••• Chapter 45^ Uterine Sarcomas^453
❍ What therapy is recommended for disseminated peritoneal leiomyomatosis?
This is a benign condition often associated with oral contraceptive use or pregnancy. No specific therapy is
required, though discontinuation of oral contraceptives or resolution of a pregnancy often results in regression.
❍ How does the development of a leiomyosarcoma within a benign leiomyoma affect prognosis?
This is considered to be a favorable prognostic feature.
❍ Are leiomyosarcomas generally solitary or multifocal lesions?
Unlike leiomyomata, they are usually solitary lesions.
❍ What prognostic feature best predicts recurrence-free interval for early stage leiomyosarcomas?
Mitotic index.
❍ What is the effect of adjuvant radiation therapy on early stage leiomyosarcomas?
Though not demonstrated in all studies, pelvic recurrences are reduced by almost 50%.
Pelvic radiation does not prevent distant recurrences and has yet to be shown to improve survival.
❍ What are the most active chemotherapeutic agents in leiomyosarcomas?
Adriamycin has an overall response rate of 25%.
Combination therapy with gemcitabine and docetaxel has also shown to have efficacy.
Smaller studies have found efficacy with aromatase inhibitors.
❍ What two histologic components must be present to make the diagnosis of a carcinosarcoma?
Carcinosarcomas are composed of an admixture of malignant epithelial (carcinoma) and stromal (sarcoma)
components, hence the name carcinosarcoma.
❍ How does an adenosarcoma differ histologically from a carcinosarcoma?
The epithelial component of an adenosarcoma is benign.
❍ How does race affect the incidence of carcinosarcoma?
The relative risk is greater for black women as compared with white women and rises at a disproportionately
greater rate with advancing age.
❍ What is the most common epithelial histologic subtype in a carcinosarcoma?
Approximately 60% are endometrioid followed in order of decreasing frequency by adenosquamous, serous, and
clear cell histologies.
❍ What proportion of carcinosarcomas contains heterologous stromal elements?
Approximately 50% of cases.
❍ What is the most common heterologous stromal component in a carcinosarcoma?
Rhabdomyosarcoma followed by chondrosarcoma and osteosarcoma.