Low-grade uterine leiomyosarcoma (uLMS) that is hormone receptor positive and metastatic represents a distinct, indolent clinical subgroup. This subpopulation behaves differently from the more common high-grade uLMS, and management decisions should account for its characteristic biological behaviour.
Confirmed low-grade uterine leiomyosarcoma, hormone receptor positive, with metastatic spread and no evidence of transformation to high-grade disease. Cases in this category are sometimes initially diagnosed as STUMP (smooth muscle tumor of uncertain malignant potential) and carry a lower recurrence risk than high-grade uLMS. Hormone receptor positivity is a clinically relevant feature of this subgroup.
For indolent low-grade metastatic disease, an initial management strategy exists that does not necessarily begin with systemic cytotoxic therapy — the full protocol details the recommended first-line approach and its supporting evidence.
Complete recommendations, including criteria for intervention and subsequent lines of therapy, are available in the full structured protocol.
DOI: 10.1136/ijgc-2024-005823
There is a small subgroup of patients with uLMS that are often diagnosed as STUMP (smooth muscle tumor of uncertain malignant potential) and behave as low-grade malignancies with a lower risk of recurrence than the much more common high-grade uLMS.
Importantly, they can respond to endocrine therapy (with aromatase inhibitors or progestins).
In indolent disease, active surveillance can be offered as initial management (IV, B).