Uterine
sarcomas comprise
leiomyosarcoma,
endometrial stromal sarcoma,
adenosarcoma, undifferentiated endometrial
sarcoma, and their variants.
Carcinosarcoma is historically classified as
sarcoma, but it is now regarded as a metaplastic
carcinoma. Uterine
sarcomas are rare, and are traditionally staged in the same way as
endometrial carcinoma. Because of their different clinical and
biological behaviours, the International Federation of Gynecology and Obstetrics introduced a new staging system in 2009 for
leiomyosarcoma,
endometrial stromal sarcoma and
adenosarcoma, and
carcinosarcoma, respectively. Following an extensive literature review no good evidence was found to support the modification of the staging system. This is mainly because of the rarity of the
sarcomas and the heterogeneity of the reports, the different diagnostic criteria and treatments changing over the decades the retrospective nature and small sample size in most studies, and the lack of uniform pathological review even in large studies. Currently, evidence is still lacking about the use of preoperative imaging for staging purpose, and uterine
sarcomas remain to be surgically staged. Total
hysterectomy is the cornerstone for both staging and treatment. Newer evidence shows that routine
lymphadenectomy and bilateral
salpingo-oophorectomy may not be necessary, unless in the presence of extra-uterine spread, suspicious ovaries or lymph nodes, and certain poor histological types, such as undifferentiated endometrial
sarcoma and
adenosarcoma with sarcomatous overgrowth. More research and data collection are definitely needed in order to verify and further revise the current staging systems.