Uterus
General
Staging-sarcoma
Last author update: 22 January 2019
Last staff update: 14 June 2023
Copyright: 2019-2024, PathologyOutlines.com, Inc.
PubMed Search: Staging corpus uteri sarcoma
Cite this page: Parra-Herran C. Staging-sarcoma. PathologyOutlines.com website. https://www.pathologyoutlines.com/topic/uterusstagingsarcoma.html. Accessed December 24th, 2024.
Pathologic TNM staging of sarcoma of the corpus uteri, AJCC 8th edition and FIGO 2018 update
Definition / general
- Both AJCC Cancer Staging Manual (8th edition) and the International Federation of Gynecology and Obstetrics (Fédération Internationale de Gynécologie et d'Obstétrique, FIGO) 2018 update have a new chapter on staging of uterine sarcomas, with staging classifications separate from uterine carcinoma
- FIGO uses surgical / pathologic staging for uterine sarcomas; the diagnosis of uterine sarcoma is often difficult based on clinical and radiologic findings
- Initial stage should not be changed due to disease progression or recurrence
- Staging classification of adenosarcoma differs from that of leiomyosarcoma, endometrial stromal sarcoma and other pure sarcomas of the uterus
- Most adenosarcomas arise in the endometrium and stage depends on the presence and depth of myometrial invasion
- Leiomyosarcoma and endometrial stromal sarcoma, on the other hand, are universally myoinvasive and stage depends on tumor size and extrauterine spread
- AJCC / TNM system now includes N0(i+) category for isolated tumor cells (ITCs)
Primary tumor [pT] and FIGO () stage
Uterine leiomyosarcoma and endometrial stromal sarcoma
- pTX: primary tumor cannot be assessed
- pT0: no evidence of primary tumor
- pT1 (I): tumor confined to the uterus
- pT1a (IA): tumor ≤ 5 cm in greatest dimension
- pT1b (IB): tumor > 5 cm
- pT2 (II): tumor extends beyond the uterus, within the pelvis
- pT2a (IIA): tumor involves adnexa
- pT2b (IIB): tumor involves other pelvic tissues
- pT3 (III): tumor infiltrates abdominal tissues (lesions must not just protrude into abdominal cavity)
- pT3a (IIIA): tumor infiltrates abdominal tissues in 1 site
- pT3b (IIIB): tumor infiltrates abdominal tissues in > 1 site
- pT4 (IVA): tumor invades bladder or rectum
Uterine adenosarcoma
- pTX: primary tumor cannot be assessed
- pT0: no evidence of primary tumor
- pT1 (I): tumor limited to the uterus
- pT1a (IA): tumor limited to the endometrium / endocervix
- pT1b (IB): tumor invades < 50% of the myometrium
- pT1c (IC): tumor invades ≥ 50% of the myometrium
- pT2 (II): tumor extends beyond the uterus, within the pelvis
- pT2a (IIA): tumor involves adnexa
- pT2b (IIB): tumor involves other pelvic tissues
- pT3 (III): tumor infiltrates abdominal tissues (lesions must not just protrude into abdominal cavity)
- pT3a (IIIA): tumor infiltrates abdominal tissues in 1 site
- pT3b (IIIB): tumor infiltrates abdominal tissues in > 1 site
- pT4 (IVA): tumor invades bladder or rectum
Regional lymph nodes [pN] and FIGO () stage
- pNX: regional lymph nodes cannot be assessed
- pN0: no regional lymph node metastasis
- pN0(i+): isolated tumor cells in regional lymph node(s) ≤ 0.2 mm
- pN1 (IIIC): regional lymph node metastasis
Stage grouping and FIGO stage
Uterine leiomyosarcoma and endometrial stromal sarcoma
| Stage I: | T1 | N0 | M0
|
| Stage IA: | T1a | N0 | M0
|
| Stage IB: | T1b | N0 | M0
|
| Stage II: | T2 | N0 | M0
|
| Stage IIIA: | T3a | N0 | M0
|
| Stage IIIB: | T3b | N0 | M0
|
| Stage IIIC: | T1 - 3 | N1 | M0
|
| Stage IVA: | T4 | any N | M0
|
| Stage IVB: | any T | any N | M1
|
Uterine adenosarcoma
| Stage I: | T1 | N0 | M0
|
| Stage IA: | T1a | N0 | M0
|
| Stage IB: | T1b | N0 | M0
|
| Stage IC: | T1c | N0 | M0
|
| Stage II: | T2 | N0 | M0
|
| Stage IIIA: | T3a | N0 | M0
|
| Stage IIIB: | T3b | N0 | M0
|
| Stage IIIC: | T1 - 3 | N1 | M0
|
| Stage IVA: | T4 | any N | M0
|
| Stage IVB: | any T | any N | M1
|
Board review style question #1
Currently, staging of uterine sarcoma:
- Divides stage T3 / III disease depending on the number of abdominal sites involved by tumor
- Follows the same staging classification of uterine carcinoma
- Has a unified staging classification for pure mesenchymal and mixed epithelial mesenchymal tumors
- Incorporates lymphovascular space invasion as a staging criterion
- Incorporates tumor grade as a staging criterion
Board review style answer #1
A. Divides stage T3 / III disease depending on the number of abdominal sites involved by tumor (IIIA: 1 site involved; IIIB: > 1 site involved). The 8th edition of AJCC and FIGO (2015 and 2018 updates) have a separate staging classification for uterine sarcomas, separate from uterine carcinoma staging. It contains two staging systems: one for leiomyosarcoma and endometrial stromal sarcoma (and one can guess, other pure uterine sarcomas) and a second one for adenosarcoma. Carcinosarcoma is staged as a uterine carcinoma. Tumor grade and lymphovascular space invasion are not required for staging purposes.
Comment here
Reference:
Uterus - Staging - corpus uteri - sarcoma
Back to top
