A 71 y.o. woman presents with nausea and vomiting. Do you see a reason?

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Our patient had a uterine sarcoma causing a small bowel obstruction.  While fibroids are present in 70% of women by age 50; uterine sarcomas represent only 4% of uterine malignancies. Most tumors occur after menopause and often they occur in the setting of pre existing fibroids. Sarcomas are more likely in women taking tamoxifen and African American women.

Sarcomas by definition have > 10 mitoses per high powered field. They are defined by the extent of their spread. Type 1 is confined to the uterus, Type 2 involves leiomyomatosis involving tumor growth within veins which can spread to the heart and type 3 involves  tumor which has metastasized to distant organs like lung or lymph nodes.  Five year survival for type 1 is 63%, type 2 is 35% and type 3 five year survival is 14%. 

 uterine sarcoma

uterine sarcoma

Our patient underwent a hysterectomy and resection of small bowel which was involved with tumor.  She is doing well.

Galducci A, Cosio S, Romamini A, Genazzani AR. The Management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol. 2008. 65(2) 129-42.

Zagouri F, Dimopoulos AM,Fotiou S, Kouloulias V, Papadimitriou CA. Treatment of early uterine sarcoma: disentangling adjuvant modalities. World J Surg oncol. 7:381477-7819-7-38.

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