1
|
Diggs A, Sia TY, Huang Y, Gockley A, Melamed A, Khoury-Collado F, St Clair C, Hou JY, Hershman DL, Wright JD. Utilization and outcomes of adjuvant therapy for stage II and III uterine leiomyosarcoma. Gynecol Oncol 2022; 166:308-316. [PMID: 35660331 DOI: 10.1016/j.ygyno.2022.05.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/17/2022] [Accepted: 05/22/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The optimal adjuvant therapy for uterine leiomyosarcoma (uLMS) remains uncertain. We analyzed the utilization of adjuvant chemotherapy and radiation therapy for stage II and III uLMS and explored the association between use of adjuvant therapy and survival. METHODS Patients with stage II or III uLMS treated from 2004 to 2016 and recorded in the National Cancer Database were identified. Multivariable regression models were fit to estimate predictors of use of either adjuvant radiation therapy or chemotherapy. To analyze the impact of chemotherapy on all-cause mortality, an inverse probability of treatment weighted (IPTW) propensity score method was used to account for measured confounders, and the receipt of radiation therapy was adjusted in the outcome model. The process was repeated to analyze the impact of radiation therapy on all-cause mortality by using an IPTW propensity score method and adjusting for the receipt of adjuvant chemotherapy. RESULTS A total of 890 patients were identified. Adjuvant chemotherapy use increased from 62.2% in 2010 to 70.4% in 2016, whereas radiation usage decreased from 26.7% in 2010 to 10.4% in 2016. Patients with stage III (vs. stage II) disease were less likely to receive radiation therapy. After propensity score weighting, chemotherapy was associated with a 30% decreased risk of all-cause mortality in stage III patients (HR 0.70, 95% CI 0.45-0.98) but had no effect on mortality for stage II patients (HR 0.93, 95% CI 0.70-1.20). Radiation therapy was associated with a 26% decreased risk of mortality for stage II tumors (HR 0.74; 95% CI, 0.53-0.99) and a 57% decrease in mortality for stage III disease (HR 0.43, 95% CI 0.18-0.99). CONCLUSIONS Among women with stage II-III uLMS, use of chemotherapy is increasing while use of radiation therapy is decreasing. Radiation therapy is associated with improved survival in both stage II and III disease, while there was no association between use of adjuvant chemotherapy and survival in stage II patients.
Collapse
Affiliation(s)
- Alexandra Diggs
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; New York Presbyterian Hospital, United States of America
| | - Tiffany Y Sia
- Memorial Sloan Kettering Cancer Center, New York, NY, United States of America
| | - Yongmei Huang
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America
| | - Allison Gockley
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Alexander Melamed
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Fady Khoury-Collado
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Caryn St Clair
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - June Y Hou
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Dawn L Hershman
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America
| | - Jason D Wright
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America; New York Presbyterian Hospital, United States of America.
| |
Collapse
|
2
|
Sia TY, Huang Y, Gockley A, Melamed A, Khoury-Collado F, St Clair C, Hou JY, Tergas AI, Hershman DL, Wright JD. Trends in ovarian conservation and association with survival in premenopausal patients with stage I leiomyosarcoma. Gynecol Oncol 2021; 161:734-740. [PMID: 33810881 DOI: 10.1016/j.ygyno.2021.03.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Accepted: 03/26/2021] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To explore trends of ovarian conservation (OCN) over time in young women with early stage leiomyosarcoma (LMS) and examine the association between OCN and survival. METHODS Patients under the age of 50 who were diagnosed with stage I LMS who underwent hysterectomy with and without oophorectomy between 2010 and 2016 were identified in the National Cancer Database (NCDB). Performance of oophorectomy vs. OCN was determined using surgery codes. Trends of OCN were reported. Multivariable regression models were fit to estimate predictors of OCN. An inverse probability of treatment weighted propensity score method was used to examine the association between all-cause mortality and OCN. RESULTS Overall, 225 patients (28%) underwent OCN. Rates of OCN decreased from 41.2% (2010) to 14.3% (2016); this finding was consistent across age groups: <35, 35-39, 40-44, and 45-49 years. Race, insurance, and stage did not affect performance of OCN. Women with poorly differentiated tumors were less likely to undergo OCN compared to well-differentiated tumors (aRR 0.59; 95% CI 0.40-0.86). After propensity score weighting, there was no association between OCN and mortality (HR 1.19, 95% CI 0.80-1.77). Five-year survival for the OCN group was 67.1% (95% CI 59.8-75.2%) compared to 72.2% for the oophorectomy group (95% CI 67.2-77.5%). CONCLUSIONS OCN for early stage LMS in premenopausal women has decreased over time. There was no association between OCN and mortality among women with stage I LMS. OCN should be considered in premenopausal women with stage I LMS given the health benefits.
Collapse
Affiliation(s)
- Tiffany Y Sia
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Yongmei Huang
- Columbia University Irving Medical Center, New York, NY, United States of America
| | - Allison Gockley
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Alexander Melamed
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Fady Khoury-Collado
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Caryn St Clair
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - June Y Hou
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Ana I Tergas
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Dawn L Hershman
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America
| | - Jason D Wright
- Columbia University Irving Medical Center, New York, NY, United States of America; Herbert Irving Comprehensive Cancer Center, United States of America.
| |
Collapse
|
3
|
|
4
|
Reif PA. Uterine Leiomyosarcoma Mimicking Benign Submucosal Leiomyoma. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2016. [DOI: 10.1177/8756479307309414] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Uterine leiomyosarcoma is a rare, aggressive tumor of the smooth muscle with a typical intramural location. Patients present with abnormal uterine bleeding and an enlarged pelvic mass with clinical signs and symptoms that are virtually indistinguishable from benign leiomyoma. Sonographically, leiomyosarcoma presents as a large solitary tumor that closely resembles a benign leiomyoma that may be undergoing degenerative changes. Because of the infiltrative nature of leiomyosarcoma, invasion into the myometrium may be demonstrated. Leiomyosarcoma has a poor prognosis due to local pelvic recurrences and spread to distant sites. This case report demonstrates a fast-growing submucosal leiomyosarcoma with characteristic sonographic echo enhancement and infiltration into the myometrium.
Collapse
|
5
|
Singhal J, Jain A, Saxena AK, Chandrakanta, Gupta A, Tyagi S, Singh P. Extensively Metastatic Vaginal Stump Leiomyosarcoma after Total Hysterectomy: A Rare Presentation—A Case Report with Review of Literature. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0014-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
6
|
Demicco EG, Boland GM, Brewer Savannah KJ, Lusby K, Young ED, Ingram D, Watson KL, Bailey M, Guo X, Hornick JL, van de Rijn M, Wang WL, Torres KE, Lev D, Lazar AJ. Progressive loss of myogenic differentiation in leiomyosarcoma has prognostic value. Histopathology 2015; 66:627-38. [PMID: 24889065 DOI: 10.1111/his.12466] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2014] [Accepted: 05/24/2014] [Indexed: 01/15/2023]
Abstract
AIMS Well-differentiated leiomyosarcomas show morphologically recognizable smooth muscle differentiation, whereas poorly differentiated tumours may form a spectrum with a subset of undifferentiated pleomorphic sarcomas. The expression of certain muscle markers has been reported to have prognostic impact. We investigated the correlation between the morphological spectrum and the muscle marker expression profile of leiomyosarcoma, and the impact of these factors on patient outcomes. METHODS AND RESULTS Tissue microarrays including 202 non-uterine and 181 uterine leiomyosarcomas with a spectrum of tumour morphologies were evaluated for expression of immunohistochemical markers of muscle differentiation. Poorly differentiated tumours frequently lost one or more conventional smooth muscle markers [smooth muscle actin, desmin, h-caldesmon, and smooth muscle myosin (P < 0.0001)], as well as the more recently described markers SLMAP, MYLK, and ACTG2 (P < 0.0001). In primary tumours, both desmin and CFL2 expression predicted improved overall survival in multivariate analyses (P = 0.0111 and P = 0.043, respectively). Patients with muscle marker-enriched tumours (expressing all four conventional markers or any three of ACTG2, CFL2, CASQ2, MYLK, and SLMAP) had improved overall survival (P < 0.05) in univariate analyses. CONCLUSIONS Morphologically and immunohistochemically, poorly differentiated leiomyosarcomas can masquerade as undifferentiated pleomorphic sarcomas with progressive loss of muscle markers. The expression of muscle markers has prognostic significance in primary leiomyosarcomas independently of tumour morphology.
Collapse
Affiliation(s)
- Elizabeth G Demicco
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
7
|
Cantú de León D, González H, Pérez Montiel D, Coronel J, Pérez-Plasencia C, Villavicencio-Valencia V, Soto-Reyes E, Herrera LA. Uterine sarcomas: Review of 26 years at The Instituto Nacional de Cancerologia of Mexico. Int J Surg 2013; 11:518-23. [DOI: 10.1016/j.ijsu.2013.04.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2012] [Revised: 04/13/2013] [Accepted: 04/27/2013] [Indexed: 01/22/2023]
|
8
|
Smith T, McLaughlin P. Uterine Leiomyosarcoma: Diagnosis, Treatment, and Nursing Management. Clin J Oncol Nurs 2012; 16:267-72. [DOI: 10.1188/12.cjon.267-272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
9
|
Gadducci A. Prognostic factors in uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011; 25:783-95. [DOI: 10.1016/j.bpobgyn.2011.06.002] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2010] [Accepted: 06/12/2011] [Indexed: 01/01/2023]
|
10
|
D'Angelo E, Espinosa I, Ali R, Gilks CB, Rijn MVD, Lee CH, Prat J. Uterine leiomyosarcomas: Tumor size, mitotic index, and biomarkers Ki67, and Bcl-2 identify two groups with different prognosis. Gynecol Oncol 2011; 121:328-33. [DOI: 10.1016/j.ygyno.2011.01.022] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2010] [Revised: 01/12/2011] [Accepted: 01/15/2011] [Indexed: 01/28/2023]
|
11
|
The role of lymphadenectomy in uterine leiomyosarcoma: review of the literature and recommendations for the standard surgical procedure. Arch Gynecol Obstet 2010; 282:293-300. [DOI: 10.1007/s00404-010-1524-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2010] [Accepted: 05/12/2010] [Indexed: 10/24/2022]
|
12
|
Hrzenjak A, Moinfar F, Kremser ML, Strohmeier B, Petru E, Zatloukal K, Denk H. Histone deacetylase inhibitor vorinostat suppresses the growth of uterine sarcomas in vitro and in vivo. Mol Cancer 2010; 9:49. [PMID: 20202195 PMCID: PMC2843655 DOI: 10.1186/1476-4598-9-49] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2009] [Accepted: 03/04/2010] [Indexed: 11/29/2022] Open
Abstract
Background Uterine sarcomas are very rare malignancies with no approved chemotherapy protocols. Histone deacetylase (HDAC) inhibitors belong to the most promising groups of compounds for molecular targeting therapy. Here, we described the antitumor effects of suberoylanilide hydroxamic acid (SAHA; vorinostat) on MES-SA uterine sarcoma cells in vitro and in vivo. We investigated effects of vorinostat on growth and colony forming ability by using uterine sarcoma MES-SA cells. We analyzed the influence of vorinostat on expression of different HDACs, p21WAF1 and activation of apoptosis. Finally, we examined the antitumor effects of vorinostat on uterine sarcoma in vivo. Results Vorinostat efficiently suppressed MES-SA cell growth at a low dosage (3 μM) already after 24 hours treatment. Decrease of cell survival was even more pronounced after prolonged treatment and reached 9% and 2% after 48 and 72 hours of treatment, respectively. Colony forming capability of MES-SA cells treated with 3 μM vorinostat for 24 and 48 hours was significantly diminished and blocked after 72 hours. HDACs class I (HDAC2 and 3) as well as class II (HDAC7) were preferentially affected by this treatment. Vorinostat significantly increased p21WAF1 expression and apoptosis. Nude mice injected with 5 × 106 MES-SA cells were treated for 21 days with vorinostat (50 mg/kg/day) and, in comparison to placebo group, a tumor growth reduction of more than 50% was observed. Results obtained by light- and electron-microscopy suggested pronounced activation of apoptosis in tumors isolated from vorinostat-treated mice. Conclusions Our data strongly indicate the high therapeutic potential of vorinostat in uterine sarcomas.
Collapse
Affiliation(s)
- Andelko Hrzenjak
- Lore Saldow Research Unit for Molecular Pathology of Gynecologic Tumors, Department of Pathology, Medical University of Graz, Auenbruggerplatz 25, 8036 Graz, Austria.
| | | | | | | | | | | | | |
Collapse
|
13
|
Bernstein-Molho R, Grisaro D, Soyfer V, Safra T, Merimsky O. Metastatic Uterine Leiomyosarcomas. Int J Gynecol Cancer 2010; 20:255-60. [DOI: 10.1111/igc.0b013e3181c9e289] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
14
|
Lee CH, Turbin DA, Sung YCV, Espinosa I, Montgomery K, van de Rijn M, Gilks CB. A panel of antibodies to determine site of origin and malignancy in smooth muscle tumors. Mod Pathol 2009; 22:1519-31. [PMID: 19734847 DOI: 10.1038/modpathol.2009.122] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Leiomyosarcomas are malignant smooth muscle tumors that occur most commonly in the gynecologic tract and soft tissue. There are different diagnostic criteria of malignancy for smooth muscle tumors arising at gynecologic and soft tissue sites and they may be managed differently but determining the primary site of a smooth muscle tumor can be difficult in some cases. In addition, the distinction between malignant and benign gynecologic tract smooth muscle tumors on morphologic grounds can be challenging. Using a series of tissue microarrays that contain 245 cases of leiomyosarcomas (102 gynecologic) with survival data, and 49 cases of uterine leiomyoma, we examined the ability of selected immune-markers (estrogen receptor (ER) and WT1) to distinguish between leiomyosarcomas of gynecologic and nongynecologic origin. In addition, we examined whether immunostains for p16, p53 and Ki-67 could distinguish between malignant and benign gynecologic smooth muscle tumors. ER nuclear positivity was observed in 3 and 50% of the nongynecologic and gynecologic leiomyosarcomas, respectively (P<0.001). Nuclear WT1 positivity was seen in 0 and 8% of the nongynecologic and gynecologic leiomyosarcomas, respectively (P<0.001). 87% of primary gynecologic leiomyosarcomas and 2% of uterine leiomyomas showed diffuse (>or=50% of cells) p16 staining (P<0.001). 23% of gynecologic leiomyosarcomas showed p53 immunopositivity (>or=50% of cells) whereas none of the leiomyomas were positive for p53 (P<0.001). 65% of the gynecologic leiomyosarcomas and 0% of the leiomyomas exhibited >10% Ki-67 proliferation index (P<0.001). Diffuse p16 and p53 immunopositivity and high Ki-67 proliferation index, singly or in combination, yielded an overall sensitivity of 92% and specificity of 98% for distinguishing between gynecologic leiomyosarcomas and leiomyomas and can be used as indicators of malignancy for gynecologic smooth muscle tumors. Although ER positivity can be used to support the gynecologic origin of a leiomyosarcomas, nuclear WT1 immunostaining is of little use.
Collapse
Affiliation(s)
- Cheng-Han Lee
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver General Hospital, Vancouver, BC, Canada
| | | | | | | | | | | | | |
Collapse
|
15
|
D'Angelo E, Spagnoli LG, Prat J. Comparative clinicopathologic and immunohistochemical analysis of uterine sarcomas diagnosed using the World Health Organization classification system. Hum Pathol 2009; 40:1571-85. [DOI: 10.1016/j.humpath.2009.03.018] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2009] [Revised: 03/20/2009] [Accepted: 03/26/2009] [Indexed: 12/20/2022]
|
16
|
Kim WY, Chang SJ, Chang KH, Yoon JH, Kim JH, Kim BG, Bae DS, Ryu HS. Uterine leiomyosarcoma: 14-year two-center experience of 31 cases. Cancer Res Treat 2009; 41:24-8. [PMID: 19688068 DOI: 10.4143/crt.2009.41.1.24] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 12/10/2008] [Indexed: 11/21/2022] Open
Abstract
PURPOSE The aim of this study was to evaluate the clinicopathological characteristics of uterine leiomyosarcoma (LMS) and possible prognostic factors. MATERIALS AND METHODS This study included 31 patients with histologically proven LMS at Samsung Medical Center and Ajou University Hospital between 1994 and 2007. The medical records and available histological slides were reviewed retrospectively. RESULTS The median age was 46 years (range, 32~63). The most common symptom was vaginal bleeding (11 patients, 35.5%). There were 23 patients with stage I, one patient with stage III, seven patients with stage IV disease. The median follow up time was 29 months (range, 1~94). The most common recurrence site was lung (5 case), followed by pelvis and upper abdomen (2 case). Nine patients died of disease with a 5-year overall survival rate of 63%. Early tumor stage and mitotic count were the prognostic factor in univariate analysis (p<0.0001 and p=0.0031, respectively), but early tumor stage only was associated with prognosis in multivariate analysis (p=0.010 vs p=0.143). Adjuvant treatment for early stage disease did not decrease the recurrence rate (p=0.1075), but high mitotic count (15>10HPF) had a trend for disease recurrence in early stage LMS (p=0.0859). CONCLUSION Mitotic count less than 15/HPF in early stage may be related with longer progression-free interval, but we could not reach the conclusion that adjuvant therapy in early stage LMS be effective.
Collapse
Affiliation(s)
- Woo Young Kim
- Department of Obstetrics and Gynecology, Ajou University Hospital, Suwon, Korea
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Courtney MW, Levine EA. Uterine leiomyosarcoma metastatic to soft tissue of the flank following a ten-year disease-free interval. South Med J 2009; 102:325-6. [PMID: 19204627 DOI: 10.1097/smj.0b013e318195132a] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A 52-year-old female presented with a metastatic uterine leiomyosarcoma to the left flank ten years following total abdominal hysterectomy for a left adnexal primary. Due to the location of the metastasis in the subcutaneous tissue, it was initially felt to be a lipoma. Following excision, pathology revealed leiomyosarcoma. Rarely do uterine leiomyosarcomas metastasize to areas such as the flank or skeletal muscle. We report the case of a uterine leiomyosarcoma metastasis to soft tissue following an extended disease-free interval. With most recurrences occurring within 8 to 16 months following hysterectomy, this case offers an atypical recurrence of this malignancy. The patient's three-year postoperative course has been uneventful.
Collapse
Affiliation(s)
- Malachi W Courtney
- Surgical Oncology Service, Department of General Surgery, Wake Forest University School of Medicine, Winston-Salem, NC 27157, USA
| | | |
Collapse
|
18
|
Hayashi T, Shimamura Y, Saegusa T, Horiuchi A, Kobayashi Y, Hiraoka N, Kanai Y, Aburatani H, Sano K, Konishi I. Molecular mechanisms of uterine leiomyosarcomas: involvement of defect in LMP2 expression. GENE REGULATION AND SYSTEMS BIOLOGY 2008; 2:297-305. [PMID: 19787091 PMCID: PMC2733082 DOI: 10.4137/grsb.s470] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Patients with uterine leiomyosarcoma (LMS) typically present with vaginal bleeding, pain, and a pelvic mass. Typical presentations with hypercalcemia or eosinophilia have been reported. Radiographic evaluation with combined positron emission tomography/computed tomography may assist in the diagnosis and surveillance of women with uterine LMS. A recently developed risk-assessment index is highly predictive of disease-specific survival. Ovarian preservation does not appear to negatively impact outcome, and the addition of adjuvant therapy after surgical treatment does not seem to improve survival. It is noteworthy that LMP2-deficient mice exhibit spontaneous development of uterine LMS with a disease prevalence of ~37% by 12 months of age. The LMP2 gene is transcribed from a promoter containing an interferon (IFN)-γ-response factor element; thus, the IFN-γ-signal strongly induces LMP2 expression. Furthermore, a recent report demonstrated the loss of ability to induce LMP2 expression, which is an interferon (IFN)-γ-inducible factor, in human uterine LMS tissues and cell lines. Analysis of human uterine LMS shows somatic mutations in the IFNγ signalling pathway, thus the loss of LMP2 induction is attributable to a defect in the earliest steps of the IFN-γ signalling pathway. The discovery of an impaired key cell-signalling pathway may provide new targets for diagnostic approaches and therapeutic intervention.
Collapse
Affiliation(s)
- Takuma Hayashi
- Department of Immunology and Infectious Disease, Shinshu University Graduate School of Medicine, Nagano, Japan.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Abstract
PURPOSE OF REVIEW To review gynaecological sarcomas, their management and future perspectives. RECENT FINDINGS Soft tissue sarcomas are a group of tumours consisting of a wide variety of subtypes. The most common subtypes encountered in the female tract are uterine leiomyosarcomas and endometrial stromal sarcomas. Other subtypes do occur but at a much lower frequency. Mixed Müllerian tumours were previously considered to be a subtype of sarcoma, but recent evidence has revealed that they should in fact be regarded as carcinomas. Given the different approaches for different subtypes of sarcomas, their rarity and the complexity of treatment, the management of patients with gynaecological sarcomas should be delivered by multidisciplinary teams experienced in the treatment of these entities. SUMMARY Gynaecological sarcomas are rare tumours and are treated differently from gynaecological carcinomas. Hopefully, improved insight into the pathogenesis of gynaecological sarcomas will yield novel therapies in the near future.
Collapse
Affiliation(s)
- Stefan Sleijfer
- Department of Medical Oncology, Erasmus University Medical Centre, Daniel den Hoed Cancer Centre, Rotterdam, The Netherlands.
| | | | | |
Collapse
|
20
|
Ma L, Wu S, Zou Y, Li W, Gong L, Gerelle G, Ni Y. One-stage surgery of low-grade malignant intravenous uterine leiomyosarcomatosis with right atrium extension. Ann Thorac Surg 2007; 84:644-7. [PMID: 17643652 DOI: 10.1016/j.athoracsur.2007.03.056] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2007] [Revised: 03/15/2007] [Accepted: 03/19/2007] [Indexed: 01/20/2023]
Abstract
Uterine leiomyosarcoma is a rare and aggressive malignant tumor arising from the smooth muscle cells of the myometrium, which rarely metastasizes to the heart. We report the case of a 49-year-old Chinese woman who underwent a successful one-stage surgical intervention after an initial diagnosis of intravenous uterine leiomyomatosis. However, her postoperative biopsy showed the presence of low-grade malignant uterine leiomyosarcoma with intravenous and right atrium extension. It is our conclusion that surgical resection is the mainstay treatment for this type of condition.
Collapse
Affiliation(s)
- Liang Ma
- Department of Cardiothoracic Surgery, 1st Affiliated Hospital, College of Medicine, ZheJiang University, HangZhou, The People's Republic of China
| | | | | | | | | | | | | |
Collapse
|
21
|
Gadducci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: a debated clinical challenge. Crit Rev Oncol Hematol 2007; 65:129-42. [PMID: 17706430 DOI: 10.1016/j.critrevonc.2007.06.011] [Citation(s) in RCA: 181] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2006] [Revised: 05/23/2007] [Accepted: 06/27/2007] [Indexed: 12/23/2022] Open
Abstract
Uterine sarcomas include a heterogeneous group of rare tumours that usually have an aggressive clinical behaviour and a poor prognosis. Total abdominal hysterectomy and bilateral salpingo-oophorectomy represents the standard surgical treatment. Pelvic and/or para-aortic lymphadenectomy is indicated for carcinosarcoma, but not for leiomyosarcoma and undifferentiated endometrial sarcoma. Some recent data on low numbers of patients with low-grade endometrial stromal sarcoma appear to show an incidence of nodal involvement higher than previously expected, thus suggesting a role for lymphadenectomy in this malignancy. Carcinosarcoma also requires a comprehensive surgical peritoneal staging. Postoperative treatment of uterine sarcomas has been long debated. Adjuvant pelvic radiotherapy appears to improve local control without any significant impact on overall survival. There is little evidence in the literature supporting the use of adjuvant chemotherapy in any gynaecological sarcomas except for carcinosarcomas. However, uterine sarcomas have a high tendency to develop distant recurrences, and recent data on adjuvant chemotherapy in soft tissue sarcomas are promising. As for the drugs to be used, it is worth noting that in a Swiss study, the combination of ifosfamide (IFO) and doxorubicin (DOX) obtained similar response rates in advanced gynaecological sarcomas and in advanced soft tissue sarcomas of other sites. In our decision-making scheme for early-stage disease, patients with leiomyosarcoma or undifferentiated endometrial sarcoma should receive adjuvant doxorubicin/epidoxorubicin (EPIDX)+ifosfamide, and those with carcinosarcoma should be treated with adjuvant cisplatin (CDDP)-based chemotherapy. The same drug regimens are used for the treatment of advanced disease. Sequential pelvic radiotherapy following chemotherapy could be delivered to selected cases. Recurrent disease often requires the integration of different therapeutic modalities, but no curative option is currently available with the possible exception of surgery for lung metastases and hormone therapy with or without debulking surgery for recurrent low-grade endometrial stromal sarcoma. Patients should be encouraged to enter clinical trials designed to identify new active drugs for these malignancies.
Collapse
Affiliation(s)
- Angiolo Gadducci
- Department of Procreative Medicine, Division of Gynecology and Obstetrics, Pisa, Italy.
| | | | | | | |
Collapse
|
22
|
Mizuno T, Imai A, Hirose Y. Skeletal muscle metastatic and pelvic leiomyosarcomas following hysterectomy. Int J Gynaecol Obstet 2006; 96:49-50. [PMID: 17187791 DOI: 10.1016/j.ijgo.2006.09.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2006] [Revised: 09/19/2006] [Accepted: 09/19/2006] [Indexed: 10/23/2022]
Affiliation(s)
- T Mizuno
- Department of Obstetrics and Gynecology, Gifu University School of Medicine, Yanagido, Gifu, Japan
| | | | | |
Collapse
|
23
|
Patai K, Illyes G, Varbiro S, Gidai J, Kosa L, Vajo Z. Uterine leiomyosarcoma with osteoclast like giant cells and long standing systemic symptoms. Gynecol Oncol 2006; 102:403-5. [PMID: 16643995 DOI: 10.1016/j.ygyno.2006.02.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2006] [Revised: 02/18/2006] [Accepted: 02/20/2006] [Indexed: 11/30/2022]
Abstract
INTRODUCTION The leiomyomatous type of uterine sarcoma with osteoclast-type giant cell component is a rare variant of uterine tumors with poor prognosis. The histological diagnosis of these rare tumors can be problematic and only five such tumors have been published previously. CASE REPORT A 54-year-old woman presented with fever and weight loss for 7 months and laboratory findings suggestive of inflammation. After extensive clinical investigation, a uterine tumor was found, which was considered to be an incidental finding and was thought to be unlikely to explain the symptoms. After hysterectomy, the patient had a surprising and quick recovery with the complete relief of systemic symptoms and normalization of laboratory changes. The tumor was a dedifferentiated leiomyosarcoma with osteoclast-like giant cells and contained extensive necrosis. The patient continues to do well and is tumor-free 1 year after the operation. DISCUSSION To our knowledge, this is the first report of a patient being alive and disease-free 12 months after surgery with a dedifferentiated uterine leiomyosarcoma with osteoclast-like giant cells.
Collapse
Affiliation(s)
- Kalman Patai
- 2nd Department of Obstetrics and Gynecology, Semmelweis Medical University, Budapest, Hungary
| | | | | | | | | | | |
Collapse
|
24
|
Hassini A, Khemiri B, Sfar E, Chelly D, Chennoufi MB, Chelly H. Sarcomes utérins : aspects cliniques et thérapeutiques. ACTA ACUST UNITED AC 2006; 35:348-55. [PMID: 16940904 DOI: 10.1016/s0368-2315(06)76407-9] [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: 11/18/2022]
Abstract
PURPOSE Uterine sarcomas are rare tumours characterized by clinical and histopathological diversity and poor prognosis. We analyzed diagnostic, prognostic and therapeutic difficulties encountered with these tumors by insisting on the importance of early diagnosis. PATIENTS AND METHODS From 1997 to 2004 ten patients with uterine sarcoma who underwent surgery in the obstetrics and gynecology unit at the Tunis maternity center were included in this retrospective study. The tumors were classified at the time of diagnosis using the FIGO staging system. The histological diagnosis was based on the WHO classification. RESULTS There were 5 cases of leiomyosarcoma, 2 cases of carcinosarcoma, 2 cases of endometrial stromal sarcoma and 1 adenosarcoma. There were four cases of stage I, two cases of stage II, two cases of stage III and two of stage IV tumors. The diagnosis of uterine sarcoma was strongly suspected and proved before the initial operation in 20% of cases and during this operation in 60% of cases. Diagnosis was only established at the histological exam in two cases. Total hysterectomy with bilateral salpingo-oophorectomy was performed in 90% of patients. Radiation therapy was performed in four. Chemotherapy was delivered in two patients. After an average of four years five patients were in remission, three had died and two were lost to follow-up. CONCLUSION Early preoperative or intra-operative diagnosis is essential while awaiting for more effective chemotherapy protocols or therapeutic strategies.
Collapse
Affiliation(s)
- A Hassini
- Service A de Gynécologie Obstétrique, Centre de Maternité et de Néonatologie de Tunis, Tunisie
| | | | | | | | | | | |
Collapse
|
25
|
Moreno Antón F, Casado Herraez A, Puente Vázquez J, Gómez Díaz R, Aragoncillo P, Díaz-Rubio García E. Cardiac metastasis from uterine leiomyosarcoma. Clin Transl Oncol 2006; 8:375-8. [PMID: 16760015 DOI: 10.1007/s12094-006-0186-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Cardiac metastases are more frequent than primary heart neoplasias. Nearly any malignant tumour may metastasize to the heart, but the most common are carcinomas rather than sarcomas. We report the case of a patient who presented with heart metastasis 6 years after resection of an uterine leiomyosarcoma. The patient died thirty months after surgical resection without evidence of cardiac recurrence. Although cardiac metastases from uterine leiomyosarcoma are exceptional, they should be suspected in the presence of suggestive symptoms, since they can be associated with long survival after surgical treatment.
Collapse
Affiliation(s)
- F Moreno Antón
- Servicio de Oncología Médica, Hospital Clínico San Carlos, Madrid, Spain.
| | | | | | | | | | | |
Collapse
|
26
|
Leiser AL, Anderson SE, Nonaka D, Chuai S, Olshen AB, Chi DS, Soslow RA. Apoptotic and cell cycle regulatory markers in uterine leiomyosarcoma. Gynecol Oncol 2006; 101:86-91. [PMID: 16289259 DOI: 10.1016/j.ygyno.2005.09.055] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2005] [Revised: 09/01/2005] [Accepted: 09/27/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVES The primary aim of this study was to investigate the expression of apoptotic and cell cycle regulators p53, p21, p27, bax, and bcl-2 in uterine leiomyosarcoma in order to identify molecular pathways that possibly could be important in the development of leiomyosarcoma. A secondary aim was to examine if the apoptotic and cell cycle regulatory protein expression profile of uterine leiomyosarcoma is potentially useful for clinical prognostic purposes. METHODS A tissue microarray representing 36 uterine leiomyosarcomas and 19 uterine leiomyomas was created with 3 representative cores from each tumor. Immunohistochemical staining was performed for bcl-2, bax, p21, p27, and p53 using standard techniques. Staining was scored 0-12 for each marker, 0-3 being negative and 4-12 positive. Outcome analyses were performed only for leiomyosarcomas. First recurrence was determined from the time of initial diagnosis. Survival was determined from the time of initial diagnosis to last follow-up. RESULTS Associations were found between disease type (leiomyosarcoma vs. leiomyoma) and the positivity status of p21 (43% vs. 0%, P < 0.001), p53 (54% vs. 0%, P < 0.001), and bax (34% vs. 94%, P < 0.001). bcl-2-positive leiomyosarcoma was associated with a longer time to recurrence (P = 0.02) in a univariate analysis. In a multivariate analysis, tumor stage was the only independent significant prognostic factor (P = 0.002). CONCLUSION The significant differential expression of apoptotic and cell cycle regulatory proteins in uterine leiomyosarcoma as compared to benign smooth muscle tumors suggests that pathways involving these proteins may be important in the development of malignant disease and, therefore, could be potential targets for molecular therapies.
Collapse
Affiliation(s)
- Aliza L Leiser
- Developmental Chemotherapy Service, Department of Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY 10021, USA
| | | | | | | | | | | | | |
Collapse
|
27
|
Matsumura N, Mandai M, Miyanishi M, Fukuhara K, Baba T, Higuchi T, Kariya M, Takakura K, Fujii S. Oncogenic Property of Acrogranin in Human Uterine Leiomyosarcoma: Direct Evidence of Genetic Contribution inIn vivoTumorigenesis. Clin Cancer Res 2006; 12:1402-11. [PMID: 16533762 DOI: 10.1158/1078-0432.ccr-05-2003] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
To identify potential oncogenes that contribute to the development of uterine leiomyosarcoma, we conducted a cDNA microarray analysis between normal uterine smooth muscle and uterine leiomyosarcoma. We found that acrogranin (also named PCDGF or progranulin) is overexpressed in uterine leiomyosarcoma. With immunohistochemical staining of 12 leiomyosarcoma cases, we verified acrogranin expression in tumor cells. Furthermore, the intensity of acrogranin expression correlated with high histologic grade and poor prognosis. To directly analyze the oncogenic properties of acrogranin, we established an immortalized uterine smooth muscle cell line by transfection of human telomerase reverse transcriptase into primary culture. This cell line retained the original characteristics of uterine smooth muscle cells, including spindle-shaped extension as well as expression of vimentin, estrogen receptor alpha, progesterone receptor, and alpha smooth muscle actin. Transfection of acrogranin into the immortalized uterine smooth muscle cells resulted in colony formation in soft agar, but the diameter of the colonies did not exceed 100 mum. Transfection of both acrogranin and SV40 early region (SV40ER) into the immortalized uterine smooth muscle cells resulted in an increased number of colonies and increased colony size in soft agar versus transfection of SV40ER alone. We show that only immortalized uterine smooth muscle cells expressing both acrogranin and SV40ER are capable of tumor formation in nude mice. Thus, acrogranin is overexpressed in uterine leiomyosarcoma cells, particularly in high-grade cases, and forced expression of acrogranin in immortalized uterine smooth muscle cells contributes to malignant transformation, which suggest that acrogranin plays an important role in the pathogenesis of uterine leiomyosarcoma.
Collapse
Affiliation(s)
- Noriomi Matsumura
- Department of Gynecology and Obstetrics, Faculty of Medicine, Kyoto University, Kyoto, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|