Uterus
Miscellaneous
Staging - corpus uteri - sarcoma


Topic Completed: 22 January 2019

Minor changes: 7 October 2019

Copyright: 2019, PathologyOutlines.com, Inc.

PubMed Search: Staging corpus uteri sarcoma

Carlos Parra-Herran, M.D.
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Cite this page: Parra-Herran C. Staging - corpus uteri - sarcoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/uterusstagingsarcoma.html. Accessed July 7th, 2020.

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)
Essential features
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
Distant metastasis [pM] and FIGO () stage
  • pM0: no distant metastasis
  • pM1 (IVB): distant metastasis (excludes adnexa, pelvic and abdominal tissues)
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:

  1. Divides stage T3 / III disease depending on the number of abdominal sites involved by tumor
  2. Follows the same staging classification of uterine carcinoma
  3. Has a unified staging classification for pure mesenchymal and mixed epithelial mesenchymal tumors
  4. Incorporates lymphovascular space invasion as a staging criterion
  5. Incorporates tumor grade as a staging criterion
Board review 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.

Reference: Uterus - Staging - corpus uteri - sarcoma

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