Uterine fibroids are not terrible, and they are afraid of rapid enlargement at this time

Ms. Fang found a uterine mass of about two centimeters in her physical examination two years ago, and she thought to herself: Many colleagues in the unit have uterine fibroids, there is no big problem. Leave it alone. Ms. Fang has been menopausal this year, but a recent physical examination found that the fibroids have grown by two centimeters. The lady below was in a hurry and rushed to the doctor. After surgical treatment and pathological examination, Ms. Fang originally thought that it was a mass of uterine fibroids, but was diagnosed as "uterine sarcoma", and the degree of malignancy was extremely high...

Several of Ms. Fang's colleagues, while caring for Ms. Fang, are also very worried about their fibroids that have grown for many years, and have come to consult how to know whether they have benign uterine fibroids or malignant uterine sarcomas?

Isn't that worry superfluous?

Next, Xiaobian takes you to find out.

Do uterine fibroids change?

Uterine fibroids are very common benign tumors, most common in women aged 30-50 years, and about 20% of women over 30 years of age have uterine fibroids. Uterine sarcoma is very rare, with an incidence of about 3/100,000 to 7/100,000. However, there are always uterine fibroid patients who will worry: how to say that it is a tumor, will it change viciously? In fact, the probability of malignancy of uterine fibroids is small, and about <1% of uterine fibroids have the opportunity to "sarcoma change". Therefore, the vast majority of fibroids will not change!

What are the risk factors for uterine sarcoma?

Risk factors for uterine sarcoma are not well understood, and known ones include:

First, fibroids and sarcoma common risk factors - race

The incidence of uterine fibroids/uterine sarcoma in black women is about 2 times higher than in white women.

II. Risk factors specific to uterine sarcoma

● Increasing age and postmenopausal status

Uterine fibroids generally grow up gradually during childbearing age, and fibroids generally do not change in size or shrink after menopause. Postmenopausal estrogen therapy may result in slight enlargement of uterine fibroids, but generally does not induce the emergence of new fibroids.

Most uterine sarcomas occur after menopause, with an average age of 60 years of diagnosis, and increasing age is an important risk factor for uterine sarcoma. However, the young age of the patient does not completely exclude the diagnosis of uterine sarcoma, because there are also reports of uterine sarcoma in young patients aged 25 years.

In postmenopausal patients, new or enlarging uterine masses are further evaluated for uterine sarcoma. In patients who are treated with estrogen after menopause and have only a slight increase in premenopausal confirmed leiomyomas, suspicion may be reduced, and postmenopausal estrogen therapy may be tried to stop postmenopausal therapy to see if the fibroids resolve.

● Tamoxifen

There is an increased risk of developing uterine sarcoma with long-term use of tamoxifen (5 years or more).

● Other risk factors

Pelvic radiation therapy, childhood history of retinoblastoma, hereditary leiomyomatous disease, and renal cell carcinoma (HLRCC) syndrome.

What are the similarities and differences between uterine sarcomas and fibroids?

●From the point of view of symptoms and signs

Both uterine fibroids and sarcomas may present with abnormal uterine bleeding, pelvic pain/compression, and pelvic lumps, making them difficult to distinguish from. Sarcoma may be suspected in premenopausal women when they experience bleeding and significant pain that is disproportionate to the size of the uterus.

●From the point of view of auxiliary inspection

Gynaecological examination — All patients with pelvic mass should have a comprehensive gynaecological examination. Unfortunately, there are currently no pelvic test results that can distinguish between uterine fibroids and uterine sarcomas.

Imaging — Imaging manifestations of uterine fibroids and sarcomas are similar, both focal masses in the uterus that can present with central necrosis. There is currently no pelvic imaging to adequately diagnose uterine sarcoma. When uterine sarcoma is suspected based on ultrasound, pelvic enhancement MRI may be helpful in assessing the likelihood of sarcoma.

●Judging from other test results

Rapid enlargement of uterine mass before menopause – Rapid growth of uterine mass has long been thought to be a sign of underlying uterine sarcoma. However, most patients with a rapidly enlarged uterine or uterine mass may not have a uterine sarcoma. In contrast, postmenopausal patients with new uterine masses or slow or rapid growth of uterine masses should be evaluated for uterine sarcoma.

Large or single uterine masses — Retrospective studies have reported that uterine sarcomas are usually the largest (or only) mass in the uterus, with an average diameter of 7–9 cm. However, uterine fibroids may also be single and can be of any size.

Endometrial sampling — A minimally invasive procedure that is indicated for many patients with abnormal uterine bleeding to rule out endometrial tumors, but only 33% to 68% of patients with uterine sarcoma can make a preoperative diagnosis with endometrial sampling.

Overall, uterine fibroids are the most common pelvic benign tumor in women (lifetime risk is 70%-80%), while uterine sarcomas are rare. The likelihood of finding sarcoma in patients with intra-uterine masses is 0.05% to 0.28%. Therefore, there is no need to worry too much about having uterine fibroids.

Finally scratch the point!

Rapidly enlarging uterine masses before menopause are not a reliable sign of uterine sarcoma. If it is a new or growing uterine mass after menopause, it is necessary to be vigilant.

Author: Zhang Xiaodan

Review: Wang Jue, Qiu Junjun

Editor: Li Miaoran

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