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Sarcoma Botryoides: Optimal Therapeutic Management and Prognosis of an Unfavorable Malignant Neoplasm of Female Children. Diagnostics (Basel) 2023; 13:diagnostics13050924. [PMID: 36900067 PMCID: PMC10000398 DOI: 10.3390/diagnostics13050924] [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: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Embryonal rhabdomyosarcoma (ERMS) is a rare malignancy and occurs primarily in the first two decades of life. Botryoid rhabdomyosarcoma is an aggressive subtype of ERMS that often manifests in the genital tract of female infants and children. Due to its rarity, the optimal treatment approach has been a matter of debate. We conducted a search in the PubMed database and supplemented it with a manual search to retrieve additional papers eligible for inclusion. We retrieved 13 case reports and case series, from which we summarized that the current trend is to approach each patient with a personalized treatment plan. This consists of a combination of local debulking surgery and adjuvant or neoadjuvant chemotherapy (NACT). Effort is made in every approach to avoid radiation for the sake of preserving fertility. Radical surgeries and radiation still have a role to play in extensive disease and in cases of relapse. Despite the rarity and aggressiveness of this tumor, disease-free survival and overall prognosis is excellent, especially when it is diagnosed early, compared with other subtypes of rhabdomyosarcoma (RMS). We conclude that the practice of a multidisciplinary approach is appropriate, with favorable outcomes; however, larger-scale studies need to be organized to have a definite consensus on optimal management.
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Meng Z, Lin D, Liu C, Wang G, Sun N. Vaginal tumours in childhood: a descriptive analysis from a large paediatric medical centre. Pediatr Surg Int 2022; 38:927-934. [PMID: 35325284 DOI: 10.1007/s00383-022-05085-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2022] [Indexed: 10/18/2022]
Abstract
PURPOSE Malignant tumours of the vagina are very rare in children. The purpose of this study was to retrospectively analyse the clinical presentation, treatment, and outcome of vaginal tumours in children treated in a single institution. METHODS This study retrospectively analysed the clinical data of children diagnosed with vaginal malignant tumours who were admitted to the Beijing Children's Hospital of Capital Medical University from January 2007 to December 2020 and followed these patients to observe their prognoses and outcomes. RESULTS During 13 years, a total of 33 children were included in this study, including 13 children with rhabdomyosarcoma and 20 children with endodermal sinus tumours. The average age at diagnosis was 20.4 months. The main clinical manifestations were vaginal bleeding and protruding masses. Of the 13 children with vaginal rhabdomyosarcoma, 12 were treated with multidrug chemotherapy combined with conservative tumour resection, and their tumours completely resolved; only one child underwent vaginectomy and hysterectomy. Twenty children with vaginal endodermal sinus received PEB chemotherapy. Among these patients, the tumour disappeared after chemotherapy in 12 children, and the remaining nodular tumour foci in 8 children were confirmed to be necrotic tissue by pathology. CONCLUSION Our research confirms that chemotherapy combined with conservative surgical treatment is effective for treating children with vaginal malignancies.
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Affiliation(s)
- Zhaoyi Meng
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Defu Lin
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Chao Liu
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Guanan Wang
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China
| | - Ning Sun
- Department of Urology, Beijing Children's Hospital Affiliated With Capital Medical University, National Center for Children's Health, No. 56 Nanlishilu Rd, West District, Beijing, China.
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3
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Ghirardi V, Bizzarri N, Guida F, Vascone C, Costantini B, Scambia G, Fagotti A. Role of surgery in gynaecological sarcomas. Oncotarget 2019; 10:2561-2575. [PMID: 31069017 PMCID: PMC6493462 DOI: 10.18632/oncotarget.26803] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022] Open
Abstract
Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.
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Affiliation(s)
- Valentina Ghirardi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Nicolò Bizzarri
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Francesco Guida
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Carmine Vascone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
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Ferron G, Angeles MA, Martínez-Gómez C, Gangloff D, Boulet B, Gabiache E, Chevreau C, Ducassou A, Guellec SL, Querleu D, Martinez A. Fertility sparing technique during pelvic exenteration for recurrent vaginal rhabdomyosarcoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2018. [DOI: 10.1016/j.epsc.2018.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
PURPOSE OF REVIEW Three primary categories of gynecologic cancer are found in pediatric and adolescent patients: stromal carcinomas including juvenile granulosa cell tumors and Sertoli-Leydig cell tumors, rhabdomyosarcomas arising from the vagina and cervix (sarcoma botryoides), and ovarian germ cell tumors which comprise a wide range of histologies. These entities are rare and treatment approaches have focused on decreasing late effects of chemotherapy treatment. Here, we review presentation, histologic classifications, diagnosis, and treatment recommendations for pediatric gynecologic cancers. RECENT FINDINGS Event-free and overall survival for these cancers is high, and the goals of treatment are minimization of morbidity and preservation of fertility with unilateral salpingo-oophorectomies and limited staging. Surveillance of tumor markers after surgery is helpful in monitoring for disease progression and adjuvant chemotherapy is often reserved for patients at recurrence. Recent literature supports avoiding chemotherapy even in high-grade germ cell tumors in the pediatric population.
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Xie W, Shen K, Yang J, Cao D, Yu M, Wang Y. Conservative management of primary vaginal endodermal sinus tumor and rhabdomyosarcoma. Oncotarget 2017; 8:63453-63460. [PMID: 28969004 PMCID: PMC5609936 DOI: 10.18632/oncotarget.18829] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 06/04/2017] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to evaluate the conservative management and prognosis of primary vaginal endodermal sinus tumor and rhabdomyosarcoma in children. Medical records of children with vaginal endodermal sinus tumor and rhabdomyosarcoma between 1996 and 2015 were reviewed. A total of 24 patients (median age, 12 months; range, 7–44 months) were included in this study, comprising 17 patients with endodermal sinus tumor and 7 patients with rhabdomyosarcoma. Among the 17 patients with endodermal sinus tumor, 15 were initially treated at our hospital with chemotherapy alone, and 2 were initially treated in other hospitals with conservative surgery and chemotherapy. All 7 patients with botryoid rhabdomyosarcoma received chemotherapy without well-defined protocols. At a median follow-up of 51 months (range, 4–237 months), 3 patients (12.5%; 1 with endodermal sinus tumor and 2 with rhabdomyosarcoma) developed recurrence. At the last follow-up, 22 patients (91.7%) were alive without evidence of disease, 1 patient with botryoid rhabdomyosarcoma died of disease progression, and 1 patient with endodermal sinus tumor died of respiratory and circulatory failure. To allow preservation of sexual and reproductive function, conservative therapeutic strategies should be considered for children with vaginal endodermal sinus tumor and botryoid rhabdomyosarcoma.
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Affiliation(s)
- Weimin Xie
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Keng Shen
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Jiaxin Yang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Dongyan Cao
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Mei Yu
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
| | - Yao Wang
- Department of Obstetrics and Gynecology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100730, China
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Nasioudis D, Alevizakos M, Chapman-Davis E, Witkin SS, Holcomb K. Rhabdomyosarcoma of the lower female genital tract: an analysis of 144 cases. Arch Gynecol Obstet 2017. [DOI: 10.1007/s00404-017-4438-1] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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10
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Abnormal vaginal bleeding in women with gynaecological malignancies. Best Pract Res Clin Obstet Gynaecol 2016; 40:134-147. [PMID: 27856158 DOI: 10.1016/j.bpobgyn.2016.09.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2016] [Accepted: 09/23/2016] [Indexed: 02/06/2023]
Abstract
Abnormal vaginal bleeding is a common gynaecological symptom, and most causes are benign. International Federation of Gynaecology and Obstetrics proposed a PALM-COEIN classification in 2011 to decrease heterogeneity in studies. The gynaecological malignancies that present with abnormal bleeding vary according to the age of the patient and the origin (upper versus lower genital tract). It is important that a thorough history and examination is performed to make this distinction. The common malignancies presenting symptoms and treatment are discussed in this article according to the age of the patient. There is a considerable overlap between the reproductive age and menopause. This article focuses on children, adolescents and women in the reproductive age group.
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Literature Review of Benign Müllerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma. J Pediatr Adolesc Gynecol 2016; 29:333-7. [PMID: 26948653 DOI: 10.1016/j.jpag.2015.02.114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2014] [Revised: 02/04/2015] [Accepted: 02/26/2015] [Indexed: 11/21/2022]
Abstract
STUDY OBJECTIVES Benign müllerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of müllerian papilloma reported and looks for clues to differentiate the 2 entities. DESIGN AND SETTING We provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center. METHODS We conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words "Müllerian papilloma" and "prepubertal bleeding." References from previous published reports were also obtained for completeness. MAIN OUTCOME Literature review of benign müllerian papilloma. RESULTS Since 1951, 56 cases of müllerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia. CONCLUSION Benign müllerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread.
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Meseci E, Onculoglu C, Ince U, Teomete M, Eser SK, Demirkıran F. Embryonal rhabdomyosarcoma of the uterine cervix in a pregnant woman. Taiwan J Obstet Gynecol 2015; 53:423-5. [PMID: 25286807 DOI: 10.1016/j.tjog.2013.10.042] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/23/2013] [Indexed: 10/24/2022] Open
Affiliation(s)
- Elif Meseci
- Department of Obstetrics and Gynecology, Acıbadem Kozyatagı Hospital, Inonu Cd. Okur S. Number 20, Kozyatagı 34742, Istanbul, Turkey.
| | - Cem Onculoglu
- Department of Obstetrics and Gynecology, Acıbadem Kozyatagı Hospital, Inonu Cd. Okur S. Number 20, Kozyatagı 34742, Istanbul, Turkey
| | - Umit Ince
- Department of Pathology, Acıbadem Kozyatagı Hospital, Inonu Cd. Okur S. Number 20, Kozyatagı 34742, Istanbul, Turkey
| | - Mehmet Teomete
- Department of Medical Oncology, Acıbadem Kozyatagı Hospital, Inonu Cd. Okur S. Number 20, Kozyatagı 34742, Istanbul, Turkey
| | - Semra Kayatas Eser
- Department of Obstetrics and Gynecology, Zeynep Kamil Education and Training Hospital, Zeynep Kamil Mahallesi, Dr. Burhanettin Ustunel Sokak Numbers 3-4, Uskudar 34668, Istanbul, Turkey
| | - Fuat Demirkıran
- Division of Gynecologic Oncology, Istanbul University Cerrahpasa Medical School, 34098 Cerrahpasa-Fatih, Istanbul, Turkey
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Melo A, Amorim-Costa C, Pires MC, Fernandes D, Soares M, Cambão M, Petiz A. Botryoid rhabdomyosarcoma of the uterine cervix. J OBSTET GYNAECOL 2012; 32:709-11. [PMID: 22943732 DOI: 10.3109/01443615.2012.698663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- A Melo
- Department of Gynaecological Oncology, Oporto Portuguese Institute of Oncology, Francisco Gentil, Portugal.
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Kriseman ML, Wang WL, Sullinger J, Schmeler KM, Ramirez PT, Herzog CE, Frumovitz M. Rhabdomyosarcoma of the cervix in adult women and younger patients. Gynecol Oncol 2012; 126:351-6. [PMID: 22609112 DOI: 10.1016/j.ygyno.2012.05.008] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2012] [Revised: 05/08/2012] [Accepted: 05/09/2012] [Indexed: 12/13/2022]
Abstract
OBJECTIVES Cervical rhabdomyosarcoma is extremely rare, and there is a paucity of literature on the subject. The purpose of this study was to describe the clinical and pathologic features of cervical rhabdomyosarcoma. METHODS We retrospectively reviewed all patients with cervical rhabdomyosarcoma who presented to our institution from 1980 to 2010. We reviewed pathologic, demographic, and clinical information. RESULTS During the study period, 11 females presented with cervical rhabdomyosarcoma. The median age at presentation was 18.4 years, and 6 patients were <19 years old at diagnosis. Vaginal bleeding was the most common presenting symptom, and a vaginal mass was often a co-presenting symptom. Eight patients (73%) presented with stage IB disease, and 8 (73%) presented with the embryonal (botryoid) histologic subtype. Nine patients (82%) received multimodal therapy consisting of surgery with chemotherapy, radiation therapy, or both. All patients were without evidence of disease after completion of primary therapy, but 3 patients experienced local recurrence. At a median follow-up of 23 months, 6 patients (55%) were without evidence of disease, 1 (9%) was alive with disease, 1 (9%) had died of disease, and 3 (27%) had died of other causes. Three patients (27%) had other primary malignancies in addition to rhabdomyosarcoma-1 had a Sertoli-Leydig tumor, 1 had a Sertoli-Leydig tumor and a pinealoblastoma, and 1 had thyroid cancer and a parotid adenocarcinoma. CONCLUSIONS With multimodal therapy, cervical rhabdomyosarcoma appears to be associated with a good prognosis. Favorable prognostic factors such as early stage at diagnosis and a favorable histologic subtype may contribute to the excellent observed survival.
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Affiliation(s)
- Maya L Kriseman
- Department of Obstetrics and Gynecology, Baylor College of Medicine, USA
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Baiocchi G, Faloppa CC, Osório CABDT, Kumagai LY, Fukazawa EM, Cunha IW. Embryonal rhabdomyosarcoma of the uterine cervix in a 47-year-old woman. J Obstet Gynaecol Res 2011; 37:940-6. [PMID: 21410833 DOI: 10.1111/j.1447-0756.2010.01449.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Embryonal rhabdomyosarcoma (RMS) of the female genital tract usually occurs in the vagina during childhood. The uterine cervix as a primary site is rare, but is more frequent until the second decade of life. It usually has a good prognosis and the treatment is based on multidrug chemotherapy, radiotherapy and surgery. RMS accounts for <5% of all adult soft tissue sarcomas. Previous reports that included all primary sites showed a poorer five-year disease specific survival for adults with RMS when compared to the pediatric population. This difference has been attributed to a higher proportion of adverse prognostic clinical and pathological factors, and to inadequate treatment given to adults with RMS. A total of 115 patients with cervical embryonal RMS have previously been described; however, only 10 cases were reported in women older than 40 years. We present a 47-year-old woman treated with radical hysterectomy followed by adjuvant chemotherapy and review the current literature.
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Affiliation(s)
- Glauco Baiocchi
- Department of Gynecological Oncology, AC Camargo Cancer Hospital, Sao Paulo, Brazil.
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Hiraizumi Y, Kamoi S, Inde Y, Kurose K, Ohaki Y, Takeshita T. A case of tumor lysis syndrome following chemotherapy for a uterine epithelioid leiomyosarcoma with focal rhabdomyosarcomatous differentiation. J Obstet Gynaecol Res 2011; 37:947-52. [PMID: 21410837 DOI: 10.1111/j.1447-0756.2010.01454.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Tumor lysis syndrome (TLS) is a potential complication characterized by hyperuricemia, hyperphosphatemia, hyperkalemia and hypocalcemia due to massive necrosis of malignant cells after cytotoxic therapy. This fatal complication occurs frequently in tumors with hematological malignancies, such as acute lymphoblastic leukemia and Burkitt's lymphoma, and in other tumors with high proliferative rates and tumor burdens. TLS is rarely associated with the treatment of solid tumors. Herein, we report a case of TLS following the initial administration of effective chemotherapy for an epithelioid leiomyosarcoma with focal rhabdomyosarcomatous differentiation of the uterus.
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Affiliation(s)
- Yoshie Hiraizumi
- Department of Obstetrics and Gynecology, Nippon Medical School, Chiba Hokusoh Hospital, Chiba, Japan.
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Abstract
Imaging the cervix for benign and malignant disease can be achieved using transvaginal ultrasound, computed tomography (CT), magnetic resonance imaging, and 18-fluorodeoxyglucose positron emission tomography. The best established role of imaging is in cervical carcinoma where magnetic resonance imaging, CT and increasingly positron emission tomography-CT are the most frequently used imaging modalities. These have a role in staging, treatment selection, recurrent disease, and imaging complications of treatment. Histopathological diagnosis of cervical disorders cannot be made on the basis of imaging alone but certain imaging features may provide an indication as to the underlying diagnosis. We describe the imaging features of some malignant tumor subtypes in which a preoperative diagnosis may alter management. Benign lesions of the cervix are usually detected incidentally or during investigations for dysfunctional vaginal bleeding. We describe the imaging features of the commonly encountered benign cervical lesions.
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Affiliation(s)
- Anju Sahdev
- Department of Radiology, Bartholomew's Hospital, London, UK.
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Bansal S, Lewin SN, Burke WM, Deutsch I, Sun X, Herzog TJ, Wright JD. Sarcoma of the cervix: natural history and outcomes. Gynecol Oncol 2010; 118:134-8. [PMID: 20541244 DOI: 10.1016/j.ygyno.2010.04.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 04/17/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cervical sarcomas are rare neoplasms thought to follow an aggressive course. We examined the natural history of cervical sarcomas and compared their outcomes to that of squamous cell and adenocarcinomas of the cervix. In addition, we examined the prognostic significance of various demographic, clinical, and treatment related factors. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify all women with primary cervical sarcomas diagnosed between 1988 and 2005. The clinical characteristics and outcomes of women with cervical sarcomas were compared to patients with squamous cell and adenocarcinomas of the cervix. Survival was examined using multivariable Cox proportional hazards models and the Kaplan-Meier method. RESULTS A total of 33,074 women with invasive cervical neoplasms were identified including 323 (1%) patients with cervical sarcomas. Among women with cervical sarcomas, carcinosarcoma was the most common and accounted for 40% (128) of the cases while adenosarcomas and leiomyosarcomas each accounted for 21% (67). Compared to women with squamous cell and adenocarcinomas, patients with cervical sarcomas tended to be younger, diagnosed in the later years of the study, have larger tumors, and have more advanced stage disease (p<0.05 for all). After adjusting for other known prognostic factors, patients with cervical sarcomas were 60% more likely to die from their tumors (cancer-specific survival HR=1.60; 95% CI, 1.30-1.96), (overall survival HR=1.60; 95% CI, 1.36-1.89) than patients with squamous cell carcinomas. A separate multivariable analysis limited to women with cervical sarcomas revealed no difference in survival for any of the sarcoma subtypes. CONCLUSION Primary cervical sarcomas are aggressive neoplasms. The prognosis for women with cervical sarcomas is inferior to that of squamous cell and adenocarcinomas matched by stage.
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Affiliation(s)
- Sharmilee Bansal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, New York, NY 10032, USA
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