Osteosarcoma of the uterus: case report and review of the literature

Multidisciplinary management for primary uterine osteosarcoma, including gene panel testing: case report and literature review

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.

Case Report: Clinical application of immunotherapy-based combination regimen in primary osteosarcoma of the uterus

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.

High-grade uterine sarcoma with osteosarcomatous differentiation arising from a MED12-mutated leiomyoma, a case report

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.

Primary osteosarcoma of the uterine corpus: A case report

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.

Malignant mesenchymoma of the uterus, arising in a leiomyoma

AIMS

To document and find evidence for the rare occurrence of malignant progression of a benign uterine leiomyoma with divergent mesenchymal differentiation. In a 54-year-old female a large pedunculated tumour was encountered which had suddenly increased in size and had apparently arisen at the site of a subserosal uterine leiomyoma first described 19 years earlier. The tumour seemed histologically diverse in its composition. The possibility of malignant progression of the benign leiomyoma with divergent mesenchymal differentiation was entertained.

METHODS AND RESULTS

In the resected tumour, smooth muscle, osseous and adipose components were identified and these were assessed using recognized histological criteria of malignancy. In addition to a benign smooth muscle component, malignant leiomyosarcomatous tissue was seen in addition to a malignant osseous component and a malignant adipose component. The tumour thus met the criteria of a malignant mesenchymoma. The relationship of the different components of the tumour was analysed by immunohistochemistry and with molecular loss of heterozygosity (LOH) analysis. In the osseous and leiomyosarcomatous components a similar LOH pattern was observed. The adipose component showed a distinct LOH pattern. Retention of smooth muscle differentiation in the osseous component was demonstrated by desmin immunostaining.

CONCLUSION

Malignant transformation of benign uterine leiomyoma may rarely occur. Mesenchymal stem cells underlying these tumours may show divergent mesenchymal differentiation.

Primary osteosarcoma of the uterine corpus: report of a case with immunohistochemical and ultrastructural study

BACKGROUND

Primary uterine osteosarcoma is extremely rare, with only 15 cases reported in the literature.

CASE

A 41-year-old woman presented with abnormal vaginal bleeding due to a large tumor arising from the uterine corpus. Histologically, the tumor showed the features of a malignant mesenchymal neoplasm with osteoid formation and lacked an epithelial component. Immunohistochemical and ultrastructural studies showed no evidence of epithelial differentiation. The tumor was excised and the patient received chemotherapy and radiation therapy postoperatively, but the tumor recurred locally at the 8-month follow-up.

CONCLUSION

Osteosarcoma as a primary uterine tumor is exceedingly rare and should be distinguished from carcinosarcoma, which shows different macroscopic and histologic features. Prognosis of this neoplasm is very poor with an average life expectancy of 5 months.

Embryonal rhabdomyosarcoma of the uterine corpus and cervix

Embryonal rhabdomyosarcomas of the uterus and cervix are rare tumors with a very poor prognosis historically. Adjuvant multidrug chemotherapy combined with local radiation therapy and/or surgery has resulted in markedly improved survival rates. Six patients with embryonal rhabdomyosarcoma of the uterus/cervix are reported, with a compilation of 28 additional patients from the literature. Nineteen of 24 patients (79%) treated with combination therapy were alive and well 4-147+ months (median 61 months) after diagnosis. The six cases from USC Medical Center and affiliated hospitals are all well 17-144 months (mean 95 months) after diagnosis. Analysis of the collected series indicates that extent of disease is an important prognostic factor. Adjuvant chemotherapy with vincristine, actinomycin D, and cyclophosphamide (VAC) improves survival. Initial therapy for embryonal rhabdomyosarcoma confined to the uterus/cervix should include radical hysterectomy, pelvic lymphadenectomy, and adjuvant chemotherapy with VAC. Pelvic radiotherapy should be employed for involved surgical margins or positive nodes. Advanced disease managed initially with chemotherapy and radiotherapy may allow subsequent curative extirpative surgery.

A rare pelvic mass: osteosarcoma of the body of the uterus

A rare, enormous, unresectable, osteosarcoma of the uterus is reported. This obstructed ureters, enclosed rectum, bladder, aorta and vena cava, and metastasized to peritoneum, lungs and liver causing death of the patient by renal and pulmonary failure.

Chondrosarcoma of the uterus

Chondrosarcoma of the uterus is a rare tumor. The clinical and pathological features of a recent case are presented and the histogenesis, treatment, and prognosis of the heterologous sarcomas are discussed. The authors favor the theory of totipotential endometrial stromal cells for the histogenesis, and suggest that radiotherapy and/or chemotherapy continue to be used in addition to total abdominal hysterectomy with bilateral salpingo-oophorectomy.