Clinical Characteristics Differentiating Uterine Sarcoma and Fibroids

Uterine fibroids are a common indication for laparoscopy. Unsuspected sarcoma can pose a serious risk if morcellation is used in the procedure. We sought to determine the clinical factors associated with uterine sarcoma compared with uterine fibroids.

We conducted a case-control study of 66 women who had hysterectomy for uterine sarcoma from April 1, 2007, to March 31, 2014. Sixty-six patients who had hysterectomy for fibroids were randomly selected as controls.

Women with sarcoma vs women with fibroids, tended to be older (mean ± SD 62.1 ± 10.1 vs 46.5 ± 6.6; P < .0001), were more likely to be postmenopausal (81.8% vs 9.2%; P < .0001), and were more likely to have a history of another nonuterine malignancy (16.7% vs 4.6%; P = .02). Women with sarcoma were more likely to have masses that were subserosal (69.4% vs 34.8%; P < .0001), rather than intramural (11.1% vs 37.0%; P = .01), and to have a solitary rather than multiple uterine mass (56.3% vs 18.5%; P < .0001). They were also more likely to have a history of documented rapid growth (16.7% vs 4.6%; P = .02).

Despite limitations in sample size related to infrequency of uterine sarcoma, our results suggest some preoperative clinical differences between women who have uterine sarcoma vs uterine fibroids. Further studies on such features may assist us in identifying patients who are at higher risk of having a uterine sarcoma among women with a uterine mass contemplating surgery.