RETROSPECTIVE ANALYSIS OF SARCOMAS OF THE UROGENITAL SYSTEM

Abstract

Abstract

Introduction: Sarcomas account for only about 1% of all malignant tumors. Less than 5% of soft tissue

sarcomas arise from the genitourinary tract, accounting for only 1 to 2% of all malignant genitourinary

tumors. Because of the rarity of these tumors, the basic problem in the management of these tumors is the lack

of a uniform approach for staging and treatment. Although sarcomas arise from different organs in the

genitourinary tract and compromise different histopathological features, the main treatment modality is

surgical resection of the tumor. The aim of this study is to evaluate the clinical and pathological features and

prognosis of genitourinary tumors treated in our clinic.

Materials and Methods: Between 1997 and 2003, after excluding the gynecological sarcomas, a total of 15

genitourinary sarcomas were treated in our clinic. All patients were evaluated with a detailed medical history,

physical examination, multiple serum analyses and imaging modalities such as ultrasonography, computed

tomography and magnetic resonance imaging if needed. Thus, tru-cut biopsy was performed if indicated. For

all patients, the primary treatment modality was open surgical resection. In addition to surgery, some of these

patients also received adjuvant radiation therapy and/or chemotherapy. For staging, Memorial Sloan-

Kettering Cancer Center soft tissue sarcoma staging system was used. Post-operative follow-up was done in

regular intervals.

Results: The mean age of patients was 50.4 ±14.7 (16-69) years and the mean tumor size was 8±3.5 cm.

The chief complaints (one or more) of these patients were hematuria in 9, flank pain in 7, weight loss in 6,

abdominal pain in 5, abdominal mass in 4, lower urinary tract symptoms in 3. Five bladder, six kidney, three

retroperitoneal and one prostate sarcoma were detected in three women and 12 men. Histopathology of these

tumors were leiomyosarcomas in nine, liposarcomas in three, rhabdomyosarcomas in two, malignant fibrous

histiocytoma in one of the patients. Of these tumors, three were low grade and 12 were high grade. All patients

except one underwent open surgical resection of the tumors. For five patients surgical resection was the only

treatment modality, while eleven patients received adjuvant chemotherapy and/or radiotherapy after surgery.

After a follow-up of 10.2± 4.7 (3-20) months, overall survival rate was found to be 20% (3/15).

Conclusion: Genitourinary sarcomas are a rare group of tumors with a generally poor prognosis.

Complete surgical resection is still the mainstay of treatment. Further large scale studies, are needed to better

understand the major prognostic determinants of these tumors and to identify specific treatments.