Objectives We aimed to determine clinicopathological characteristics of uterine sarcomas and compare the initial histological diagnosis at a tertiary oncology centre with the expert opinion from a specialist sarcoma unit.

Methods The histopathology electronic data base was searched using the key words ‘Uterine’ and ‘Sarcoma’. All clinical and histological characteristics were collected retrospectively. The expert pathology diagnosis was also collected, where available and compared with the initial opinion offered by our department.

Results From January 2015 to January 2020 thirty seven patients were identified. Their median age was 61 years (23–82). Eighteen patients (48.6%) had Leiomyosarcoma, 6 (16.2%) Low grade endometrial stromal sarcoma, 5 (13.5%) High grade endometrial stromal sarcoma, 3 (8.1%) Undifferentiated uterine sarcoma, 3 (8.1%) Rhabdomyosarcoma and 2 Adenosarcoma (5.4%). In 19 (51.3%) cases a second expert review had been sought from a sarcoma unit. There was diagnostic agreement in almost 80% of the cases with the HGESS being the most challenging. 81% of patients underwent surgery and 7(18.9%) received chemotherapy or radiotherapy. 30 (81%) patients had early stage disease. Fifteen patients (40.5%) had a recurrence, with the commonest sites being the pelvis and distant lung metastasis. Seventeen of the patients have died (46%).

Conclusions In our series there was good correlation between the initial diagnosis and the expert opinion. However, in certain tumour types, specialist review was particularly beneficial in reaching the final diagnosis. This may reflect the enhanced availability of molecular testing at centralised specialist centres. The prognosis is generally unfavourable even in early stage disease.