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Fusco R, Tesi C, Spina P, Fulcheri E, Licata M. Calcified uterine leiomyoma from an 18th-century nunnery in North Italy. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2024; 45:1-6. [PMID: 38377784 DOI: 10.1016/j.ijpp.2024.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 01/20/2024] [Accepted: 01/31/2024] [Indexed: 02/22/2024]
Abstract
OBJECTIVE To develop a differential diagnosis of a mass retrieved alongside skeletal remains in the crypt of the church of Santissima Annunziata of Valenza (Province of Alessandria, Northern Italy). MATERIAL A calcified mass measuring 40 × 39 mm and 17.62 × 16.3817.62 × 16.38 mm. METHOD The analysis utilized macroscopic assessment and histologic examination (including histochemical and immunohistochemical analyses). RESULTS Morphological traits include an irregular and spongy external surface. Holes of different sizes lead toward the inner part of the object. A section of the mass shows an "intertwined bundle" pattern, confirmed by microscopic examination. CONCLUSIONS Differential diagnosis determined the mass to be consistent with calcified leiomyoma. SIGNIFICANCE Identifying uterine leiomyoma adds to the paucity of paleopathological literature on the condition and to calcified tumors more broadly. It also allows for an important discussion of women's gynecological health in the past and potentially among nulliparous women. LIMITATIONS Neither histochemical staining nor immunohistochemical analysis demonstrated the certain muscular nature of the specimens due to the rehydration and decalcification processes, for which there are no gold standards. SUGGESTIONS FOR FURTHER RESEARCH Calcified masses are common in the clinical literature but remain rare in paleopathological literature. Careful excavation and improved recognition of apparently calcified masses are necessary to improve recognition, diagnosis, and interpretation.
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Affiliation(s)
- Roberta Fusco
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
| | - Chiara Tesi
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy.
| | - Paolo Spina
- Department of Health Sciences, University of Eastern Piedmont, Novara, Italy; Cantonal Institute of Pathology, Locarno, Switzerland
| | - Ezio Fulcheri
- Section of Pathological Anatomy and Histology (DICMI), University of Genova, Italy
| | - Marta Licata
- Department of Biotechnologies and Life Sciences, University of Insubria, Varese, Italy
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2
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Kusanishi T, Tanaka N, Itoi M, Ijiri M, Ebisawa K, Suzuka K, Hagiwara Y, Yonemoto T, Araki A, Itami M. Multidisciplinary management for primary uterine osteosarcoma, including gene panel testing: case report and literature review. Int Cancer Conf J 2023; 12:241-247. [PMID: 37577351 PMCID: PMC10421837 DOI: 10.1007/s13691-023-00613-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 04/28/2023] [Indexed: 08/15/2023] Open
Abstract
Primary osteosarcoma of the uterus (uOS) is rare, and its standard treatment has not yet been established. Herein, we present the case of a 50-year-old woman with uOS who demonstrated an improved prognosis after multiple surgeries to the metastatic sites. After the initial diagnosis of uOS, the patient showed recurrence and distant metastasis and hence expected to exhibit a poor prognosis. The patient underwent multiple surgical resections of the metastatic as well as primary tumors, which enabled the patient to survive for 24 months after the initial surgery. Considering that the median survival time of patients with uOS is approximately 6 months, the survival rate of our patient is noteworthy. Based on our observations, it is suggested that the resection of the primary and metastatic tumors might contribute to the extension of the survival period of the patient with chemo-resistant uOS.
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Affiliation(s)
- Takako Kusanishi
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Naotake Tanaka
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Mizue Itoi
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Miwa Ijiri
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Keiko Ebisawa
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Kiyomi Suzuka
- Department of Gynecology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Youko Hagiwara
- Department of Orthopedics, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Tukasa Yonemoto
- Department of Orthopedics, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Akinobu Araki
- Department of Pathology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
| | - Makiko Itami
- Department of Pathology, Chiba Cancer Center, 666-2, Nitona-cho, Chuo-ku, Chiba 260-8717 Japan
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3
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Yang J, Chen X, Li X, Liu W, Liao S, Wang Y, Zuo Y. Case Report: Clinical application of immunotherapy-based combination regimen in primary osteosarcoma of the uterus. Front Oncol 2023; 13:1198765. [PMID: 37469418 PMCID: PMC10352772 DOI: 10.3389/fonc.2023.1198765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 06/01/2023] [Indexed: 07/21/2023] Open
Abstract
Primary osteosarcoma of the uterus is an extremely rare pure heterologous sarcoma of the uterus. The relevant available information is limited to case reports. To date, only 31 cases of this type of cancer have been reported. Here, we report the first clinical experience with the administration of an immunotherapy-based combination regimen for multiple metastatic primary osteosarcomas of the uterus. The patient had undergone multiple treatments prior to this regimen, but her condition continued to progress. However, after 3 cycles of immunotherapy combined with targeted therapy and chemotherapy, a review showed that the disease was stable and even in partial remission. The patient has a good quality of life, and long-term survival is expected.
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Affiliation(s)
- Jing Yang
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaowen Chen
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Xiaofang Li
- Department of Pathology, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Wenci Liu
- Department of Imaging, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Sihai Liao
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yuzhou Wang
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
| | - Yufang Zuo
- Department of Gynecological Oncology, Cancer Center, Affiliated Hospital of Guangdong Medical University, Zhanjiang, China
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4
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Ruhotina M, Kukla J, Wilcox A, Murphy C, Menderes G. Primary uterine osteosarcoma arising in a leiomyoma with rapid local recurrence: A case report. Gynecol Oncol Rep 2022; 44:101102. [PMID: 36405307 PMCID: PMC9672400 DOI: 10.1016/j.gore.2022.101102] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Revised: 10/31/2022] [Accepted: 11/03/2022] [Indexed: 11/13/2022] Open
Abstract
Background Extraskeletal osteosarcoma is an extremely rare malignant neoplasm. Literature regarding primary osteosarcoma of the uterus is confined to only a small number of case reports. Case: A 57-year-old female with a history of uterine fibroids presented to the emergency department with abdominal pain. Imaging was notable for an enlarged uterus with a 15 cm calcified fibroid extending along the posterior uterus. The patient underwent a laparotomy for total hysterectomy and bilateral salpingo-oophorectomy. Pathological evaluation of the specimen yielded mesenchymal proliferation with osteoid formation and tumor cells with densely eosinophilic cytoplasm resembling osteoblasts with a final diagnosis of primary uterine osteosarcoma. Multidisciplinary tumor board recommended against adjuvant treatment, given the lack of evidence for improved outcomes for early-stage uterine sarcomas. The patient was followed up with surveillance visits every-three months, entailing physical examination and computed tomography(CT) scans. Unfortunately, she had locoregional oligometastatic recurrence of her disease at 1-year follow up. Conclusion Primary uterine osteosarcoma is an extremely rare and aggressive neoplasm with limited understanding regarding optimal treatment options.
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Affiliation(s)
- Merima Ruhotina
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
- Corresponding author at: Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health 267 Grant Street, Bridgeport, CT 06610, USA.
| | - Joanna Kukla
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Annemieke Wilcox
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
| | - Colleen Murphy
- Department of Obstetrics and Gynecology, Bridgeport Hospital/Yale New Haven Health, Bridgeport, CT, USA
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5
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Le MK, Omori M, Oishi N, Oi M, Fukasawa H, Hirata S, Kondo T. High-grade uterine sarcoma with osteosarcomatous differentiation arising from a MED12-mutated leiomyoma, a case report. Pathol Int 2021; 71:199-203. [PMID: 33444473 DOI: 10.1111/pin.13065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Accepted: 12/26/2020] [Indexed: 11/30/2022]
Abstract
Uterine osteosarcoma has been reported, but it is an extremely rare tumor with highly aggressive behavior and poor prognosis. The pathogenesis of uterine osteosarcoma is not fully understood. Herein, we report on a high-grade uterine sarcoma with focal osteosarcomatous differentiation that developed from a long-standing MED12-mutated leiomyoma. A 47-year-old nulligravida woman, with known uterine leiomyoma presented with abdominal pain and distention. Imaging analyses revealed a tumor with a large cystic area in the uterine corpus and multiple metastases in intrapelvic and paraaortic lymph nodes, left ovary and left lung. With a clinical diagnosis of uterine sarcoma the patient underwent abdominal total hysterectomy, bilateral salpingo-oophorectomy, partial omentectomy and removal of the left obturator lymph node. Despite postoperative chemotherapy and radiation therapy, the tumor progressed rapidly. She died 18 weeks after the surgery. Histopathologic examination identified a high-grade pleomorphic sarcoma in which focal osteoid production was observed. This high-grade sarcoma with focal osteosarcomatous differentiation was located within the uterine leiomyoma, and Sanger sequencing showed the identical MED12 L36R mutation in both the osteosarcomatous and leiomyomatous components supporting the shared origin of these two components. We, therefore, concluded that the high-grade sarcoma with osteosarcomatous differentiation arose from the transformation of the precedent leiomyoma.
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Affiliation(s)
- Minh-Khang Le
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Makiko Omori
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Naoki Oishi
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
| | - Megumi Oi
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Hiroko Fukasawa
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Shuji Hirata
- Department of Obstetrics and Gynecology, University of Yamanashi, Yamanashi, Japan
| | - Tetsuo Kondo
- Department of Pathology, University of Yamanashi, Yamanashi, Japan
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Uterine osteosarcoma with peritoneo-omental osteosarcomatosis: a case report and review of the literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2020. [DOI: 10.1007/s40944-020-0373-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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7
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Clinicopathologic Features and Genetic Alterations of a Primary Osteosarcoma of the Uterine Corpus. Int J Gynecol Pathol 2019; 38:414-419. [DOI: 10.1097/pgp.0000000000000511] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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8
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Tsuji K, Watanabe Y, Tokunaga H, Shimada M, Watanabe M, Yaegashi N. Primary osteosarcoma of the uterine cervix: A case report. J Obstet Gynaecol Res 2017; 43:1781-1783. [PMID: 28815813 DOI: 10.1111/jog.13443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 05/16/2017] [Accepted: 06/10/2017] [Indexed: 12/31/2022]
Abstract
Primary osteosarcoma of the uterine cervix is extremely rare. Only 20 cases have been reported, 19 of which originated in the uterine corpus. We report a case of primary uterine cervical osteosarcoma with pulmonary metastasis in a 30-year-old nulligravida woman. The initial diagnosis was carcinosarcoma of the uterine cervix, as detected by cervical cytology and biopsy analysis. We performed a total hysterectomy, bilateral salpingo-oophorectomy and colostomy without macroscopic residual tumors in the abdominal cavity, but pelvic recurrent tumors appeared 14 days postoperatively. Both recurrent and metastatic tumors were effectively reduced by combination therapy of adriamycin with ifosfamide; however, the patient died as a result of of disease progression nine months after her first visit to our department.
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Affiliation(s)
- Keita Tsuji
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoh Watanabe
- Department of Obstetrics and Gynecology, Tohoku Medical and Pharmaceutical University, Sendai, Japan
| | - Hideki Tokunaga
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Muneaki Shimada
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University Graduate School of Medicine, Sendai, Japan
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9
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Tsukasaki N, Mori T, Yasukawa S, Konishi E, Kokabu T, Kitawaki J. Primary osteosarcoma of the uterine corpus: A case report. J Obstet Gynaecol Res 2016; 42:1604-1608. [PMID: 27319757 DOI: 10.1111/jog.13079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 05/07/2016] [Indexed: 12/18/2022]
Abstract
Pure osteosarcoma arising from the uterus is extremely rare. Only 15 cases of this type of cancer have been reported to date. Most patients showed local or lung metastasis early after surgery and died within a year of treatment initiation, regardless of multimodality therapy, indicating that this tumor is aggressive with a poor prognosis. Herein, we report the first clinical experience treated with a combination of docetaxel and gemcitabine for local and lung metastasis from primary osteosarcoma of the uterus. Although the disease was considered stable after three cycles of treatment, new metastatic lesions appeared in the lungs after six cycles. The patient was asymptomatic for 13 months; however, she died two months after symptom recurrence. Our case demonstrates that a combined regimen of docetaxel and gemcitabine may be a sound therapeutic option to control primary osteosarcoma of the uterus.
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Affiliation(s)
- Nanami Tsukasaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Taisuke Mori
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan.
| | - Satoru Yasukawa
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Eiichi Konishi
- Department of Surgical Pathology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Tetsuya Kokabu
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | - Jo Kitawaki
- Department of Obstetrics and Gynecology, Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
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10
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Kefeli M, Baris S, Aydin O, Yıldız L, Yamak S, Kandemir B. An unusual case of an osteosarcoma arising in a leiomyoma of the uterus. Ann Saudi Med 2012; 32:544-6. [PMID: 22634486 PMCID: PMC6081004 DOI: 10.5144/0256-4947.2012.23.5.1111] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Leiomyoma is the most common uterine neoplasm. It has several histological variants such as atypical, cellular, myxoid, and epithelioid. Leiomyoma with heterologous elements is a rare variant of leiomyoma, which may contain heterologous elements such as fat, skeletal muscle, and chondroid and osseous tissues. The heterologous sarcomatous differentiation is also rarely seen. We report on a 53-year-old woman who was admitted with abnormal vaginal bleeding and symptoms related to an abdominal mass. She had a huge uterine leiomyoma that contained osteosarcomatous differentiation in several foci. Although malignant progression for leiomyoma is exceedingly rare, when it occurs it may result not only in a leiomyosarcoma but also in a heterologous sarcomatous differention. We have reported histopathological, immunohistochemical, and clinical features of this rare case and reviewed the published studies.
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Affiliation(s)
- Mehmet Kefeli
- Department of Pathology, Ondokuz Mayis University, Medical School, Gazi State Hospital, Samsun, Turkey.
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11
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Heterologous and rare homologous sarcomas of the uterine corpus: a clinicopathologic review. Adv Anat Pathol 2011; 18:60-74. [PMID: 21169739 DOI: 10.1097/pap.0b013e3182026be7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Pure sarcomas of the uterine corpus are uncommon, constituting less than 3% of all malignancies at this site, and most of them are leiomyosarcomas and endometrial stromal sarcomas. Rare histotypes of homologous sarcomas and heterologous sarcomas are occasionally encountered, and the absence of significant accumulated experience with these histotypes at this location may potentially raise diagnostic and patient management difficulties. In this article, the clinicopathologic attributes of all earlier reported sarcomas of the uterine corpus other than leiomyosarcomas and endometrial stromal sarcomas are summarized. Included are embryonal rhabdomyosarcoma, pleomorphic rhabdomyosarcoma, angiosarcoma, alveolar soft part sarcoma, malignant perivascular epithelioid cell tumors (PEComas), osteosarcoma, chondrosarcoma, liposarcomatous tumors, malignant extrarenal rhabdoid tumors, Ewing sarcoma/primitive neuroectodermal tumor, and other rare histotypes. Embryonal rhabdomyosarcoma (20%), Ewing sarcoma/primitive neuroectodermal tumor (17%), angiosarcoma (14%), and pleomorphic rhabdomyosarcoma (13%) appeared to be more common than the others, although there was no single overwhelmingly prevalent histotype in the group. A subset, including embryonal rhabdomyosarcoma, alveolar soft part sarcoma, and PEComas, peak in the premenopausal years, but most of the others were observed in postmenopausal women. Favorable outcomes have been reported for the patients diagnosed with alveolar soft part sarcoma, and the prognosis for their counterparts with PEComa remains a matter of debate. Multimodal therapeutic approaches to contemporary patients with embryonal rhabdomyosarcomas have resulted in significantly improved outcomes. Unfortunately, most of the other sarcomas have been associated with rapid tumor progression and unfavorable patient outcomes. The differential diagnosis for these sarcomas is often extensive and varies by histotype, but their accurate diagnosis fundamentally requires the careful exclusion of biphasic malignancies.
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Ribeiro-Silva A, Ximenes L. Pathologic quiz case: a 60-year-old woman with diffuse uterine enlargement. Primary osteosarcoma of the uterus. Arch Pathol Lab Med 2004; 128:e172-4. [PMID: 15578905 DOI: 10.5858/2004-128-e172-pqcayw] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Alfredo Ribeiro-Silva
- Department of Pathology, Faculty of Medicine of Ribeirão Preto, University of São Paulo, Brazil.
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13
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Lin JW, Ko SF, Ng SH, Eng HL, Changchien CC, Huang CC. Primary osteosarcoma of the uterus with peritoneal osteosarcomatosis: CT features. Br J Radiol 2002; 75:772-4. [PMID: 12200248 DOI: 10.1259/bjr.75.897.750772] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A 67-year-old woman presented with lower abdominal pain for 1 month. Pelvic ultrasound revealed a calcified uterine mass and ascites. CT showed a heavily calcified uterine tumour, with ascites and disseminated calcified nodules in the peritoneum. Microscopic and immunohistochemical studies demonstrated features typical of osteosarcoma without any epithelial differentiation. Although rare, uterine osteosarcoma with associated peritoneal osteosarcomatosis should be included in the differential diagnosis of an elderly woman with a calcified uterine mass and disseminated peritoneal calcifications.
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Affiliation(s)
- J-W Lin
- Department of Pathology, Chang Gung University, Chang Gung Memorial Hospital, Niao-Sung Hsiang, Kaohsiung Hsien, Taiwan
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Kostopoulou E, Dragoumis K, Zafrakas M, Myronidou Z, Agelidou S, Bontis I. Primary osteosarcoma of the uterus with immunohistochemical study. Acta Obstet Gynecol Scand 2002; 81:678-80. [PMID: 12190845 DOI: 10.1034/j.1600-0412.2002.810716.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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