Introduction/Background Endometrial high-grade sarcoma is a rare and aggressive form of cancer that primarily affects the endometrium, accounts for only about 5% of all uterine cancers.

Methodology This retrospective observational study conducted at the Institute of Salah Azaiez aimed to analyze their experience in managing high-grade endometrial sarcomas over a period from 1999 to 2022. Out of 50 diagnosed cases, 40 exploitable files were selected for analysis.

Results The average age of the 40 patients included in the study was 56 years, with a range of 31 to 84 years. The most common presenting symptom was endouterine bleeding (65%), followed by the presence of an abdominal mass (20%). Clinical examinations revealed an enlarged uterus in 25% of cases and a lateral mass in 15% of cases.

Among the patients, 20.8% of cases were metastatic, with lung, bone, and peritoneal involvement observed. Histologically, leiomyosarcoma was the most frequent subtype (85%), followed by stromal sarcoma (10%) and carcinosarcoma (5%).

The treatment approach, determined through multidisciplinary meetings, predominantly involved surgery (80%) with hysterectomy and bilateral adnexectomy or enlarged colpohysterectomy.

The average duration of surgical procedures was 210 minutes, with a low incidence of postoperative complications.

Adjuvant therapy included postoperative radiotherapy (44.7%) and chemotherapy (32.4%).

After a mean follow-up of 36 months, 10.5 % of patients died, and 68.4 % of patients were lost to follow-up.

Conclusion Endometrial high-grade sarcoma is associated with a poor prognosis due to its aggressive nature and high recurrence rate. Early detection, comprehensive treatment, and vigilant monitoring for recurrence are crucial for improving patient outcomes in this challenging malignancy.

Disclosures None.