Stadification FIGO : VII) Evolution :

Dans le document Sarcomes utérins (Page 86-109)

Fiche d’Exploitation des dossiers N° Dossier :

VI) Stadification FIGO : VII) Evolution :

Î Rémission complète : oui … non … Î Rémission partielle : oui … non … Î Progression : oui … non … Î Récidive : oui … non …

Si oui : Locale … Métastatique … Intervalle de récidive :

ÎPerdue de vue : oui … non …

Si oui : Précoce … Tardive … Durée de suivi

Les sarcomes utérins sont des tumeurs rares, caractérisées par une diversité histopathologique et clinique importante et un pronostic médiocre. Nous avons analysé les difficultés diagnostiques, thérapeutiques et pronostiques posés par ces tumeurs en insistant sur un diagnostic précoce à partir de treize cas recensés au service d’anatomie pathologique du CHU Mohammed VI de Marrakech entre 2000-2007. Notre étude a permis de dégager les résultats suivant : L’âge moyen des patientes était de 55 ans. 77 % étaient ménopausées. Les circonstances de découverte étaient dominées par les ménomètrorragies et les douleurs pelviennes. La clinique n’a permis d’apporter le diagnostic chez aucune patiente. L’échographie était en faveur d’un fibrome chez trois patientes. Le diagnostic était connu en préopératoire chez quatre patientes grâce à l’examen histopathologique de deux polypectomies, d’une biopsie tumorale et d’un curetage biopsique de l’endomètre ce qui a permis de bien codifier le traitement chirurgical. Une hystérectomie totale avec annexectomie bilatérale, constituant le traitement standard des sarcomes utérins, a été pratiquée dans 76 % des cas. La radiothérapie adjuvante a montré dans la littérature un bénéfice en terme de contrôle local mais sans bénéfice sur la survie globale. Le rôle de la chimiothérapie n’est pas encore clairement défini. Le sarcome du stroma endométrial de bas grade et l’adénosarcome sont réputés de pronostic meilleur que les autres types histologiques. Le stade d’extension tumoral est le facteur pronostique le plus puissant. En attendant de nouvelles stratégies thérapeutiques efficaces pour la prise en charge des sarcomes utérins, un diagnostic précoce en préopératoire ou en peropératoire s’avère nécessaire.

Abstract

Uterine sarcoma tumors are rare, characterized by an important clinical and histopathological diversity and a poor prognosis. We analyzed the diagnostic, therapeutic and prognostic difficulties posed by these tumours with emphasis on early diagnosis from thirteen cases in pathology department of the Mohammed VI university hospital in Marrakech between 2000-2007. Our study identified the following results: The average age of patients was 55 years. 77% were postmenopausal. The circumstances of discovery were dominated by vaginal bleeding and pelvic pain. The clinic has helped to make the diagnosis in any patient. Ultrasonography was in favour of a fibroma in three patients. The diagnosis was known preoperatively in four patients with the histopathological examination of two polypectomies; a tumor sampling and an endometrial curreting which helped codifies the treatment well. A total hysterectomy with salpingo-oophorectomy, is the standard treatment for uterine sarcomas, was performed in 76% of cases. In the literature, adjuvant radiotherapy has shown a benefit in terms of local control but without benefit on overall survival. The role of chemotherapy is not yet clearly defined. The low grade ESS as adenosarcoma are deemed better prognosis than other histological types. The tumour staging is the most powerful prognostic factor. Pending new therapeutic strategies effective for the treatment of uterine sarcomas, early diagnosis with preoperative or intraoperative proves necessary.

ﻊﻳﺮﺳ رﻮهﺪﺘﺑ و يﺮﻳﺮﺳ و ﻲﺠﻴﺴﻧ عﻮﻨﺘﺑ ﺰﻴﻤﺘﺗ ﻲﺘﻟا ﺔﺜﻴﺒﺨﻟا و ةردﺎﻨﻟا ماروﻷا ﻦﻣ ﻢﺣﺮﻟا نﺮﻏ ﺮﺒﺘﻌﻳ

ضﺮﻤﻠﻟ

.

ﺪﻳﺪﺸﺘﻟا ﻊﻣ ماروﻷا ﻩﺬﻬﻟ ﺔﻴﺝﻼﻌﻟا و ﺔﻴﺼﻴﺨﺸﺘﻟا تﺎﺑﻮﻌﺼﻟا ﻰﻠﻋ ءﻮﻀﻟا ﻂﻴﻠﺴﺗ ﺎﻨﻟوﺎﺣ ﺚﺤﺒﻟا اﺬه ﻲﻓ

ﻜﺒﻤﻟا ﺺﻴﺨﺸﺘﻟا ﺔﻴﻤهأ ﻰﻠﻋ

.

ﺔﺤﻠﺼﻤﺑ ﺎﻬﺼﻴﺨﺸﺗ ﻢﺗ ﺔﻟﺎﺣ ﺮﺸﻋ ﺔﺙﻼﺜﻟ ﺔﻴﻌﺝر ﺔﺳارﺪﺑ ﻚﻟﺬﻟ ﺎﻨﻌﺘﺳا ﺪﻗ و

ﻲﺘﻨﺳ ﻦﻴﺑ ﺎﻣ ﺶآاﺮﻤﺑ سدﺎﺴﻟا ﺪﻤﺤﻣ ﻲﻌﻣﺎﺠﻟا ﻰﻔﺸﺘﺴﻤﻠﻟ ﻲﺽﺮﻤﻟا ﺢﻳﺮﺸﺘﻟا

2000

و

2007

.

تﺎﻀﻳﺮﻤﻟا ﺮﻤﻋ لﺪﻌﻣ ﻎﻠﺑ

55

، ﺔﻨﺳ

77

%

سﺄﻴﻟا ﻦﺳ ﻲﻓ ﻦآ

.

ﻒﻳﺰﻨﻟا ﻲﻓ ضاﺮﻋﻷا ﻢهأ ﻞﺜﻤﺘﺗ

ﻲﻠﺒﻬﻤﻟا

ﺔﻴﺽﻮﺤﻟا مﻻﻵا و

.

ﻦﻜﻤﻳ ﻢﻟ

ﺔﻀﻳﺮﻣ ﺔﻳأ ﺪﻨﻋ ضﺮﻤﻟا ﺺﻴﺨﺸﺗ ﻦﻣ يﺮﻳﺮﺴﻟا ﺚﺤﺒﻟا

.

ﻂﻴﻄﺨﺘﻟا ﺪﺝوو

تﺎﻀﻳﺮﻣ ثﻼﺙ ﺪﻨﻋ ﻢﺣﺮﻠﻟ ﻲﻔﻴﻠﻟا مرﻮﻠﻟ ﺔﻠﺙﺎﻤﻣ ةرﻮﺹ ىﺪﺼﻟﺎﺑ

.

ﻊﺑرأ ﺪﻨﻋ ﺔﺣاﺮﺠﻟا ﻞﺒﻗ ﺺﻴﺨﺸﺘﻟا فﺮﻋ

ﻞﺜﻤﺘﺗ ﻲﺘﻟا و ﺔﺒﺳﺎﻨﻤﻟا ﺔﻴﺣاﺮﺠﻟا ﺔﻴﻠﻤﻌﻟا ﺬﻴﻔﻨﺗ ﻦﻣ ﻦﻜﻣ ﺎﻤﻣ ،مرﻮﻟا ﻦﻣ تﺎﻨﻴﻌﻟ ﺔﻴﺠﻴﺴﻧ ﺔﺳارد ﻞﻀﻔﺑ تﺎﻀﻳﺮﻣ

ا لﺎﺼﺌﺘﺳا ﻲﻓ

ﻦﻴﻀﻴﺒﻤﻟا و بﻮﻟﺎﻓ ﻲﺗﺎﻨﻗ ﻊﻣ ﻢﺣﺮﻟ

.

ضﺮﻤﻟا ﺮﺼﺣ ﻲﻓ ﻂﻘﻓ ﺪﻋﺎﺴﻳ ﻮﻬﻓ زﺰﻌﻤﻟا عﺎﻌﺸﺘﺳﻹا ﺎﻣأ

ﺪﻌﺑ ﺎﺤﺽاو ﺲﻴﻟ يوﺎﻤﻴﻜﻟا جﻼﻌﻟا رود ﺎﻤﻨﻴﺑ ﺎﻴﻠﺤﻣ

.

ﺔﻳﺆﺒﻨﺘﻟا ﻞﻣاﻮﻌﻟا ﻢهأ ﻦﻣ ضﺮﻤﻟا رﺎﺸﺘﻧا ﺔﻠﺣﺮﻣ ﺮﺒﺘﻌﺗ

ضﺮﻤﻠﻟ

.

قﺮﻃ ﻒﺸﺘﻜﻧ نأ رﺎﻈﺘﻧا ﻲﻓ ﻢﻬﻣ ﺔﺣاﺮﺠﻟا ءﺎﻨﺙأ وأ ﻞﺒﻗ ﺮﻜﺒﻤﻟا ﺺﻴﺨﺸﺘﻟﺎﻓ ﻲﻟﺎﺘﻟﺎﺑ و

جﻼﻌﻠﻟ ةﺪﻳﺪﺝ

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