Do you routinely perform bilateral oophorectomy at the time of hysterectomy for a premenopausal woman with a uterine leiomyosarcoma that appears to be limited to the uterus?
How do you manage a uterine leiomyosarcoma that appears to be limited to the uterus in a premenopausal woman?
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Since this is an unusual cancer, there is not a whole lot of data on this subject. Having said that, the literature has suggested that the chance of ovarian mets in a stage 1, 11 is 2-5%. As a result, this factor is not a major consideration in regards to survival. In a patient so presented, would not routinely do a BSO as the benefits of leaving them seem to outweigh removing possible micromets.
Most LMS are diagnosed in the path lab so doing a BSO at the time of hysterectomy in a premenopausal woman is probably not usually under consideration. I certainly would not go back and do a later BSO.
I don't think hormone status has any bearing on the subject. Unfortunately, this diagnosis carries a very limited prognosis so keep the patient comfortable--not hot flushes, sleepless nights, etc.