoma (grading) ocenia się na podstawie nasilenia atypii komórkowej, liczby mitoz i obecności martwicy. Im wyższy stopień złośliwości, tym bardziej agresywny nowotwór i gorsze rokowanie.2

Różnicowanie

Leiomyosarcoma należy różnicować z innymi nowotworami i zmianami, które mogą prezentować podobne cechy kliniczne i obrazowe. W szczególności:2

  • Mięśniaki gładkokomórkowe (leiomyoma) – są to łagodne guzy mięśni gładkich, które mogą być trudne do odróżnienia od leiomyosarcoma, szczególnie w przypadku lokalizacji w macicy.3
  • Guz podścieliskowy endometrium (endometrial stromal sarcoma) – inny typ mięsaka macicy, który może przypominać leiomyosarcoma.1
  • Mięsak naczyniowy (angiosarcoma) – rzadki nowotwór złośliwy naczyń krwionośnych.4
  • STUMP (smooth muscle tumor of uncertain malignant potential) – guzy mięśni gładkich o niepewnym potencjale złośliwości, które nie spełniają wszystkich kryteriów leiomyosarcoma, ale wykazują cechy niepokojące dla nowotworu łagodnego.1

Różnicowanie leiomyosarcoma macicy od łagodnych mięśniaków jest szczególnie trudne, ale istnieje kilka cech, które mogą pomóc w diagnostyce różnicowej:5

  • Pacjentki z leiomyosarcoma są zazwyczaj starsze niż pacjentki z mięśniakami.1
  • Szybki wzrost guza, szczególnie u kobiet po menopauzie, może sugerować leiomyosarcoma.1
  • W badaniu MRI, nieregularne lub guzkowe granice, martwica, intensywne wzmocnienie po podaniu kontrastu i ograniczenie dyfuzji mogą sugerować leiomyosarcoma.6

Staging i ocena zaawansowania

Po postawieniu diagnozy leiomyosarcoma, konieczne jest określenie stopnia zaawansowania choroby (staging), co pomoże w wyborze odpowiedniego leczenia i przewidywaniu rokowania.1

Stopień zaawansowania leiomyosarcoma ocenia się na podstawie systemu TNM (Tumor – guz, Node – węzły chłonne, Metastasis – przerzuty) oraz systemów specyficznych dla lokalizacji nowotworu. W przypadku leiomyosarcoma macicy stosuje się klasyfikację FIGO (Międzynarodowa Federacja Ginekologii i Położnictwa).1

Najważniejszymi czynnikami prognostycznymi w leiomyosarcoma są:2

  • Stopień złośliwości histologicznej – im wyższy stopień, tym gorsze rokowanie.1
  • Rozmiar guza – guzy większe niż 5 cm wiążą się z gorszym rokowaniem.1
  • Głębokość guza – guzy zlokalizowane głębiej mają tendencję do bardziej agresywnego przebiegu.3
  • Obecność przerzutów – obecność przerzutów odległych znacząco pogarsza rokowanie.1

Ocena zaawansowania obejmuje również badania obrazowe całego ciała w celu wykrycia potencjalnych przerzutów, najczęściej do płuc, wątroby i kości.4

Wyzwania diagnostyczne

Diagnoza leiomyosarcoma wiąże się z kilkoma wyzwaniami:1

  • Rzadkość występowania – leiomyosarcoma stanowi tylko około 1,3% wszystkich nowotworów złośliwych macicy, co sprawia, że wielu lekarzy ma ograniczone doświadczenie w jego diagnostyce.5
  • Trudności w różnicowaniu – leiomyosarcoma, szczególnie w macicy, może być trudne do odróżnienia od łagodnych mięśniaków zarówno klinicznie, jak i w badaniach obrazowych.1
  • Różnorodność genetyczna – leiomyosarcoma charakteryzuje się złożonymi i niezrównoważonymi kariotypami oraz dużą niestabilnością genomową, co utrudnia jednoznaczną diagnostykę molekularną.4
  • Brak specyficznych markerów – brak specyficznych markerów laboratoryjnych dla leiomyosarcoma utrudnia wczesne wykrycie i różnicowanie z innymi schorzeniami.1

Z uwagi na te wyzwania, zaleca się, aby diagnoza i leczenie leiomyosarcoma były prowadzone w ośrodkach specjalistycznych, które mają doświadczenie w diagnostyce i leczeniu mięsaków.1

Nowe perspektywy w diagnostyce

Badania nad nowymi metodami diagnostycznymi leiomyosarcoma są w toku. Obiecujące kierunki obejmują:1

  • Zaawansowane techniki obrazowania – takie jak radiomika, analiza tekstury i uczenie maszynowe, które mogą poprawić dokładność diagnostyczną badań obrazowych.2
  • Klasyfikatory oparte na transkryptomie – badania sugerują, że analiza ekspresji genów może być przydatna w różnicowaniu leiomyosarcoma macicy od łagodnych mięśniaków.21
  • Płynna biopsja – analiza krążącego DNA guza (ctDNA) we krwi może stanowić nieinwazyjną metodę monitorowania choroby i wczesnego wykrywania nawrotów.2
  • Identyfikacja nowych biomarkerów – badania nad nowymi biomarkerami, które mogłyby pomóc w diagnozowaniu leiomyosarcoma i przewidywaniu odpowiedzi na leczenie.3
  • Kompleksowa analiza genetyczna – może dostarczyć cennych informacji o biologii nowotworu i potencjalnych celach terapeutycznych.1

Te nowe podejścia diagnostyczne mogą w przyszłości przyczynić się do wcześniejszego wykrywania leiomyosarcoma, bardziej precyzyjnej klasyfikacji podtypów nowotworu i lepszego doboru terapii.1

Znaczenie wczesnej i dokładnej diagnostyki

Wczesna i dokładna diagnoza leiomyosarcoma ma kluczowe znaczenie dla rokowania pacjenta:2

  • Wczesne wykrycie zwiększa szansę na całkowite wyleczenie chirurgiczne.1
  • Dokładna diagnoza pozwala na odpowiednie zaplanowanie leczenia, w tym wybór zakresu zabiegu chirurgicznego i potrzebę leczenia uzupełniającego.1
  • Prawidłowa identyfikacja podtypu nowotworu może wpływać na wybór terapii, szczególnie w kontekście leczenia celowanego i immunoterapii.4
  • Wczesna diagnoza może zapobiec nieodpowiednim interwencjom, takim jak morcelacja mięśniaków w przypadku nierozpoznanego leiomyosarcoma, co może prowadzić do rozsiewu nowotworu.3

Z tego powodu, przy podejrzeniu leiomyosarcoma, zaleca się skierowanie pacjenta do ośrodka specjalistycznego, który ma doświadczenie w diagnostyce i leczeniu tego rzadkiego nowotworu.1

Aspekty praktyczne procesu diagnostycznego

Proces diagnostyczny leiomyosarcoma może być długi i złożony. Oto kilka praktycznych aspektów, które mogą być pomocne zarówno dla lekarzy, jak i pacjentów:1

  • Diagnoza leiomyosarcoma zazwyczaj wymaga współpracy wielodyscyplinarnego zespołu, w skład którego wchodzą radiolog, patolog, onkolog oraz chirurg.2
  • Często konieczne jest uzyskanie drugiej opinii patologicznej, szczególnie w przypadkach, gdy diagnoza jest niejednoznaczna.2
  • Pacjenci powinni być świadomi, że proces diagnostyczny może trwać od kilku dni do 2 tygodni, w zależności od dostępności badań i złożoności przypadku.2
  • Dla pacjentów istotne jest zapoznanie się z wynikami badań, zadawanie pytań lekarzom i, w razie potrzeby, zasięganie drugiej opinii.1
  • Po postawieniu diagnozy, pacjenci powinni być skierowani do ośrodka specjalistycznego, gdzie zostanie opracowany indywidualny plan leczenia.1

W praktyce klinicznej warto również pamiętać o kilku specyficznych sytuacjach:

  • W przypadku leiomyosarcoma macicy, diagnoza często jest stawiana dopiero po operacji usunięcia tzw. mięśniaków, które po badaniu histopatologicznym okazują się być nowotworem złośliwym.1
  • U kobiet po menopauzie z szybko rosnącym guzem macicy zawsze należy rozważyć możliwość leiomyosarcoma.2
  • W przypadku leiomyosarcoma zlokalizowanego poza macicą (np. w kończynach, przewodzie pokarmowym), diagnoza może być trudniejsza z powodu rzadkości występowania i niespecyficznych objawów.1

Podsumowanie

Diagnostyka leiomyosarcoma wymaga kompleksowego podejścia, obejmującego badanie kliniczne, badania obrazowe, biopsję oraz badania histopatologiczne i molekularne. Z uwagi na rzadkość występowania i trudności diagnostyczne, zaleca się, aby diagnoza i leczenie tego nowotworu były prowadzone w ośrodkach specjalistycznych, które mają doświadczenie w diagnostyce i leczeniu mięsaków.1

Wczesna i dokładna diagnoza ma kluczowe znaczenie dla rokowania pacjenta, umożliwiając wdrożenie odpowiedniego leczenia na wczesnym etapie choroby. Nowe metody diagnostyczne, takie jak zaawansowane techniki obrazowania, analiza transkryptomu i płynna biopsja, mogą w przyszłości przyczynić się do poprawy wyników leczenia leiomyosarcoma.2

Pacjentom zaleca się aktywne uczestnictwo w procesie diagnostycznym, zadawanie pytań lekarzom i, w razie potrzeby, zasięganie drugiej opinii. Po postawieniu diagnozy, ważne jest skierowanie do ośrodka specjalistycznego, gdzie zostanie opracowany indywidualny plan leczenia, uwzględniający najnowsze doniesienia naukowe i dostępne metody terapeutyczne.1

Kolejne rozdziały

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  1. 10.04.2026
  2. www.leksykon.com.pl

Materiały źródłowe

  • #1 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    Leiomyosarcoma is an aggressive tumor of smooth muscle origin and one of the most common subtypes of sarcoma. A core needle biopsy is typically required for diagnosis. This activity describes the epidemiology, genetics, clinical presentation, and management of leiomyosarcoma, emphasizing the significance of interdisciplinary collaboration in diagnosing and managing leiomyosarcoma to improve patient outcomes. […] Determine the diagnostic algorithm for a suspected leiomyosarcoma. […] Leiomyosarcoma accounts for 10% to 20% of all newly diagnosed STS. In recent years, advancements in molecular diagnostics have enhanced the accuracy of diagnosis. […] The appropriate workup of a suspected sarcoma is critical. Initial cross-sectional imaging using either a computed tomography (CT) scan or magnetic resonance imaging (MRI) helps identify the extent of the lesion, its relationship to surrounding structures, and potential targets for biopsy.
  • #1 Leiomyosarcoma – Diagnosis & Disease Information for HCPs
    https://www.cancertherapyadvisor.com/ddi/leiomyosarcoma/
    Diagnosing leiomyosarcoma requires a multimodal approach incorporating clinical evaluation, imaging, and histopathological correlation for a confirmed diagnosis. […] The diagnostic evaluation starts with a patient history and physical examination. Important factors include the duration and growth rate of the tumor, previous exposure to ionizing radiation, chronic immunosuppression, and past presence of a benign smooth muscle tumor elsewhere in the body. […] Advanced imaging modalities are required for the initial evaluation, as well as for staging. Magnetic resonance imaging is the most helpful modality for evaluating soft tissue sarcomas because it can provide important information regarding the tumor size, extent, and relationship to contiguous structures. […] A biopsy and histopathological analysis are necessary for a definitive diagnosis. Fine needle aspiration or core needle biopsy is usually done to obtain a tissue sample.
  • #1 Uterine Sarcoma: Symptoms, Diagnosis, Treatment & Prevention
    https://my.clevelandclinic.org/health/diseases/16408-uterine-sarcoma
    If your provider thinks you might have uterine sarcoma, they will perform a physical examination and take your medical history. Your provider will also conduct a pelvic examination of your vagina, cervix, uterus, fallopian tubes, ovaries, and rectum. To examine these organs, your provider inserts a gloved finger or two into your vagina and rectum to feel for anything unusual. They may also use a speculum to look inside your vagina. […] Your provider can confirm a uterine sarcoma by examining its cells underneath a microscope after either a biopsy or a hysterectomy. […] You may need additional tests to stage your cancer once you’ve been diagnosed with uterine sarcoma. Magnetic resonance imaging (MRI), CT scans, PET scans, and chest X-rays can reveal whether your cancer has spread throughout your body. […] Your provider may refer you to a gynecologist who specializes in cancer (gynecological oncologist) to help with both diagnosis and treatment for uterine sarcoma.
  • #1 Soft Tissue Sarcoma: Leiomyosarcoma | Memorial Sloan Kettering Cancer Center
    https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/types/leiomyosarcoma
    Leiomyosarcoma is a rare condition. The cancer cells grow and multiply abnormally to form a tumor in the smooth muscle tissue of the body. Smooth muscle refers to the muscle tissue that lines hollow parts of the body, such as the bladder, uterus, stomach, veins, and arteries. […] Leiomyosarcoma is a form of soft tissue sarcoma, which is a cancer that begins in the connective tissues of the body. […] Doctors use imaging to detect leiomyosarcoma. These tests typically include MRIs or CTs. The scans can show the size of the tumor, where it started, whether any nearby organs or tissues are involved, and whether the tumor has spread to other parts of the body. […] Biopsy is usually the next step. A biopsy is the only test that can make a definite diagnosis of leiomyosarcoma. It involves taking a sample of the tumor. That sample is checked under a microscope for cancer cells by a pathologist (a doctor who is specially trained to diagnose disease).
  • #1 Outcomes of patients with pelvic leiomyosarcoma treated by surgery and relevant auxiliary diagnosis
    https://www.wjgnet.com/2307-8960/full/v8/i10/1887.htm
    Only medical imaging can identify the existence and position of lesions. […] Ultrasonography was the most widely performed procedure and was performed in 45.7% and 68.8% of patients in the uterine leiomyosarcoma and non-uterine leiomyosarcoma groups, respectively. […] These data imply that ultrasonography has limited ability in distinguishing between benign and malignant foci. […] The differential diagnosis of uterine leiomyoma and leiomyosarcoma remains a challenge in the medical imaging field. […] Our study suggests that serum tumour markers are of little value in leiomyosarcoma diagnosis, and ultrasonography cannot accurately differentiate leiomyosarcoma from uterine leiomyoma, although it remains valuable in monitoring recurrence.
  • #1 Uterine Leiomyosarcoma (ULMS) | LMSDR Foundation
    https://www.lmsdr.org/uterine-leiomyosarcoma-ulms-information
    Uterine leiomyosarcoma is typically a surprise discovery after a routine surgery to remove fibroids or the uterus. Preoperative diagnosis of uLMS is extremely difficult because a biopsy can miss the tumor cells and MRI scans can not tell the difference between fibroids and uLMS tumors. […] Complete surgical removal of the tumor is the definitive treatment for uterine leiomyosarcoma. […] Therefore, it is essential for all women with fibroids to have an informed discussion with their gynecologists and NOT rule out the possibility of uLMS.
  • #1 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    Once a sarcoma is suspected, an image-guided core needle biopsy is required for diagnosis; fine-needle aspiration is insufficient for establishing a diagnosis. […] The management of leiomyosarcoma depends on the disease site, tumor size, grade, and patient-dependent factors. […] The clinical presentation of a patient with STS is vague and nonspecific. The morphological diagnosis based on microscopic examination remains the gold standard. […] The general surgery principles applicable to any sarcoma also pertain to patients diagnosed with leiomyosarcoma. […] The primary goal of surgery is to perform an R0 resection while making every attempt to preserve critical neurovascular structures. […] The current National Comprehensive Cancer Network (NCCN) guidelines recommend pulmonary metastasectomy for oligometastatic disease in highly selected patients with no other sites of distant disease.
  • #1 Leiomyosarcoma Diagnosis: Imaging Tests, Biopsies
    https://www.webmd.com/cancer/leiomyosarcoma-diagnosis
    Your doctor can easily diagnose some health problems by sight or touch. But you will need to have certain tests done to find out if you have leiomyosarcoma. Because leiomyosarcomas are rare, your doctor may refer you to a medical center that has doctors who have diagnosed or treated many people who have this type of cancer. […] Your doctor may want you to have one or more of these tests. […] A biopsy removes cells from a growth or lump. A pathologist, a doctor who studies disease in tissues and body fluids, will examine the cells to see if you have a leiomyosarcoma. You may have one or more of these types of biopsies: […] If the test results show that you have leiomyosarcoma, you will need to meet with a cancer specialist to discuss your treatment options.
  • #1 Leiomyosarcoma: 7 facts about this rare soft tissue cancer | MD Anderson Cancer Center
    https://www.mdanderson.org/cancerwise/leiomyosarcoma–7-facts-about-this-rare-soft-tissue-cancer.h00-159536589.html
    Leiomyosarcoma is a rare type of cancer that falls into the category of sarcomas, which generally arise from connective tissue. Leiomyosarcoma generally forms in the smooth muscles of the body. […] The gold standard for diagnosis is tissue biopsy of the primary tumor. This can be accomplished by needle biopsy. This is when a needle is used to obtain a sample of cells from the tumor for laboratory testing. […] Its important to have a consultation with an oncologist who is familiar with the disease. The pathologic diagnosis can be difficult, and sometimes review of the biopsy by an expert pathologist is needed. A complete staging is needed before formulating a treatment plan. Once we have an accurate diagnosis and stage, we can work with the patient to come up with the best treatment plan for them.
  • #1 Leiomyosarcoma – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/leiomyosarcoma/diagnosis-treatment/drc-20577224
    To diagnose leiomyosarcoma, a healthcare professional might start with a physical exam to understand your symptoms. Other tests and procedures used to diagnose leiomyosarcoma include imaging tests and a biopsy. […] A biopsy is a procedure to remove a sample of tissue for testing in a lab. How a healthcare professional collects the biopsy sample depends on where the affected tissue is. For leiomyosarcoma, the biopsy is often collected with a needle. The healthcare professional puts the needle through the skin to get the sample. […] A biopsy for leiomyosarcoma needs to be done in a way that won’t cause problems with future surgery. For this reason, it’s a good idea to seek care at a medical center that sees many people with this type of cancer. Experienced healthcare teams will select the best type of biopsy.
  • #1 Diagnosis of soft tissue sarcoma | Canadian Cancer Society
    https://cancer.ca/en/cancer-information/cancer-types/soft-tissue-sarcoma/diagnosis
    A physical exam allows your doctor to look for any signs of soft tissue sarcoma. […] A complete blood count (CBC) measures the number and quality of white blood cells, red blood cells and platelets. A CBC is done to check your general health, often before a biopsy. […] Blood clotting (coagulation) tests check if your blood is clotting properly. […] Blood chemistry tests measure certain chemicals in the blood. […] An MRI is commonly used to examine a lump that doctors think may be a soft tissue sarcoma. […] A CT scan is commonly used to examine a lump in a specific area, including checking its size and finding out what tissues and areas are nearby. […] An ultrasound uses high-frequency sound waves to make images of parts of the body. It may be used to find out if a lump is a fluid-filled cyst or a solid tumour.
  • #1 Leiomyosarcoma – prognosis, symptoms, causes, diagnosis and treatment in the best clinics
    https://medtour.help/disease/leiomyosarcoma/
    If leiomyosarcoma is suspected, doctors prescribe a comprehensive examination, which includes laboratory tests and instrumental diagnostics. Tests may vary depending on the type of tumor and its location. […] The most commonly used diagnostic methods include: MRI and CT. With their help, it is possible to accurately determine the size and location of the tumor and identify metastases. […] Laboratory tests. General tests of blood, urine, feces, blood biochemistry, and special tests to check specific indicators may be prescribed. […] Biopsy. This method makes it possible to make a definitive diagnosis and differentiate leiomyosarcoma from other tumors. This procedure involves collecting tumor cells and then studying them in the laboratory. The method of tissue collection may vary depending on the location of the tumor. The biopsy can be taken using a special needle under CT guidance, and the procedure can be performed laparoscopically or by other methods.
  • #1 Markers for the differentiation of uterine leiomyosarcoma | CMAR
    https://www.dovepress.com/preoperative-blood-inflammatory-markers-for-the-differentiation-of-ute-peer-reviewed-fulltext-article-CMAR
    Preoperative diagnosis of uterine leiomyosarcoma (LMS) is challenging because the disease can mimic benign leiomyoma (LM). […] The objective of the present study was to investigate the role of preoperative clinical characteristics and hematologic parameters to differentiate uterine LMS and LM. […] A significant difference was observed between LMS and LM in terms of the median value of age at diagnosis, menopausal status, white blood cell (WBC) count, absolute neutrophil count (ANC), C-reactive protein (CRP), lactate dehydrogenase (LDH), and neutrophil-to-lymphocyte ratio (NLR) (all P 0.001). […] Our results suggest that in older or postmenopausal patients, high WBC count, ANC, CRP, LDH, and NLR could be useful biomarkers for the differentiation of LMS and LM, which indicate that serum markers might be useful, cost-effective, and broadly available diagnostic markers for uterine LMS.
  • #1 Lineage-defined leiomyosarcoma subtypes emerge years before diagnosis and determine patient survival | Nature Communications
    https://www.nature.com/articles/s41467-021-24677-6
    Leiomyosarcomas (LMS) are genetically heterogeneous tumors differentiating along smooth muscle lines. Currently, LMS treatment is not informed by molecular subtyping and is associated with highly variable survival. […] We uncover three specific subtypes of LMS that likely develop from distinct lineages of smooth muscle cells. […] Homologous recombination defects lead to genome-wide mutational signatures, and a corresponding sensitivity to PARP trappers and other DNA damage response inhibitors, suggesting a promising therapeutic strategy for LMS. […] The majority of LMS patients present with non-specific symptoms at 5060 years of age. These tumors may develop gradually over the course of several years. A better understanding of the timing of mutations in LMS would therefore provide knowledge about tumor development, and perhaps aid in early detection.
  • #1 Sarcoma Diagnosis – Virginia Oncology
    https://www.virginiacancer.com/sarcoma/diagnosis/
    If a soft tissue sarcoma is suspected, a biopsy will be done. The type of biopsy will be based on the size and location of the tumor. […] The following tests may be done on the tissue that was removed: […] Cytogenetic analysis: Used to look for certain changes in the chromosomes. […] FISH (fluorescence in situ hybridization): A laboratory test used to look at genes or chromosomes in cells and tissues. […] Flow cytometry: A laboratory test that measures the number of cells in a sample, the percentage of live cells in a sample, and certain characteristics of cells, such as size, shape, and the presence of tumor markers on the cell surface. […] Immunohistochemistry study: is used to tell the difference between different types of cancer. […] Light and electron microscopy: Used to look for certain changes in the cells.
  • #1 Leiomyosarcoma – Diagnosis & Disease Information for HCPs
    https://www.cancertherapyadvisor.com/ddi/leiomyosarcoma/
    Molecular genetic tests may detect chromosomal aberrations or genetic mutations, which may help to diagnose leiomyosarcoma. […] The tumor is graded according to mitotic count, necrosis, and cellular atypia. This gives an indication of the aggressiveness of the tumor and helps in formulating treatment. Staging determines the local invasiveness and presence of any distant metastasis.
  • #1 Lineage-defined leiomyosarcoma subtypes emerge years before diagnosis and determine patient survival | Nature Communications
    https://www.nature.com/articles/s41467-021-24677-6
    This study also highlights the potential use of a DNA damage inhibitors (DDRi), including PARP trappers, as a promising therapeutic avenue in these patients. […] We observed widespread genetic diversity within primary tumors and between metastatic relapses, especially with respect to rearrangements and clustered mutations that are only detectable by WGS. The results provide compelling support for molecular subtyping in LMS, and evidence for early systemic spread years prior to diagnosis. […] The degree to which this variability is explained by overall genomic and transcriptomic features is largely unknown. […] Subtype 1 was mixed: 43.4% gynecological, 30.4% extremity, 13.0% abdominal, 8.6% metastases, and 4.3% other. […] LMS subtypes 1 and 3 (mixed and gynecological, respectively) harbored a higher overall burden of somatic mutations and displayed inferior overall and disease-specific survival compared to subtype 2 (abdominal/extremity).
  • #1 Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment
    https://trp.cancer.gov/spores/abstracts/umich_sarcoma.htm
    The objectives of Project 3 are to collect and analyze serial liquid biopsy samples from blood samples of more than 200 patients with metastatic LMS enrolled in a randomized prospective clinical trial for circulating tumor DNA (ctDNA) to monitor clinical outcomes and to characterize and validate recurrent patterns of tumor heterogeneity and tumor evolution including the emergence of resistance. […] The specific challenge in LMS diagnosis is amplified with the phrase that the predominant cell resembles a smooth muscle cell. Indeed, accurate IHC staining is required to support the diagnosis. […] Hypothesis: ctDNA may be used as a biomarker of LMS patient prognosis and tumor response to chemotherapy. […] At the conclusion of this project, we anticipate that we will have validated the first dynamic biomarker of prognosis and treatment response for clinical use in patients with LMS.
  • #1 Diagnosis challenges in a uterine leiomyosarcoma | Archive of Clinical Cases
    https://www.clinicalcases.eu/index.php/acc/article/view/351
    Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. […] Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. […] The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. […] At least 5 atypical mitoses/ 10 HPF were also found. […] Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. […] The final histopathological diagnosis was that of uterine LMS. […] Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.
  • #1 Tests for Uterine Sarcoma | American Cancer Society
    https://www.cancer.org/cancer/types/uterine-sarcoma/detection-diagnosis-staging/how-diagnosed.html
    These hormone receptors are found on many endometrial stromal sarcomas and some leiomyosarcomas. […] Cancers with estrogen receptors are more likely to grow with estrogen, while those with progesterone receptors often don’t grow if exposed to progesterone. […] Checking for these receptors helps predict which cancers might benefit from hormone treatment. […] CT scans are rarely used to diagnose uterine sarcoma, but they might be helpful in seeing if the cancer has spread to other organs. […] MRI scans also make cross-section pictures of your insides but use radio waves and strong magnets instead of x-rays. […] An MRI scan can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. […] PET/CT scans can be useful for patients with uterine sarcomas, if your doctor thinks the cancer might have spread but doesn’t know where.
  • #1 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.
  • #1 Comprehensive Review of Uterine Leiomyosarcoma: Pathogenesis, Diagnosis, Prognosis, and Targeted Therapy
    https://www.mdpi.com/2073-4409/13/13/1106
    Uterine leiomyosarcoma (uLMS) is the most common subtype of uterine sarcomas. They have a poor prognosis with high rates of recurrence and metastasis. The five-year survival for uLMS patients is between 25 and 76%, with survival rates approaching 10–15% for patients with metastatic disease at the initial diagnosis. […] Currently, the diagnosis of uLMS is established at the time of pathologic analysis of the resected tumor. This method remains the gold standard. […] The Complexity Index in SARComas (CINSARC) is a transcriptomic signature related to identifying high-risk sarcoma and high metastatic potential. Consequently, CINSARC is currently evaluated in clinical trials for treatment response prediction and stratification of therapy. […] The diagnosis can be made depending on the presence of at least two of these criteria.
  • #1 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Adjuvant chemotherapy for early stage disease is controversial […] Lymphadenectomy is only indicated if there is evidence of concerning lymph nodes (J Adv Pract Oncol 2022;13:70, StatPearls: Leiomyosarcoma [Accessed 26 October 2022]) […] Adjuvant chemotherapy is indicated for metastatic / recurrent tumors […] Immunotherapy is a potential option for MSI high uterine leiomyosarcoma (Gynecol Oncol Rep 2021;35:100701) […] Sample pathology report […] Myometrium: Leiomyosarcoma […] Tumor size: 15 cm […] Cytologic atypia: diffuse, marked […] Coagulative tumor cell necrosis: present […] Mitotic count: 25 per 10 high power fields […] Lymphovascular invasion: negative […] Margin status: negative […] Other findings: leiomyomata
  • #1 Uterine leiomyosarcoma | Radiology Reference Article | Radiopaedia.org
    https://radiopaedia.org/articles/uterine-leiomyosarcoma?lang=us
    Uterine leiomyosarcomas are malignant uterine tumors that arise from the myometrium. The uterus is the commonest location for a leiomyosarcoma. […] Most commonly, patients present with abnormal vaginal bleeding, pelvic mass, and/or pelvic pain. Uncommonly, patients present with symptoms from local extension or metastases. […] Leiomyosarcomas mostly arise de novo from uterine musculature or the connective tissue of uterine blood vessels, but can rarely arise from a pre-existing leiomyoma. […] A leiomyosarcoma is differentiated histologically from a leiomyoma by noting the presence of infiltrative margins, nuclear atypia and increased mitotic figures. […] Surgical resection, followed by chemotherapy and/or radiotherapy, is the treatment of choice when possible. They generally carry a poor prognosis. […] Consider other uterine masses such as other uterine sarcomas: carcinosarcoma of the uterus (previously known as a malignant mixed Mllerian tumor of the uterus) and endometrial stromal sarcoma (ESS).
  • #1 Sonographic imaging in uterine sarcoma: a narrative review of literature – Giunchi – Gynecology and Pelvic Medicine
    https://gpm.amegroups.org/article/view/7437/html
    Uterine sarcomas include a heterogeneous group of tumors with an aggressive clinical behavior and poor prognosis. According to 2011 Word Health Organization (WHO) sarcomas comprise three main histotypes: leiomyosarcoma, endometrial stroma sarcoma, and undifferentiated endometrial sarcoma. In the majority of uterine sarcomas diagnosis is incidentally carried out during surgery or at pathology in patients with sonographic suspicion of fibroids. The correct differential diagnosis between benign myoma and sarcoma is mandatory for a correct surgical treatment. Leiomyosarcomas, endometrial stromal sarcomas and undifferentiated endometrial sarcomas rarely have internal shadows and fan shaped shadowing. An incorrect diagnosis was made in one fifth of all sarcoma cases. Ultrasound diagnosis of sarcomas is difficult and an incorrect diagnosis is common. The objective of this review is to focus on the role of ultrasound in diagnosis of uterine sarcoma. Leiomyosarcomas result the most common subtype of uterine sarcomas, even if they represent only 12% of the malignant tumors of the uterus. Pathological diagnosis of leiomyosarcomas is difficult because the differential diagnosis includes all leiomyoma variants, that may mimic malignant lesions, atypical smooth muscle tumors (STUMPs). The correct preoperative diagnosis is most important, because an incorrect treatment such as morcellation of the sarcoma or tumor-positive resection margins significantly worsens the prognosis. The correct diagnosis was made in approximately 80% of the 195 sarcomas and undifferentiated endometrial sarcomas were correctly diagnosed in 93% of cases. In conclusion, all large inhomogeneous uterine lesions with irregular cystic areas, without shadows and calcification in symptomatic patients especially with abnormal vaginal bleeding suggests malignancy. Preoperative diagnosis of sarcomas remains difficult. The correct preoperative diagnosis is essential for correct treatment.
  • #1 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    More likely to have a history of another nonuterine malignancy. […] Women with sarcoma were more likely to have masses that are subserosal. […] Leiomyomas usually have a uniformly solid consistency. […] Biopsy and histology. […] Symptoms related to uterine leiomyoma such as abdominal pain, abnormal uterine bleeding, and abdominal distension. […] No specific lab finding. […] Biopsy and Histology.
  • #1 Leiomyosarcoma | Sarcoma UK
    https://sarcoma.org.uk/about-sarcoma/what-is-sarcoma/types-of-sarcoma/leiomyosarcoma/
    Leiomyosarcomas are usually found by a patient when a lump appears on the leg, arm or trunk. They can also be found during an investigation of other symptoms or during a routine operation. […] A specialist doctor will diagnose leiomyosarcoma through a series of tests. These may include: Physical examination looking at and feeling any lump, A scan taking pictures of the inside of the body using ultrasound, x-ray, CT, EUS, PET or MRI, A biopsy taking and testing a tissue sample. […] You may have a hysteroscopy, which is a procedure used to examine and diagnose problems in the uterus. […] Uterine leiomyosarcomas can often be misdiagnosed as benign fibroids. If the fibroids continue to grow in size after menopause, you should be seen for further examination.
  • #1 Sarcoma Diagnostic Process | Stanford Health Care
    https://stanfordhealthcare.org/medical-conditions/cancer/sarcoma/patient-care-resources/diagnosis.html
    Your care team will also determine the stage of your cancer. Staging describes the size of the cancer and whether (and how far) it has spread. Staging is the most important step in planning your treatment. […] At Stanford, we tailor the diagnostic phase of Sarcoma care to each patient. If you need further testing to complete your diagnosis, your doctor and care team will work with you to determine which tests you need. Tests may include: […] If your imaging or other screening tests show that you may have sarcoma, you will need a biopsy. This test takes a tiny sample of cells from abnormal tissues. […] Genetic testing is a medical test that identifies changes in genes, chromosomes, or proteins. For sarcoma, genetic testing can show whether you have inherited mutations in genes related to the disease. […] Blood tests can provide a variety of information, helping to establish your diagnosis and plan your course of sarcoma treatment.
  • #1 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    The general principles of radiotherapy for any STS also apply to patients diagnosed with non-uterine leiomyosarcoma. […] Leiomyosarcoma is a tumor with complex and unbalanced karyotypes characterized by severe genomic instability, which results in multiple genetic aberrations. As a result, leiomyosarcoma is considered moderately sensitive to chemotherapy. […] After surgery, adjuvant chemotherapy for a patient diagnosed with STS has primarily been tested in patients with extremity and truncal STS. […] Leiomyosarcoma staging is according to the organ of origin. Uterine leiomyosarcoma staging follows the Federation of Gynecology and Obstetrics (FIGO) staging system. […] The three most important prognostic factors are histologic grade, tumor size, and tumor depth.
  • #1 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Uterus Smooth muscle tumors Leiomyosarcoma […] Diagnosis […] Myomectomy, hysterectomy […] No laboratory values are diagnostic: Some studies suggest leiomyosarcomas have higher levels of lactate dehydrogenase (LDH) versus uterine leiomyoma (BMC Cancer 2020;20:514) […] No pathognomonic findings […] Difficult to distinguish from benign smooth muscle tumors (Curr Opin Oncol 2021;33:464) […] Most common initial imaging modality […] Successfully detects uterine leiomyomas […] Does not differentiate between leiomyomas and leiomyosarcomas […] Advanced imaging modalities show potential diagnostic improvement: Machine learning, Radiomics, Texture analysis (Jpn J Radiol 2022;40:385) […] Most important prognostic factor is stage […] Additional prognostic measures include age, tumor size, mitotic rate and lymphovascular invasion
  • #1 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    High recurrence rate (50 – 70%) regardless of stage at initial diagnosis […] Poor prognosis even if the tumor is confined to the uterus […] More favorable prognosis if tumor is < 5 cm and confined to the uterus [...] 5 year overall survival (OS) rate for all stages is poor, ranging from 15 to 25% [...] OS rates are more favorable at low stages (1 - 2), ranging from 40 to 70% [...] Morcellation is associated with significantly increased risk of recurrence (Gynecol Oncol 2021;160:99) [...] Risk stratification model, including mitoses > 25 per 2.4 mm² (10 high power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion and serosal abutment, is significantly associated with disease free and disease specific survival in stage I tumors (Mod Pathol 2022;35:794) […] Surgical resection (hysterectomy) is standard treatment for patients with localized leiomyosarcoma
  • #1 Leiomyosarcoma: Success of Treatment, Stages, Support
    https://www.verywellhealth.com/leiomyosarcoma-7509839
    Leiomyosarcoma is a cancer that develops in the smooth muscles. […] The only way to detect a leiomyosarcoma, other than through imaging tests, is to watch for signs and symptoms of a tumor. […] To diagnose leiomyosarcoma, your healthcare provider will ask about your symptoms and medical history and examine your body. […] They’ll order imaging tests, such as magnetic resonance imaging (MRI), computed tomography (CT), angiography, and positron-emission tomography (PET). […] They’ll also order blood tests to look for signs of cancer. They’ll take a small tissue sample called a biopsy to check that a tumor is a leiomyosarcoma. […] Surgical resection is the most effective treatment for leiomyosarcoma. […] If found early, leiomyosarcoma can be cured. […] Healthcare providers stage leiomyosarcoma using the tumor’s size, spread, and grade. […] Early detection, proper staging, and comprehensive treatment are crucial for improving outcomes.
  • #1 A differential diagnosis between uterine leiomyoma and leiomyosarcoma using transcriptome analysis | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11394-0
    The objective of this study was to estimate the accuracy of transcriptome-based classifier in differential diagnosis of uterine leiomyoma and leiomyosarcoma. […] Preoperative differential diagnosis between uterine leiomyoma and leiomyosarcoma is important because it affects treatment and prognosis. […] However, preoperative differential diagnosis between uterine leiomyoma and leiomyosarcoma is difficult. […] We hypothesized that transcriptome analysis would be useful in differential diagnosis between uterine leiomyoma and leiomyosarcoma. […] The transcriptome-based classifier accurately distinguished uterine leiomyosarcoma from leiomyoma. […] A new transcriptome-based classifier was able to accurately distinguish uterine leiomyoma from leiomyosarcoma using data from preoperative biopsy specimens.
  • #1 Expert Sheds Light on Uterine Leiomyosarcoma Diagnosis, Treatment
    https://www.onclive.com/view/expert-sheds-light-on-uterine-leiomyosarcoma-diagnosis-treatment
    Kristen N. Ganjoo, MD, discusses the diagnosis, presentation, and management of patients with uterine leiomyosarcoma. […] Many uterine leiomyosarcomas present as metastatic disease after having been misdiagnosed as a fibroid, explained Kristen N. Ganjoo, MD, and although there are treatment options for these patients, an early and accurate diagnosis is the only chance of cure. […] Unfortunately, its really hard to diagnose patients based on an ultrasound or magnetic resonance imaging. If you do a biopsy, you may biopsy a part that is nondiagnostic, said Ganjoo, an associate professor of medicine at Stanford University Medical Center. […] Early diagnosis is extremely important. If the disease is metastatic, then it becomes incurable. […] Usually, these tumors are found in younger women. Many of these women are diagnosed with fibroids, which are a benign form of smooth muscle, [also known as] leiomyomas.
  • #1 Outcomes of patients with pelvic leiomyosarcoma treated by surgery and relevant auxiliary diagnosis
    https://www.wjgnet.com/2307-8960/full/v8/i10/1887.htm
    Outcomes of patients with pelvic leiomyosarcoma treated by surgery and relevant auxiliary diagnosis. […] Clinical characteristics and relevant diagnosis of pelvic leiomyosarcoma should be further explored. […] Serum tumour biomarkers cannot be used for pelvic leiomyosarcoma diagnosis. […] Ultrasonography is more reliable for postoperative follow-up than preoperative diagnosis. […] Although various diagnostic tools have been used to preoperatively evaluate uterine leiomyosarcoma, they have a low sensitivity for differentiating uterine leiomyosarcoma from fibroids; a previous study revealed that only approximately 54% of uterine leiomyosarcoma lesions were unidentified before surgery. […] Unlike in the case of ovarian cancer, regular serum tumour markers have limited value in diagnosing uterine leiomyosarcoma.
  • #1 Treatment and prognosis of uterine leiomyosarcoma – UpToDate
    https://www.uptodate.com/contents/treatment-and-prognosis-of-uterine-leiomyosarcoma/print
    Uterine leiomyosarcoma (LMS) is a rare uterine malignancy that arises from the smooth muscle of the uterine wall. Compared with other types of uterine cancers, LMS is an aggressive tumor associated with a high risk of recurrence and death, regardless of stage at presentation. […] Whenever possible, patients with uterine sarcomas should be referred to specialty centers with expertise in their diagnosis and management. […] This topic will cover the treatment approach to high-grade uterine LMS. The classification, clinical manifestations, diagnosis, and staging of other uterine sarcomas are covered separately.
  • #1 A differential diagnosis between uterine leiomyoma and leiomyosarcoma using transcriptome analysis | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11394-0
    The impact of preoperative differential diagnosis between uterine leiomyoma and leiomyosarcoma is huge. Unnecessary surgery can be avoided in women with uterine leiomyoma and early surgery can be performed in women with uterine leiomyosarcoma. […] We successfully developed a transcriptome-based classifier using publicly available transcriptome data and showed that the classifier accurately distinguished uterine leiomyosarcoma from leiomyoma.
  • #1 Uterine Sarcoma > Fact Sheets > Yale Medicine
    https://www.yalemedicine.org/conditions/uterine-sarcoma
    About two thirds (66%) of women who are diagnosed with early-stage leiomyosarcoma survive 5 years or longer. […] With the goal to personalize cancer treatment modalities for uterine sarcoma patients, Yale researchers have recently reported the most comprehensive genetic analysis of uterine leiomyosarcoma.
  • #1 Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment
    https://trp.cancer.gov/spores/abstracts/umich_sarcoma.htm
    This SPORE grant is entitled Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment. […] Our goal is to improve the knowledge regarding leiomyosarcoma (LMS) genetics, biology, and therapeutic approaches to rationally develop novel and more effective therapies including combinations of different agents targeting different pathways to exploit unique vulnerabilities. […] Project 1 aims to identify and exploit genomic vulnerabilities in LMS targeting the dependency on the non-homologous end joining DNA repair pathway and the associated enzyme DNA-activated protein kinase (DNA-PK). […] Project 2 focuses on studying the genetic epidemiology of LMS defining the risk for cancer in families with cancer predisposition syndromes such as Li-Fraumeni Syndrome, as well as the general population by evaluating the largest ever cohort of LMS patients.
  • #1 Scalp Leiomyosarcoma: Diagnosis and Treatment During a Global Pandemic With COVID-19 | Hassan | World Journal of Oncology
    https://www.wjon.org/index.php/wjon/article/view/1393/1069
    Final pathology demonstrated 5.4 5.1 2.2 cm grade 2 malignant spindle cells consistent with leiomyosarcoma (T3). […] Prompt diagnosis and treatment is crucial to improve overall survival from this challenging disease. […] Cure of leiomyosarcoma depends on early diagnosis and prompt management; if the sarcoma is diagnosed before locally advanced state or distant metastasis, complete tumor excision has potential to be curative. […] Had our patient sought care earlier and if he had been able to have proper appointments with regular follow-up, the diagnosis may have been obtained much sooner. […] Delaying in cancer diagnosis can lead to what may have been an early-stage disease presenting in an advanced stage with a grimmer prognosis, especially if the patient will only present once symptoms reach such a point that their concern overcomes their fear of the pandemic.
  • #1 Leiomyosarcoma | Macmillan Cancer Support
    https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/leiomyosarcoma
    Knowing the stage and grade of the cancer helps doctors decide on the best treatment for you. […] A team of specialists meet to discuss the best possible treatment plan for you. This is called a multidisciplinary team (MDT). […] The main treatments for leiomyosarcoma are surgery and radiotherapy. Sometimes chemotherapy is used as well. […] Surgery is the main treatment for leiomyosarcoma. The aim is to remove all of the cancer and an area of healthy tissue around it. […] You may have radiotherapy after surgery to reduce the chance of the cancer coming back. […] Chemotherapy is used less often than radiotherapy. It is sometimes used before or after surgery, or if the cancer cannot be removed with surgery. […] You will have regular check-up appointments at the hospital. Your doctor will examine you and ask about any side effects or symptoms. […] Sometimes side effects may continue or develop months or years after treatment. These are called late effects. […] If you are worried about your fertility it is important to talk with your doctor before you start treatment.
  • #1 Soft tissue sarcoma – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/soft-tissue-sarcoma/diagnosis-treatment/drc-20377730
    Tests and procedures used to diagnose soft tissue sarcoma include imaging tests and procedures to remove a sample of cells for testing. […] Imaging tests create pictures of the inside of the body. They might help show the size and location of the soft tissue sarcoma. […] A procedure to remove some cells for testing is called a biopsy. A biopsy for soft tissue sarcoma needs to be done in a way that won’t cause problems with future surgery. […] The biopsy sample goes to a lab for testing. Doctors who specialize in analyzing blood and body tissue, called pathologists, will test the cells to see if they’re cancerous. Other tests in the lab show more details about the cancer cells, such as what type of cells they are. […] If your doctor thinks you might have soft tissue sarcoma, you’ll likely be referred to a cancer doctor, called an oncologist. Soft tissue sarcoma is rare and is best treated by someone who has experience with it. Doctors with this kind of experience are often found within an academic or specialized cancer center.
  • #1 Sarcoma Diagnostic Process | Stanford Health Care
    https://stanfordhealthcare.org/medical-conditions/cancer/sarcoma/patient-care-resources/diagnosis.html
    This overview explains what to expect as you go through diagnosis. […] An accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options for you, in the right sequence. […] For everyone who comes to us, we start your care by confirming a diagnosis. […] Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis. […] After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you. […] Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist.
  • #1 Soft tissue sarcoma – Diagnosis and treatment – Mayo Clinic
    https://www.mayoclinic.org/diseases-conditions/soft-tissue-sarcoma/diagnosis-treatment/drc-20377730
    What kinds of tests do I need to confirm the diagnosis? Do these tests require any special preparation? […] What type of sarcoma do I have? […] What stage is it? […] What treatments are available, and which do you recommend? […] Can the cancer be removed? […] What types of side effects can I expect from treatment? […] Are there clinical trials available?
  • #1 Soft Tissue Sarcoma: Leiomyosarcoma | Memorial Sloan Kettering Cancer Center
    https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/types/leiomyosarcoma
    It is very important to receive a diagnosis from a team of doctors that is highly experienced in the diagnosis and treatment of soft tissue sarcoma. There are more than 80 subtypes of soft tissue sarcoma, so it can be a difficult to diagnose. Getting the correct evaluation and diagnosis is the first step to being cured.
  • #1 Tests for Uterine Sarcoma | American Cancer Society
    https://www.cancer.org/cancer/types/uterine-sarcoma/detection-diagnosis-staging/how-diagnosed.html
    If you have symptoms of uterine sarcoma, the first step is to see your doctor. […] If your doctor suspects cancer based on your symptoms and/or exam, you may be told you need other tests and also be referred to a gynecologist or a doctor specializing in cancers of the female reproductive system (called a gynecologic oncologist). […] The tests will find endometrial stromal sarcomas, but not as many leiomyosarcomas (LMSs). […] These tests don’t find LMSs as often because these cancers start in the muscle layer of the wall of the uterus, not the inner lining. […] In most cases, the only way to diagnose a LMS is by removing it with surgery. […] Many uterine sarcomas are diagnosed during or after surgery for what’s thought to be benign fibroid tumors. […] The tissue sample or biopsy might also be tested to see if the cancer cells have estrogen receptors and progesterone receptors.
  • #1 Leiomyosarcoma | Radiology Reference Article | Radiopaedia.org
    https://radiopaedia.org/articles/leiomyosarcoma?lang=us
    Leiomyosarcomas are extremely rare malignant neoplasms that originate from smooth muscle cells and may be considered the malignant counterpart of a leiomyoma. They are classified as soft tissue tumors and account for ~8% of malignant soft tissue tumors. […] Morphological imaging features would be invariably dependent on the site. Generally, they tend to be large masses, especially in cases of abdominopelvic lesions. […] For a meaningful differential, it is necessary to consider site-specific tumors.
  • #1 Soft Tissue Sarcoma Diagnosis | Memorial Sloan Kettering Cancer Center
    https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/diagnosis
    Getting an accurate diagnosis is crucial to getting the best care for soft tissue sarcoma. By making absolutely sure that we have diagnosed the correct sarcoma type, we can better determine the most effective treatment approach for you. […] Diagnosing soft tissue sarcoma is not straightforward. When people come to us for a second opinion, our pathologists change their diagnosis approximately 15 percent of the time. […] While these tests are very helpful, the gold standard for diagnosing soft tissue sarcoma is a biopsy. In this procedure, we take a tiny sample of the tumor so that a pathologist (a doctor who is specially trained to diagnose disease) can look at it under a microscope. […] We use genetic and molecular sequencing on the tumors of nearly all our patients with soft tissue sarcoma. By making absolutely sure that we have diagnosed the correct sarcoma type, we can better determine the most effective treatment approach.
  • #1 First Steps After Diagnosis
    https://www.leiomyosarcoma.info/firststeps.htm
    LMS Primary or Metastasis? Make sure you know where the primary tumor is. […] Nature of Leiomyosarcomas Leiomyosarcomas are well known for local recurrence and metastatic spread. […] General Principles of Treatment A sarcoma oncologist will generally give you an edge. […] LMS & Treatment STI-571 & CD117 & GIST The experimental drug STI-571, now known as Glivec, is undergoing clinical trials against some forms of Leiomyosarcoma. […] Adjuvant Treatment OR Not? For the situation of: ISOLATED PRIMARY, SURGICALLY RESECTED WITH CLEAR MARGINS. Sounds like it was completely removed at this time… so there isn’t any left, is there? […] PDQ files and the NCI The National Cancer Institute (NCI) is the lead Federal agency for cancer research. […] Dealing with Doctors After a diagnosis of sarcoma, choosing the right physician can be a difficult and confusing process. […] Seeking Second Opinions Seeking a second opinion is not taboo or something to be embarrassed about.
  • #2 Leiomyosarcoma: Symptoms, Treatment & Prognosis
    https://my.clevelandclinic.org/health/diseases/22059-leiomyosarcoma
    Leiomyosarcoma (LMS) is a type of soft tissue sarcoma. Its a rare, aggressive cancer that starts in the smooth muscles of your hollow organs (like your bladder, stomach, uterus, intestines or blood vessels). […] Leiomyosarcoma is a cancerous tumor that forms in smooth muscles like stomach, intestines, bladder, blood vessels, uterus. […] Leiomyosarcoma (LMS) is a rare, aggressive cancer that forms in smooth muscles. […] Some people dont develop LMS symptoms until the disease reaches an advanced stage. In these cases, leiomyosarcoma is life-threatening. But when its detected and treated early, recovery is possible. […] A healthcare provider will do a physical examination and ask you about your symptoms. Theyll also review your medical history, including any past or current health conditions.
  • #2 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    Leiomyosarcoma is an aggressive tumor of smooth muscle origin and one of the most common subtypes of sarcoma. A core needle biopsy is typically required for diagnosis. This activity describes the epidemiology, genetics, clinical presentation, and management of leiomyosarcoma, emphasizing the significance of interdisciplinary collaboration in diagnosing and managing leiomyosarcoma to improve patient outcomes. […] Determine the diagnostic algorithm for a suspected leiomyosarcoma. […] Leiomyosarcoma accounts for 10% to 20% of all newly diagnosed STS. In recent years, advancements in molecular diagnostics have enhanced the accuracy of diagnosis. […] The appropriate workup of a suspected sarcoma is critical. Initial cross-sectional imaging using either a computed tomography (CT) scan or magnetic resonance imaging (MRI) helps identify the extent of the lesion, its relationship to surrounding structures, and potential targets for biopsy.
  • #2 Tests for Uterine Sarcoma | American Cancer Society
    https://www.cancer.org/cancer/types/uterine-sarcoma/detection-diagnosis-staging/how-diagnosed.html
    These hormone receptors are found on many endometrial stromal sarcomas and some leiomyosarcomas. […] Cancers with estrogen receptors are more likely to grow with estrogen, while those with progesterone receptors often don’t grow if exposed to progesterone. […] Checking for these receptors helps predict which cancers might benefit from hormone treatment. […] CT scans are rarely used to diagnose uterine sarcoma, but they might be helpful in seeing if the cancer has spread to other organs. […] MRI scans also make cross-section pictures of your insides but use radio waves and strong magnets instead of x-rays. […] An MRI scan can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. […] PET/CT scans can be useful for patients with uterine sarcomas, if your doctor thinks the cancer might have spread but doesn’t know where.
  • #2 Soft Tissue Sarcoma: Leiomyosarcoma | Memorial Sloan Kettering Cancer Center
    https://www.mskcc.org/cancer-care/types/soft-tissue-sarcoma/types/leiomyosarcoma
    Leiomyosarcoma is a rare condition. The cancer cells grow and multiply abnormally to form a tumor in the smooth muscle tissue of the body. Smooth muscle refers to the muscle tissue that lines hollow parts of the body, such as the bladder, uterus, stomach, veins, and arteries. […] Leiomyosarcoma is a form of soft tissue sarcoma, which is a cancer that begins in the connective tissues of the body. […] Doctors use imaging to detect leiomyosarcoma. These tests typically include MRIs or CTs. The scans can show the size of the tumor, where it started, whether any nearby organs or tissues are involved, and whether the tumor has spread to other parts of the body. […] Biopsy is usually the next step. A biopsy is the only test that can make a definite diagnosis of leiomyosarcoma. It involves taking a sample of the tumor. That sample is checked under a microscope for cancer cells by a pathologist (a doctor who is specially trained to diagnose disease).
  • #2 Markers for the differentiation of uterine leiomyosarcoma | CMAR
    https://www.dovepress.com/preoperative-blood-inflammatory-markers-for-the-differentiation-of-ute-peer-reviewed-fulltext-article-CMAR
    The aim of this study was to investigate the diagnostic values of preoperative clinical characteristics and hematological parameters in patients with uterine LMS. […] Significant differences were observed between the LMS and LM groups for the following variables: age at diagnosis, menopausal status, WBC count, ANC, CRP, LDH, and NLR (all P 0.001). […] Older or postmenopausal patients with a high WBC count, high ANC, high serum CRP, high serum LDH, and high NLR were more likely to be diagnosed with LMS. […] In the present study, multivariate analysis revealed preoperative CRP 0.195, LDH 339.5, or NLR 2.195 independently predicted the presence of LMS.
  • #2 Lineage-defined leiomyosarcoma subtypes emerge years before diagnosis and determine patient survival | Nature Communications
    https://www.nature.com/articles/s41467-021-24677-6
    The established marker for this subtype, ARL4C expression, was overexpressed in subtype 1 LMS, as expected. […] This suggests that LMS subtype 1 may represent an aggressive dedifferentiated form of LMS. […] We found SBS8, linked to a deficiency in nucleotide excision repair, as well as SBS3 and ID6, which are signatures of defective homologous recombination-based DNA damage repair. […] Thus, we are able to confirm the existence of HR-deficiency substitution signatures, albeit at a lower frequency than previously reported, as well as the existence of a corresponding HR-indel signature in LMS. […] The present study suggests that LMS patients should be considered for comprehensive HR profiling for use of mutational signatures as biomarkers of therapy. […] We report that the utility of DNA damage response inhibitors is promising and warrants further exploration.
  • #2 Diagnosis challenges in a uterine leiomyosarcoma | Archive of Clinical Cases
    https://www.clinicalcases.eu/index.php/acc/article/view/351
    Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. […] Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. […] The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. […] At least 5 atypical mitoses/ 10 HPF were also found. […] Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. […] The final histopathological diagnosis was that of uterine LMS. […] Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.
  • #2 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Adjuvant chemotherapy for early stage disease is controversial […] Lymphadenectomy is only indicated if there is evidence of concerning lymph nodes (J Adv Pract Oncol 2022;13:70, StatPearls: Leiomyosarcoma [Accessed 26 October 2022]) […] Adjuvant chemotherapy is indicated for metastatic / recurrent tumors […] Immunotherapy is a potential option for MSI high uterine leiomyosarcoma (Gynecol Oncol Rep 2021;35:100701) […] Sample pathology report […] Myometrium: Leiomyosarcoma […] Tumor size: 15 cm […] Cytologic atypia: diffuse, marked […] Coagulative tumor cell necrosis: present […] Mitotic count: 25 per 10 high power fields […] Lymphovascular invasion: negative […] Margin status: negative […] Other findings: leiomyomata
  • #2 Leiomyosarcoma – Diagnosis & Disease Information for HCPs
    https://www.cancertherapyadvisor.com/ddi/leiomyosarcoma/
    Molecular genetic tests may detect chromosomal aberrations or genetic mutations, which may help to diagnose leiomyosarcoma. […] The tumor is graded according to mitotic count, necrosis, and cellular atypia. This gives an indication of the aggressiveness of the tumor and helps in formulating treatment. Staging determines the local invasiveness and presence of any distant metastasis.
  • #2 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.
  • #2 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    The general principles of radiotherapy for any STS also apply to patients diagnosed with non-uterine leiomyosarcoma. […] Leiomyosarcoma is a tumor with complex and unbalanced karyotypes characterized by severe genomic instability, which results in multiple genetic aberrations. As a result, leiomyosarcoma is considered moderately sensitive to chemotherapy. […] After surgery, adjuvant chemotherapy for a patient diagnosed with STS has primarily been tested in patients with extremity and truncal STS. […] Leiomyosarcoma staging is according to the organ of origin. Uterine leiomyosarcoma staging follows the Federation of Gynecology and Obstetrics (FIGO) staging system. […] The three most important prognostic factors are histologic grade, tumor size, and tumor depth.
  • #2 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Uterus Smooth muscle tumors Leiomyosarcoma […] Diagnosis […] Myomectomy, hysterectomy […] No laboratory values are diagnostic: Some studies suggest leiomyosarcomas have higher levels of lactate dehydrogenase (LDH) versus uterine leiomyoma (BMC Cancer 2020;20:514) […] No pathognomonic findings […] Difficult to distinguish from benign smooth muscle tumors (Curr Opin Oncol 2021;33:464) […] Most common initial imaging modality […] Successfully detects uterine leiomyomas […] Does not differentiate between leiomyomas and leiomyosarcomas […] Advanced imaging modalities show potential diagnostic improvement: Machine learning, Radiomics, Texture analysis (Jpn J Radiol 2022;40:385) […] Most important prognostic factor is stage […] Additional prognostic measures include age, tumor size, mitotic rate and lymphovascular invasion
  • #2 A differential diagnosis between uterine leiomyoma and leiomyosarcoma using transcriptome analysis | BMC Cancer | Full Text
    https://bmccancer.biomedcentral.com/articles/10.1186/s12885-023-11394-0
    The objective of this study was to estimate the accuracy of transcriptome-based classifier in differential diagnosis of uterine leiomyoma and leiomyosarcoma. […] Preoperative differential diagnosis between uterine leiomyoma and leiomyosarcoma is important because it affects treatment and prognosis. […] However, preoperative differential diagnosis between uterine leiomyoma and leiomyosarcoma is difficult. […] We hypothesized that transcriptome analysis would be useful in differential diagnosis between uterine leiomyoma and leiomyosarcoma. […] The transcriptome-based classifier accurately distinguished uterine leiomyosarcoma from leiomyoma. […] A new transcriptome-based classifier was able to accurately distinguish uterine leiomyoma from leiomyosarcoma using data from preoperative biopsy specimens.
  • #2 Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment
    https://trp.cancer.gov/spores/abstracts/umich_sarcoma.htm
    The objectives of Project 3 are to collect and analyze serial liquid biopsy samples from blood samples of more than 200 patients with metastatic LMS enrolled in a randomized prospective clinical trial for circulating tumor DNA (ctDNA) to monitor clinical outcomes and to characterize and validate recurrent patterns of tumor heterogeneity and tumor evolution including the emergence of resistance. […] The specific challenge in LMS diagnosis is amplified with the phrase that the predominant cell resembles a smooth muscle cell. Indeed, accurate IHC staining is required to support the diagnosis. […] Hypothesis: ctDNA may be used as a biomarker of LMS patient prognosis and tumor response to chemotherapy. […] At the conclusion of this project, we anticipate that we will have validated the first dynamic biomarker of prognosis and treatment response for clinical use in patients with LMS.
  • #2 Expert Sheds Light on Uterine Leiomyosarcoma Diagnosis, Treatment
    https://www.onclive.com/view/expert-sheds-light-on-uterine-leiomyosarcoma-diagnosis-treatment
    Kristen N. Ganjoo, MD, discusses the diagnosis, presentation, and management of patients with uterine leiomyosarcoma. […] Many uterine leiomyosarcomas present as metastatic disease after having been misdiagnosed as a fibroid, explained Kristen N. Ganjoo, MD, and although there are treatment options for these patients, an early and accurate diagnosis is the only chance of cure. […] Unfortunately, its really hard to diagnose patients based on an ultrasound or magnetic resonance imaging. If you do a biopsy, you may biopsy a part that is nondiagnostic, said Ganjoo, an associate professor of medicine at Stanford University Medical Center. […] Early diagnosis is extremely important. If the disease is metastatic, then it becomes incurable. […] Usually, these tumors are found in younger women. Many of these women are diagnosed with fibroids, which are a benign form of smooth muscle, [also known as] leiomyomas.
  • #2 Leiomyosarcoma | Macmillan Cancer Support
    https://www.macmillan.org.uk/cancer-information-and-support/soft-tissue-sarcoma/leiomyosarcoma
    Knowing the stage and grade of the cancer helps doctors decide on the best treatment for you. […] A team of specialists meet to discuss the best possible treatment plan for you. This is called a multidisciplinary team (MDT). […] The main treatments for leiomyosarcoma are surgery and radiotherapy. Sometimes chemotherapy is used as well. […] Surgery is the main treatment for leiomyosarcoma. The aim is to remove all of the cancer and an area of healthy tissue around it. […] You may have radiotherapy after surgery to reduce the chance of the cancer coming back. […] Chemotherapy is used less often than radiotherapy. It is sometimes used before or after surgery, or if the cancer cannot be removed with surgery. […] You will have regular check-up appointments at the hospital. Your doctor will examine you and ask about any side effects or symptoms. […] Sometimes side effects may continue or develop months or years after treatment. These are called late effects. […] If you are worried about your fertility it is important to talk with your doctor before you start treatment.
  • #2 Leiomyosarcoma: 7 facts about this rare soft tissue cancer | MD Anderson Cancer Center
    https://www.mdanderson.org/cancerwise/leiomyosarcoma–7-facts-about-this-rare-soft-tissue-cancer.h00-159536589.html
    Leiomyosarcoma is a rare type of cancer that falls into the category of sarcomas, which generally arise from connective tissue. Leiomyosarcoma generally forms in the smooth muscles of the body. […] The gold standard for diagnosis is tissue biopsy of the primary tumor. This can be accomplished by needle biopsy. This is when a needle is used to obtain a sample of cells from the tumor for laboratory testing. […] Its important to have a consultation with an oncologist who is familiar with the disease. The pathologic diagnosis can be difficult, and sometimes review of the biopsy by an expert pathologist is needed. A complete staging is needed before formulating a treatment plan. Once we have an accurate diagnosis and stage, we can work with the patient to come up with the best treatment plan for them.
  • #2 Sarcoma Diagnostic Process | Stanford Health Care
    https://stanfordhealthcare.org/medical-conditions/cancer/sarcoma/patient-care-resources/diagnosis.html
    This overview explains what to expect as you go through diagnosis. […] An accurate diagnosis is critical for your treatment plan. It helps us recommend the most effective treatment options for you, in the right sequence. […] For everyone who comes to us, we start your care by confirming a diagnosis. […] Our team meets with you for a thorough diagnostic evaluation. We gather more information during your first appointment but may still need additional tests to confirm or rule out a diagnosis. […] After this testing, it typically takes a few days to 2 weeks to review the results and confirm your diagnosis. Getting your test results can take time because your care team is working hard to determine an accurate diagnosis for you. […] Many health care professionals collaborate in the process and provide expert analysis, including your oncologist (cancer doctor), radiologist, and pathologist.
  • #2 Leiomyosarcoma | Sarcoma UK
    https://sarcoma.org.uk/about-sarcoma/what-is-sarcoma/types-of-sarcoma/leiomyosarcoma/
    Leiomyosarcomas are usually found by a patient when a lump appears on the leg, arm or trunk. They can also be found during an investigation of other symptoms or during a routine operation. […] A specialist doctor will diagnose leiomyosarcoma through a series of tests. These may include: Physical examination looking at and feeling any lump, A scan taking pictures of the inside of the body using ultrasound, x-ray, CT, EUS, PET or MRI, A biopsy taking and testing a tissue sample. […] You may have a hysteroscopy, which is a procedure used to examine and diagnose problems in the uterus. […] Uterine leiomyosarcomas can often be misdiagnosed as benign fibroids. If the fibroids continue to grow in size after menopause, you should be seen for further examination.
  • #2 Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment
    https://trp.cancer.gov/spores/abstracts/umich_sarcoma.htm
    This SPORE grant is entitled Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment. […] Our goal is to improve the knowledge regarding leiomyosarcoma (LMS) genetics, biology, and therapeutic approaches to rationally develop novel and more effective therapies including combinations of different agents targeting different pathways to exploit unique vulnerabilities. […] Project 1 aims to identify and exploit genomic vulnerabilities in LMS targeting the dependency on the non-homologous end joining DNA repair pathway and the associated enzyme DNA-activated protein kinase (DNA-PK). […] Project 2 focuses on studying the genetic epidemiology of LMS defining the risk for cancer in families with cancer predisposition syndromes such as Li-Fraumeni Syndrome, as well as the general population by evaluating the largest ever cohort of LMS patients.
  • #3 Leiomyosarcoma – Diagnosis & Disease Information for HCPs
    https://www.cancertherapyadvisor.com/ddi/leiomyosarcoma/
    Diagnosing leiomyosarcoma requires a multimodal approach incorporating clinical evaluation, imaging, and histopathological correlation for a confirmed diagnosis. […] The diagnostic evaluation starts with a patient history and physical examination. Important factors include the duration and growth rate of the tumor, previous exposure to ionizing radiation, chronic immunosuppression, and past presence of a benign smooth muscle tumor elsewhere in the body. […] Advanced imaging modalities are required for the initial evaluation, as well as for staging. Magnetic resonance imaging is the most helpful modality for evaluating soft tissue sarcomas because it can provide important information regarding the tumor size, extent, and relationship to contiguous structures. […] A biopsy and histopathological analysis are necessary for a definitive diagnosis. Fine needle aspiration or core needle biopsy is usually done to obtain a tissue sample.
  • #3 Tests for Uterine Sarcoma | American Cancer Society
    https://www.cancer.org/cancer/types/uterine-sarcoma/detection-diagnosis-staging/how-diagnosed.html
    These hormone receptors are found on many endometrial stromal sarcomas and some leiomyosarcomas. […] Cancers with estrogen receptors are more likely to grow with estrogen, while those with progesterone receptors often don’t grow if exposed to progesterone. […] Checking for these receptors helps predict which cancers might benefit from hormone treatment. […] CT scans are rarely used to diagnose uterine sarcoma, but they might be helpful in seeing if the cancer has spread to other organs. […] MRI scans also make cross-section pictures of your insides but use radio waves and strong magnets instead of x-rays. […] An MRI scan can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. […] PET/CT scans can be useful for patients with uterine sarcomas, if your doctor thinks the cancer might have spread but doesn’t know where.
  • #3 Lineage-defined leiomyosarcoma subtypes emerge years before diagnosis and determine patient survival | Nature Communications
    https://www.nature.com/articles/s41467-021-24677-6
    The established marker for this subtype, ARL4C expression, was overexpressed in subtype 1 LMS, as expected. […] This suggests that LMS subtype 1 may represent an aggressive dedifferentiated form of LMS. […] We found SBS8, linked to a deficiency in nucleotide excision repair, as well as SBS3 and ID6, which are signatures of defective homologous recombination-based DNA damage repair. […] Thus, we are able to confirm the existence of HR-deficiency substitution signatures, albeit at a lower frequency than previously reported, as well as the existence of a corresponding HR-indel signature in LMS. […] The present study suggests that LMS patients should be considered for comprehensive HR profiling for use of mutational signatures as biomarkers of therapy. […] We report that the utility of DNA damage response inhibitors is promising and warrants further exploration.
  • #3 Diagnosis challenges in a uterine leiomyosarcoma | Archive of Clinical Cases
    https://www.clinicalcases.eu/index.php/acc/article/view/351
    Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. […] Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. […] The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. […] At least 5 atypical mitoses/ 10 HPF were also found. […] Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. […] The final histopathological diagnosis was that of uterine LMS. […] Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.
  • #3 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Adjuvant chemotherapy for early stage disease is controversial […] Lymphadenectomy is only indicated if there is evidence of concerning lymph nodes (J Adv Pract Oncol 2022;13:70, StatPearls: Leiomyosarcoma [Accessed 26 October 2022]) […] Adjuvant chemotherapy is indicated for metastatic / recurrent tumors […] Immunotherapy is a potential option for MSI high uterine leiomyosarcoma (Gynecol Oncol Rep 2021;35:100701) […] Sample pathology report […] Myometrium: Leiomyosarcoma […] Tumor size: 15 cm […] Cytologic atypia: diffuse, marked […] Coagulative tumor cell necrosis: present […] Mitotic count: 25 per 10 high power fields […] Lymphovascular invasion: negative […] Margin status: negative […] Other findings: leiomyomata
  • #3 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.
  • #3 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    The general principles of radiotherapy for any STS also apply to patients diagnosed with non-uterine leiomyosarcoma. […] Leiomyosarcoma is a tumor with complex and unbalanced karyotypes characterized by severe genomic instability, which results in multiple genetic aberrations. As a result, leiomyosarcoma is considered moderately sensitive to chemotherapy. […] After surgery, adjuvant chemotherapy for a patient diagnosed with STS has primarily been tested in patients with extremity and truncal STS. […] Leiomyosarcoma staging is according to the organ of origin. Uterine leiomyosarcoma staging follows the Federation of Gynecology and Obstetrics (FIGO) staging system. […] The three most important prognostic factors are histologic grade, tumor size, and tumor depth.
  • #3 Genetics and Genomics of Leiomyosarcoma (LMS): Improved understanding of cancer biology and new approaches to diagnosis and treatment
    https://trp.cancer.gov/spores/abstracts/umich_sarcoma.htm
    The objectives of Project 3 are to collect and analyze serial liquid biopsy samples from blood samples of more than 200 patients with metastatic LMS enrolled in a randomized prospective clinical trial for circulating tumor DNA (ctDNA) to monitor clinical outcomes and to characterize and validate recurrent patterns of tumor heterogeneity and tumor evolution including the emergence of resistance. […] The specific challenge in LMS diagnosis is amplified with the phrase that the predominant cell resembles a smooth muscle cell. Indeed, accurate IHC staining is required to support the diagnosis. […] Hypothesis: ctDNA may be used as a biomarker of LMS patient prognosis and tumor response to chemotherapy. […] At the conclusion of this project, we anticipate that we will have validated the first dynamic biomarker of prognosis and treatment response for clinical use in patients with LMS.
  • #3 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    High recurrence rate (50 – 70%) regardless of stage at initial diagnosis […] Poor prognosis even if the tumor is confined to the uterus […] More favorable prognosis if tumor is < 5 cm and confined to the uterus [...] 5 year overall survival (OS) rate for all stages is poor, ranging from 15 to 25% [...] OS rates are more favorable at low stages (1 - 2), ranging from 40 to 70% [...] Morcellation is associated with significantly increased risk of recurrence (Gynecol Oncol 2021;160:99) [...] Risk stratification model, including mitoses > 25 per 2.4 mm² (10 high power fields), atypical mitoses, coagulative necrosis, lymphovascular invasion and serosal abutment, is significantly associated with disease free and disease specific survival in stage I tumors (Mod Pathol 2022;35:794) […] Surgical resection (hysterectomy) is standard treatment for patients with localized leiomyosarcoma
  • #4 Leiomyosarcoma – NCI
    https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-soft-tissue-tumors/leiomyosarcoma
    Symptoms depend on where the tumor is and how big it is. Some people with LMS do not have symptoms when the cancer first starts. Later, when the tumor gets larger, symptoms can include: […] Imaging: If you have symptoms of LMS, your doctor will use imaging scans such as MRI, CT, angiography, and PET to look at where the tumor is and how big it is. They will also check for signs that the tumor has spread to other parts of the body. […] Biopsy: To check if the tumor is LMS, your doctor will do a biopsy, taking a small sample from the tumor with a needle. An expert, called a pathologist, will study cells from the sample under the microscope to see what kind of tumor it is. […] Sometimes, LMS may be mistaken for a different type of tumor or condition using imaging scans. A biopsy will confirm the tumor is LMS. Getting the correct diagnosis is very important in order to get the right treatment.
  • #4 Diagnosis challenges in a uterine leiomyosarcoma | Archive of Clinical Cases
    https://www.clinicalcases.eu/index.php/acc/article/view/351
    Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. […] Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. […] The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. […] At least 5 atypical mitoses/ 10 HPF were also found. […] Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. […] The final histopathological diagnosis was that of uterine LMS. […] Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.
  • #4 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.
  • #4 Tests for Uterine Sarcoma | American Cancer Society
    https://www.cancer.org/cancer/types/uterine-sarcoma/detection-diagnosis-staging/how-diagnosed.html
    These hormone receptors are found on many endometrial stromal sarcomas and some leiomyosarcomas. […] Cancers with estrogen receptors are more likely to grow with estrogen, while those with progesterone receptors often don’t grow if exposed to progesterone. […] Checking for these receptors helps predict which cancers might benefit from hormone treatment. […] CT scans are rarely used to diagnose uterine sarcoma, but they might be helpful in seeing if the cancer has spread to other organs. […] MRI scans also make cross-section pictures of your insides but use radio waves and strong magnets instead of x-rays. […] An MRI scan can help tell if a uterine tumor looks like cancer, but a biopsy is still needed to tell for sure. […] PET/CT scans can be useful for patients with uterine sarcomas, if your doctor thinks the cancer might have spread but doesn’t know where.
  • #4 Leiomyosarcoma – StatPearls – NCBI Bookshelf
    https://www.ncbi.nlm.nih.gov/books/NBK551667/
    The general principles of radiotherapy for any STS also apply to patients diagnosed with non-uterine leiomyosarcoma. […] Leiomyosarcoma is a tumor with complex and unbalanced karyotypes characterized by severe genomic instability, which results in multiple genetic aberrations. As a result, leiomyosarcoma is considered moderately sensitive to chemotherapy. […] After surgery, adjuvant chemotherapy for a patient diagnosed with STS has primarily been tested in patients with extremity and truncal STS. […] Leiomyosarcoma staging is according to the organ of origin. Uterine leiomyosarcoma staging follows the Federation of Gynecology and Obstetrics (FIGO) staging system. […] The three most important prognostic factors are histologic grade, tumor size, and tumor depth.
  • #4 Pathology Outlines – Leiomyosarcoma
    https://www.pathologyoutlines.com/topic/uteruslms.html
    Adjuvant chemotherapy for early stage disease is controversial […] Lymphadenectomy is only indicated if there is evidence of concerning lymph nodes (J Adv Pract Oncol 2022;13:70, StatPearls: Leiomyosarcoma [Accessed 26 October 2022]) […] Adjuvant chemotherapy is indicated for metastatic / recurrent tumors […] Immunotherapy is a potential option for MSI high uterine leiomyosarcoma (Gynecol Oncol Rep 2021;35:100701) […] Sample pathology report […] Myometrium: Leiomyosarcoma […] Tumor size: 15 cm […] Cytologic atypia: diffuse, marked […] Coagulative tumor cell necrosis: present […] Mitotic count: 25 per 10 high power fields […] Lymphovascular invasion: negative […] Margin status: negative […] Other findings: leiomyomata
  • #5 Leiomyosarcoma – NCI
    https://www.cancer.gov/pediatric-adult-rare-tumor/rare-tumors/rare-soft-tissue-tumors/leiomyosarcoma
    Symptoms depend on where the tumor is and how big it is. Some people with LMS do not have symptoms when the cancer first starts. Later, when the tumor gets larger, symptoms can include: […] Imaging: If you have symptoms of LMS, your doctor will use imaging scans such as MRI, CT, angiography, and PET to look at where the tumor is and how big it is. They will also check for signs that the tumor has spread to other parts of the body. […] Biopsy: To check if the tumor is LMS, your doctor will do a biopsy, taking a small sample from the tumor with a needle. An expert, called a pathologist, will study cells from the sample under the microscope to see what kind of tumor it is. […] Sometimes, LMS may be mistaken for a different type of tumor or condition using imaging scans. A biopsy will confirm the tumor is LMS. Getting the correct diagnosis is very important in order to get the right treatment.
  • #5 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.
  • #5 Diagnosis challenges in a uterine leiomyosarcoma | Archive of Clinical Cases
    https://www.clinicalcases.eu/index.php/acc/article/view/351
    Uterine leiomyosarcoma (LMS) represents a rare tumor, accounting for 1.3% of all uterine malignancies. […] Although this tumor shares morphological and clinical features with other uterine benign and malignant tumors, the accurate diagnosis is necessary, due to their different biological behavior and prognosis. […] The microscopic examination of this tumor nodule revealed fascicles of spindle cells, with pleomorphic hyperchromatic nuclei exhibiting moderate to severe atypia and areas of tumor necrosis. […] At least 5 atypical mitoses/ 10 HPF were also found. […] Immunohistochemistry technique, with a panel of six antibodies, comprising ER, PR, PCNA, SMA, p53, and bcl-2, has been performed for the differential diagnosis. […] The final histopathological diagnosis was that of uterine LMS. […] Considering LMS an aggressive tumor, the patient has been recommended a thorough follow-up.
  • #6 Leiomyosarcoma differential diagnosis – wikidoc
    https://www.wikidoc.org/index.php/Leiomyosarcoma_differential_diagnosis
    Leiomyosarcoma must be differentiated from other soft tissue tumors, some variants of leiomyoma resembles malignant tumor. Other possible differential diagnosis of leimyosarcoma include, epithelioid endometrial stromal sarcoma, epithelioid angiosarcoma. […] The table below summarizes the findings that differentiate Leiomyosarcoma from other conditions that may cause similar signs and symptoms. […] In uterine leiomyosarcomas (LMSs) p16 is overexpressed compared with leiomyoma. […] Features such as tumor localization, irregular or nodular margins, necrosis, rapid growth, intense contrast enhancement, and restriction at diffusion-weighted imaging can suggest the diagnosis and help differentiate from more common leiomyomas and endometrial carcinoma. […] Women with sarcoma vs women with fibroids, tend to be older.

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angiografia mięśnie gładkie receptory progesteronowe sekwencjonowanie genetyczne biopsja chirurgiczna białko p53 mięsak naczyniowy krążące DNA guza morfologia krwi biopsja gruboigłowa białko p16 martwica koagulacyjna rezonans magnetyczny klasyfikacja FIGO dehydrogenaza mleczanowa wywiad lekarski płynna biopsja inhibitory PARP pozytonowa tomografia emisyjna ultrasonografia receptory estrogenowe system TNM atypia cytologiczna tomografia komputerowa stosunek neutrofilów do limfocytów aktyna mięśni gładkich badanie ginekologiczne analiza cytogenetyczna leiomyosarcoma białko C-reaktywne mięśniak gładkokomórkowy