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Bruguier H, Maalouf N, Smyth SL, Damato S, Reddy P, Soleymani Majd H. Rare Mullerian adenosarcoma of the uterine cervix arising on a background of endometriosis: A diagnostic challenge with risk of malignant transformation-A case report and review of the current literature. Clin Case Rep 2024; 12:e9075. [PMID: 38883216 PMCID: PMC11176736 DOI: 10.1002/ccr3.9075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2023] [Revised: 05/13/2024] [Accepted: 05/29/2024] [Indexed: 06/18/2024] Open
Abstract
Endometriosis may contribute to Mullerian adenosarcoma development but makes diagnosis challenging given similar symptoms. Survival benefit has not been definitively shown for chemotherapy, hormonal therapy, or radiotherapy, consolidating surgery as the mainstay treatment. Local excision may be a treatment option for patients with confined tumors wishing to preserve their fertility.
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Affiliation(s)
- Hannah Bruguier
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Natalie Maalouf
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Sarah Louise Smyth
- Department of Obstetrics and Gynaecology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Stephen Damato
- Department of Cellular Pathology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Priyanka Reddy
- Department of Radiology, John Radcliffe Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
| | - Hooman Soleymani Majd
- Department of Gynaecological Oncology, Churchill Hospital Oxford University Hospitals NHS Foundation Trust Oxford UK
- Medical Sciences Division, Nuffield Department of Women's Reproductive Health Oxford University Oxford UK
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Wang Y, Chen SY, Ta M, Senz J, Tao LV, Thornton S, Tamvada N, Yang W, Moscovitz Y, Li E, Guo J, Shen C, Douglas JM, Ei-Naggar AM, Kommoss FKF, Underhill TM, Singh N, Gilks CB, Morin GB, Huntsman DG. Biallelic Dicer1 Mutations in the Gynecologic Tract of Mice Drive Lineage-Specific Development of DICER1 Syndrome-Associated Cancer. Cancer Res 2023; 83:3517-3528. [PMID: 37494476 DOI: 10.1158/0008-5472.can-22-3620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 07/28/2023]
Abstract
DICER1 is an RNase III enzyme essential for miRNA biogenesis through cleaving precursor-miRNA hairpins. Germline loss-of-function DICER1 mutations underline the development of DICER1 syndrome, a rare genetic disorder that predisposes children to cancer development in organs such as lung, gynecologic tract, kidney, and brain. Unlike classical tumor suppressors, the somatic "second hit" in DICER1 syndrome-associated cancers does not fully inactivate DICER1 but impairs its RNase IIIb activity only, suggesting a noncanonical two-hit hypothesis. Here, we developed a genetically engineered conditional compound heterozygous Dicer1 mutant mouse strain that fully recapitulates the biallelic DICER1 mutations in DICER1 syndrome-associated human cancers. Crossing this tool strain with tissue-specific Cre strains that activate Dicer1 mutations in gynecologic tract cells at two distinct developmental stages revealed that embryonic biallelic Dicer1 mutations caused infertility in females by disrupting oviduct and endometrium development and ultimately drove cancer development. These multicystic tubal and intrauterine tumors histologically resembled a subset of DICER1 syndrome-associated human cancers. Molecular analysis uncovered accumulation of additional oncogenic events (e.g., aberrant p53 expression, Kras mutation, and Myc activation) in murine Dicer1 mutant tumors and validated miRNA biogenesis defects in 5P miRNA strand production, of which, loss of let-7 family miRNAs was identified as a putative key player in transcriptomic rewiring and tumor development. Thus, this DICER1 syndrome-associated cancer model recapitulates the biology of human cancer and provides a unique tool for future investigation and therapeutic development. SIGNIFICANCE Generation of a Dicer1 mutant mouse model establishes the oncogenicity of missense mutations in the DICER1 RNase IIIb domain and provides a faithful model of DICER1 syndrome-associated cancer for further investigation.
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Affiliation(s)
- Yemin Wang
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Shary Yuting Chen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Monica Ta
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Janine Senz
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Lan Valerie Tao
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Shelby Thornton
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Nirupama Tamvada
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Winnie Yang
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Yana Moscovitz
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Eunice Li
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jingjie Guo
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Cindy Shen
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - J Maxwell Douglas
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Amal M Ei-Naggar
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - Felix K F Kommoss
- Department of Pathology, Heidelberg University Hospital, Heidelberg, Germany
| | - T Michael Underhill
- Department of Cellular and Physiological Sciences and Biomedical Research Centre, University of British Columbia, Vancouver, British Columbia, Canada
| | - Naveena Singh
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - C Blake Gilks
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Gregg B Morin
- Department of Medical Genetics, University of British Columbia, Vancouver, British Columbia, Canada
- Michael Smith Genome Science Centre, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
| | - David G Huntsman
- Department of Pathology and Laboratory Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Department of Molecular Oncology, British Columbia Cancer Research Institute, Vancouver, British Columbia, Canada
- Department of Obstetrics and Gynecology, University of British Columbia, Vancouver, British Columbia, Canada
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Karabajakian A, Genestie C, Meeus P, Guyon F, Llacer Moscardo C, Croce S, Taieb S, Duffaud F, Pautier P, Ray-Coquard I, Blay JY. [Uterin adenosarcoma: French Guidelines of the French Sarcoma Group and the Rare Gynecologic Tumor Group]. Bull Cancer 2023; 110:836-843. [PMID: 37202293 DOI: 10.1016/j.bulcan.2023.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Uterine adenosarcoma is a very rare malignancy defined as a biphasic tumor composed of both benign epithelial component and a malignant sarcoma component. The stage of the disease is determined by the presence of myometrial invasion and the extent of extra-uterine disease. The most important histopronostic factors are the existence of a sarcomatous overgrowth defined by a sarcomatous contingent occupying more than 25 % of the volume of the tumor (directly correlated to the grade of the disease), the presence of a heterologous and/or a high-grade component. Stage I adenosarcomas without sarcomatous overgrowth have a good prognosis, with an overall 5-year survival of up to 80 %. In localized disease, complete surgical removal is recommended. The role of hormone therapy, chemotherapy and adjuvant radiotherapy is not established. If possible, relapses should be re-treated surgically, with the aim of achieving complete resection. In the advanced inoperable or metastatic setting, hormone therapy is an option for low-grade adenosarcomas with estrogen receptor (ER) and progesterone receptor (PR) overexpression. For high-grade tumors, the standard chemotherapies are doxorubicin-based combinations, although an integrated approach of surgery and medical treatment should also be considered in this setting.
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Affiliation(s)
- Andy Karabajakian
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Catherine Genestie
- Gustave-Roussy cancer campus, service de biopathologie, 94805 Villejuif, France
| | - Pierre Meeus
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Centre Léon-Bérard, département de chirurgie oncologique, 69008 Lyon, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie oncologique, 33076 Bordeaux, France
| | - Carmen Llacer Moscardo
- Institut du cancer de Montpellier (ICM), département de radiothérapie oncologique, 208, avenue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 5, France
| | - Sabrina Croce
- Institut Bergonié, département de biopathologie, 33076 Bordeaux, France
| | - Sophie Taieb
- Centre Oscar Lambret, département de radiologie, 59000 Lille, France
| | - Florence Duffaud
- AP-HM, hôpitaux universitaires de Marseille Timone, département d'oncologie médicale, 13005 Marseille, France
| | - Patricia Pautier
- Gustave-Roussy Cancer Campus, département d'oncologie médicale, 94805 Villejuif, France.
| | - Isabelle Ray-Coquard
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
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Hasegawa C, Washimi K, Hiroshima Y, Kasajima R, Kikuchi K, Notomi T, Kato H, Hiruma T, Sato S, Okubo Y, Yoshioka E, Ono K, Miyagi Y, Yokose T. Differential diagnosis of uterine adenosarcoma: identification of JAZF1-BCORL1 rearrangement by comprehensive cancer genomic profiling. Diagn Pathol 2023; 18:5. [PMID: 36639698 PMCID: PMC9837955 DOI: 10.1186/s13000-022-01279-4] [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: 08/25/2022] [Accepted: 12/19/2022] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Uterine adenosarcoma is a rare malignant tumor that accounts for 8% of all uterine sarcomas, and less than 0.2% of all uterine malignancies. However, it is frequently misdiagnosed in clinical examinations, including pathological diagnosis, and imaging studies owing to its rare and non-specific nature, which is further compounded by the lack of specific diagnostic markers. CASE PRESENTATION We report a case of uterine adenosarcoma for which a comprehensive genomic profiling (CGP) test provided a chance to reach the proper diagnosis. The patient, a woman in her 60s with a history of uterine leiomyoma was diagnosed with an intra-abdominal mass post presentation with abdominal distention and loss of appetite. She was suspected to have gastrointestinal stromal tumor (GIST); the laparotomically excised mass was found to comprise uniform spindle-shaped cells that grew in bundles with a herringbone architecture, and occasional myxomatous stroma. Immunostaining revealed no specific findings, and the tumor was diagnosed as a spindle cell tumor/suspicious adult fibrosarcoma. The tumor relapsed during postoperative follow-up, and showed size reduction with chemotherapy, prior to regrowth. CGP was performed to identify a possible treatment, which resulted in detection of a JAZF1-BCORL1 rearrangement. Since the rearrangement has been reported in uterine sarcomas, we reevaluated specimens of the preceding uterine leiomyoma, which revealed the presence of adenosarcoma components in the corpus uteri. Furthermore, both the uterine adenosarcoma and intra-abdominal mass were partially positive for CD10 and BCOR staining. CONCLUSION These results led to the conclusive identification of the abdominal tumor as a metastasis of the uterine adenosarcoma. The JAZF1-BCORL1 rearrangement is predominantly associated with uterine stromal sarcomas; thus far, ours is the second report of the same in an adenosarcoma. Adenosarcomas are rare and difficult to diagnose, especially in atypical cases with scarce glandular epithelial components. Identification of rearrangements involving BCOR or BCORL1, will encourage BCOR staining analysis, thereby potentially resulting in better diagnostic outcomes. Given that platinum-based chemotherapy was proposed as the treatment choice for this patient post diagnosis with adenosarcoma, CGP also indirectly contributed to the designing of the best-suited treatment protocol.
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Affiliation(s)
- Chie Hasegawa
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Kota Washimi
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yukihiko Hiroshima
- grid.414944.80000 0004 0629 2905Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Rika Kasajima
- grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Keiji Kikuchi
- grid.414944.80000 0004 0629 2905Division of Advanced Cancer Therapeutics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Tsuguto Notomi
- grid.414944.80000 0004 0629 2905Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Hisamori Kato
- grid.414944.80000 0004 0629 2905Department of Gynecology, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Toru Hiruma
- grid.414944.80000 0004 0629 2905Department of Musculoskeletal Tumor Surgery, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
| | - Shinya Sato
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Yoichiro Okubo
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Emi Yoshioka
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Kyoko Ono
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan
| | - Yohei Miyagi
- grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan ,grid.414944.80000 0004 0629 2905Division of Molecular Pathology and Genetics, Kanagawa Cancer Center Research Institute, Yokohama, Kanagawa Japan
| | - Tomoyuki Yokose
- grid.414944.80000 0004 0629 2905Department of Pathology, Kanagawa Cancer Center, 2-3-2 Nakao Asahi-ku, Yokohama, Kanagawa 241-8515 Japan ,grid.414944.80000 0004 0629 2905Center for Cancer Genome Medicine, Kanagawa Cancer Center, Yokohama, Kanagawa Japan
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Embryonal Rhabdomyosarcoma of the Uterine Cervix: A Clinicopathologic Study of 94 Cases Emphasizing Issues in Differential Diagnosis Staging, and Prognostic Factors. Am J Surg Pathol 2022; 46:1477-1489. [PMID: 35941719 DOI: 10.1097/pas.0000000000001933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Embryonal rhabdomyosarcoma of the uterine cervix (cERMS) is rare and frequently associated with DICER1 mutations. We report 94 tumors that arose in patients aged 7 to 59 (median=23) years and presented with vaginal bleeding (52), protruding vaginal mass (17), cervical polyp (8), or expelled tumor fragments per vagina (5). Nine had DICER1 syndrome, 8 of whom had other syndromic manifestations including ovarian Sertoli-Leydig cell tumor (7), multinodular goiter (3), pleuropulmonary blastoma (2), pineoblastoma (1), and osteosarcoma (1). Syndromic patients were younger than nonsyndromic patients (16 vs. 24 y). Tumor size ranged from 2 to 24 (median=4.5) cm. Ninety-two tumors were polypoid, most being grape-like (77 of 92). They were characterized by aggregates of primitive cells, almost always exhibiting a cambium layer, within a variably myxoedematous stroma and were hypocellular (63), moderately cellular (22), or hypercellular (9). Entrapped glands, typically scant, were present in 84 tumors. Primitive hyperchromatic ovoid to spindled cells with minimal cytoplasm predominated but differentiated rhabdomyoblasts with abundant eosinophilic cytoplasm (having cross-striations in 30) were seen in 83 tumors; they were often sparse but predominated in three. Nine tumors showed areas of intersecting fascicles and 4 zones with densely cellular (solid) growth. Cartilage was present in 38. Anaplasia was seen in 15 tumors, as was necrosis. Mitotic activity ranged from 1 to 58/10 high-power fields (median=8). The varied microscopic features resulted in a spectrum of differential diagnostic considerations, mainly typical and cellular forms of fibroepithelial polyps, Mullerian adenosarcoma, and other sarcomas. Follow-up was available for 79 patients ranging from 6 to 492 (median=90) months. Treatment information was available in 62 and included polypectomy in 6 patients (2 also received chemotherapy), limited resection in 26 (14 also received chemotherapy), hysterectomy in 29 (15 with adjuvant chemotherapy), and biopsies only in 1 (with chemotherapy). Staging was possible in 56 tumors; according to the "uterine sarcoma" system (tumor size and extent) they were: stage I (10/56; could not be further subclassified as size not available), IA (22/56), IB (18/56), IIA (2/56), IIB 3/56), IIIC (1/56). According to the "adenosarcoma" system (depth of invasion and extent) they were: stage IA (26/56), IB (14/56), IC (10/56), IIA (2/56), IIB (3/56), IIIC (1/56). Eight patients had local recurrence following incomplete excision (10%). Eleven of 79 patients had extrauterine recurrences (14%) and 9 died of disease (11%). Older age was associated with extrauterine recurrence (median 44 vs. 22; P=0.002) and decreased disease-specific survival (median 44 vs. 22; P=0.02). For patients with tumors initially confined to the cervix, the adenosarcoma staging system was superior to the uterine sarcoma staging system for predicting survival (P=0.02). Three patients with DICER1 syndrome who underwent fertility-preserving surgery developed a second primary cERMS 7, 7, and 12 years after their primary tumor. All 9 patients with DICER1 syndrome had tumors confined to the cervix and none died of disease. This study highlights the intriguing clinical aspects of cERMS including its long-known tendency to occur in the young but also more recently appreciated association with DICER1 syndrome. Establishing the diagnosis may still be difficult because of the hazard of sampling a neoplasm which in areas may appear remarkably bland and also because of its potential confusion with other neoplasms. This study indicates that this tumor has a good prognosis at this site and in selected cases a conservative surgical approach is a realistic consideration.
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Mayr D, Horn LC, Hiller GGR, Höhn AK, Schmoeckel E. [Endometrial and other rare uterine sarcomas : Diagnostic aspects in the context of the 2020 WHO classification]. DER PATHOLOGE 2022; 43:183-195. [PMID: 35362728 DOI: 10.1007/s00292-022-01072-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Uterine sarcomas are a heterogeneous group of rare malignancies. Mostly (40-50%), they are leiomyosarcomas, followed by endometrial stromal sarcomas (ESS), low-grade (LG) and high-grade (HG), as well as undifferentiated sarcoma of the uterus (UUS) and adenosarcomas (AS). Other, non-organ-specific tumours such as NTRK-rearranged spindle cell neoplasia, perivascular epithelioid cell tumour (PEComa) and inflammatory myofibroblastic tumour (IMT) are extremely difficult to differentiate.In the most recent WHO classification, endometrial stromal tumours are subdivided as follows: benign, expansively growing endometrial stromal nodule (ESN) with sharp demarcation, the histologically similar-looking LG-ESS with infiltrative growth, the highly malignant HG-ESS and, as a diagnosis of exclusion, the highly aggressive UUS lacking specific lines of differentiation. LG-ESS can be differentiated from HG-ESS in most cases histomorphologically and immunohistochemically, but molecular investigations are necessary in individual cases. HG-ESS can be divided into 4 subtypes (YWHAE/NUTM2 fusion low-grade component, YWHAE/NUTM2 fusion high-grade component, ZC3H7B-BCOR fusion or BCOR-ITD) on the basis of molecular findings. Prognostically unfavourable factors in AS are severe sarcomatous overgrowth, deep myometrial invasion, high-grade histology and lymphatic vessel invasion. Tumours with NTRK fusion are immunohistochemically positive for S100 and TRK. PEComas express cathepsin K and HMB45, as well as TFE3 when translocation is present. Almost every IMT shows an alteration in the ALK gene In the case of overlapping morphology and simultaneous therapeutic and prognostic relevance, it is becoming increasingly important to verify or confirm the suspected histomorphological diagnosis by immunohistochemical and possibly molecular investigations.
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Affiliation(s)
- Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland.
| | - Lars-Christian Horn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | | | - Anne Kathrin Höhn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland
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Tamura S, Hayashi T, Ichimura T, Yaegashi N, Abiko K, Konishi I. Characteristic of Uterine Rhabdomyosarcoma by Algorithm of Potential Biomarkers for Uterine Mesenchymal Tumor. Curr Oncol 2022; 29:2350-2363. [PMID: 35448164 PMCID: PMC9027675 DOI: 10.3390/curroncol29040190] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 03/24/2022] [Accepted: 03/25/2022] [Indexed: 12/03/2022] Open
Abstract
Background/Aim: Patients with uterine sarcoma comprise 2–5% of all patients with uterine malignancies; however, the morbidity of uterine sarcoma is low compared with that of other gynecological cancers. For many cases, malignant uterine tumors are diagnosed during follow-up of benign uterine leiomyoma. Of the uterine sarcomas, rhabdomyosarcoma is considered a mixed tumor containing components of epithelial cells and mesenchymal cells. Therefore, the onset of primary uterine rhabdomyosarcoma during follow-up of uterine leiomyoma is extremely rare. Rhabdomyosarcoma is a relatively common malignant tumor in children, but rhabdomyosarcoma in adults is extremely rare, accounting for approximately 3% of all patients with soft tissue sarcoma. Rhabdomyosarcoma in children is highly sensitive to chemotherapy and radiation therapy; however, the response to chemotherapy and radiation therapy in adult rhabdomyosarcoma is low and survival in adult rhabdomyosarcoma with metastatic lesions to other organs is approximately 14 months. We experienced a case of pleomorphic rhabdomyosarcoma during the follow-up of a uterine leiomyoma. Materials and Methods: We examined the oncological properties of uterine rhabdomyosarcoma in adults using molecular pathological techniques on tissue excised from patients with uterine leiomyoma. Result: A differential diagnosis was made for this case by molecular pathology, which included candidate biomarkers for uterine smooth muscle tumors. The oncological nature of uterine rhabdomyosarcoma was found to be similar to the oncological properties of uterine leiomyosarcoma. However, in uterine rhabdomyosarcoma, LMP2/β1i-positive cells were clearly observed. Conclusion: It is expected that establishing a diagnostic and treatment method targeting characteristics of mesenchymal tumor cells will lead to the treatment of malignant tumors with a low risk of recurrence and metastasis.
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Affiliation(s)
- Saya Tamura
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
| | - Takuma Hayashi
- Section of Cancer Medicine, National Hospital Organization Kyoto Medical Center, Kyoto 612-8555, Japan
- START-Program, Japan Science and Technology Agency (JST), Tokyo 102-8666, Japan
- Correspondence: or ; Tel.: +81-263372629
| | - Tomoyuki Ichimura
- Department of Obstetrics and Gynecology, Osaka City University School of Medicine, Osaka 545-8586, Japan;
| | - Nobuo Yaegashi
- Department of Obstetrics and Gynecology, Tohoku University School of Medicine, Miyagi 980-8575, Japan;
| | - Kaoru Abiko
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
| | - Ikuo Konishi
- National Hospital Organization Kyoto Medical Center, Department of Obstetrics and Gynecology, Kyoto 612-8555, Japan; (S.T.); (K.A.); (I.K.)
- Department of Obstetrics and Gynecology, Kyoto University School of Medicine, Kyoto 606-8501, Japan
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Li JY, Mutlu L, Tymon-Rosario J, Khadraoui W, Nagarkatti N, Hui P, Buza N, Lu L, Schwartz P, Menderes G. Clinicopathologic characteristics and oncologic outcomes in adenosarcoma of gynecologic sites. Gynecol Oncol Rep 2022; 39:100913. [PMID: 35005157 PMCID: PMC8715286 DOI: 10.1016/j.gore.2021.100913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 12/11/2021] [Accepted: 12/14/2021] [Indexed: 11/25/2022] Open
Abstract
Objective To examine clinicopathologic characteristics and oncologic outcomes of patients diagnosed with Mullerian adenosarcoma and to evaluate ovarian preservation as a practical management option in early-stage disease. Methods A retrospective review was performed of 31 patients treated for uterine, ovarian, or cervical adenosarcoma at our institution between 1/2000-3/2020. Recurrence-free survival (RFS) and overall survival (OS) were analyzed with Kaplan-Meier estimates, the log-rank test, and Cox proportional hazards regression. Results Median age was 51 years (IQR: 41-68). Primary sites included uterine corpus (n = 23, 74.2%), uterine cervix (n = 7, 22.6%), and ovary (n = 1, 3.2%). Surgical management primarily consisted of total hysterectomy +/- bilateral adnexectomy +/- lymph node dissection. Fifteen (48.1%) patients underwent lymph node dissection; no patients had positive nodes. Ovaries were preserved in 6 (19.4%). Twenty-two (71.0%) patients received no adjuvant therapy, 4 (12.9%) received chemotherapy, 1 (3.2%) received chemoradiation, and 3 (9.7%) received hormonal therapy. Sarcomatous overgrowth (p = 0.04), high grade histology (p = 0.002), and greater depth of myometrial invasion (p = 0.001) were associated with decreased RFS. None of the 6 patients with ovarian preservation had recurrences. At last follow up, 21 patients (67.7%) had no evidence of disease, 7 (22.6%) were deceased due to disease, and 3 (9.7%) were deceased due to non-cancerous reasons. Conclusions Uterine adenosarcoma appears to have a relatively good prognosis, especially in the absence of risk factors, such as sarcomatous overgrowth, high grade histology, and deep myometrial invasion. Ovarian preservation may be a feasible management option with non-inferior outcomes for premenopausal women with early-stage disease. Future studies including larger patient cohorts are needed for this rare disease.
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Affiliation(s)
- Jessie Y Li
- Yale University School of Medicine, New Haven, CT, USA
| | - Levent Mutlu
- Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Joan Tymon-Rosario
- Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Wafa Khadraoui
- Bridgeport Hospital, Department of Obstetrics and Gynecology, Bridgeport, CT, USA
| | - Nupur Nagarkatti
- Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Pei Hui
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Natalia Buza
- Yale University School of Medicine, Department of Pathology, New Haven, CT, USA
| | - Lingeng Lu
- Yale School of Public Health, Department of Chronic Disease Epidemiology, New Haven, CT, USA
| | - Peter Schwartz
- Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
| | - Gulden Menderes
- Yale University School of Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, New Haven, CT, USA
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9
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Zhao M, He H, Cao D, Fan D, Xu M, Zhang X, Ru G. Solitary Fibrous Tumor With Extensive Epithelial Inclusions. Am J Clin Pathol 2022; 158:35-46. [PMID: 34999741 DOI: 10.1093/ajcp/aqab211] [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: 10/01/2021] [Accepted: 11/16/2021] [Indexed: 12/11/2022] Open
Abstract
OBJECTIVES Solitary fibrous tumor (SFT) harboring extensive epithelial inclusions is rare and can stimulate a biphasic neoplasm composed of epithelial and stromal elements. METHODS Three cases of SFT with extensive epithelial inclusions were retrieved. H&E stain, immunohistochemical stain, and targeted next-generation sequencing were performed. RESULTS There were two male patients and one female patient aged 54, 32, and 68 years. All tumors were located in abdominopelvic sites involving the kidney (case 1), omentum (case 2), and prostate (case 3), respectively. Microscopically, all tumors were circumscribed and composed of a background of SFT admixed with randomly embedded glands or cysts, organizing sometimes in a phyllodes-like architecture. The covered epithelium displayed a range of morphologies from simple cystic to stratified and to complex papillary proliferation. Immunohistochemically, both STAT6 and CD34 were expressed in the spindle cells but not in the epithelial inclusions. RNA sequencing revealed fusions involving NAB2~STAT6 in all cases. DNA sequencing demonstrated TERT c.-124C>T mutation in case 1. Prognostic stratification scores were intermediate in case 1 and low in cases 2 and 3. CONCLUSIONS SFT with extensive epithelial inclusions represents a rare but potentially underrecognized variant of SFT and shows compatible molecular features with conventional SFT.
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Affiliation(s)
- Ming Zhao
- Cancer Center, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Huiying He
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, China
| | - Dengfeng Cao
- Department of Pathology, Shanghai CoreOne Pathology Diagnostics, Shanghai, China
| | - Dage Fan
- Department of Pathology, Second Affiliated Hospital of Fujian Medical University, Quanzhou, China
| | - Mingxin Xu
- Department of Pathology, Tongxiang First People’s Hospital, Jiaxing, China
| | - Xin Zhang
- Cancer Center, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
| | - Guoqing Ru
- Cancer Center, Department of Pathology, Zhejiang Provincial People’s Hospital, People’s Hospital of Hangzhou Medical College, Hangzhou, China
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10
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Ashley CW, Da Cruz Paula A, Ferrando L, Gularte-Mérida R, Sebastiao APM, Brown DN, Gazzo AM, Pareja F, Stylianou A, Abu-Rustum NR, Reis-Filho JS, Buehler D, Weisman P, Chiang S, Weigelt B. Genetic characterisation of adult primary pleomorphic uterine rhabdomyosarcoma and comparison with uterine carcinosarcoma. Histopathology 2021; 79:176-186. [PMID: 33527450 DOI: 10.1111/his.14346] [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: 12/18/2020] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
AIMS To characterise the genetic alterations in adult primary uterine rhabdomyosarcomas (uRMSs) and to investigate whether these tumours are genetically distinct from uterine carcinosarcomas (UCSs). METHODS AND RESULTS Three tumours originally diagnosed as primary adult pleomorphic uRMS were subjected to massively parallel sequencing targeting 468 cancer-related genes and RNA-sequencing. Mutational profiles were compared with those of UCSs (n = 57) obtained from The Cancer Genome Atlas. Sequencing data analyses were performed using validated bioinformatic approaches. Pathogenic TP53 mutations and high levels of genomic instability were detected in the three cases. uRMS1 harboured a likely pathogenic YTHDF2-FOXR1 fusion. uRMS2 harboured a PPP2R1A hotspot mutation and amplification of multiple genes, including WHSC1L1, FGFR1, MDM2, and CCNE1, whereas uRMS3 harboured an FBXW7 hotspot mutation and an ANKRD11 homozygous deletion. Hierarchical clustering of somatic mutations and copy number alterations revealed that these tumours initially diagnosed as pleomorphic uRMSs and UCSs were similar. Subsequent comprehensive pathological re-review of the three uRMSs revealed previously unidentified minute pan-cytokeratin-positive atypical glands in one case (uRMS3), favouring its reclassification as UCS with extensive rhabdomyosarcomatous overgrowth. CONCLUSIONS Adult pleomorphic uRMSs harbour TP53 mutations and high levels of copy number alterations. Our findings underscore the challenge in discriminating between uRMS and UCS with rhabdomyosarcomatous differentiation.
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Affiliation(s)
- Charles W Ashley
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Arnaud Da Cruz Paula
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Lorenzo Ferrando
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Rodrigo Gularte-Mérida
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA.,Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Ana P M Sebastiao
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - David N Brown
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrea M Gazzo
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Fresia Pareja
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Anthe Stylianou
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nadeem R Abu-Rustum
- Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Jorge S Reis-Filho
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Darya Buehler
- Department of Pathology, University of Wisconsin-Madison, Madison, WI, USA
| | - Paul Weisman
- Department of Pathology, University of Wisconsin-Madison, Madison, WI, USA
| | - Sarah Chiang
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Britta Weigelt
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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11
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Yoon JY, de Kock L, Stewart CJR, McCluggage WG, Foulkes WD, Clarke BA, Rouzbahman M. Endometrial Stem/Progenitor cell (ES/PC) Marker Expression Profile in Adenosarcoma and Endometrial Stromal Sarcoma. Cancer Treat Res Commun 2021; 27:100363. [PMID: 33838572 DOI: 10.1016/j.ctarc.2021.100363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 02/28/2021] [Accepted: 03/23/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND The uterus is one of the most dynamic organs in the human body, and this dynamic homeostasis is supported by endometrial stem/progenitor cells (ES/PCs), which are heterogeneous in their phenotype and degree of differentiation. ES/PCs are generally localized in the endometrial stroma, the site of origin for adenosarcoma and endometrial stromal sarcoma (ESS). Subsets of ESSs and adenosarcomas harbor SUZ12 or DICER1 gene alterations, two genes with roles in embryonic stem cell biology. However, the possible contribution of ES/PCs to tumorigenesis is unexplored. METHOD We examined the expression of eleven ES/PC markers, along with three proteins expressed in the mature endometrial stroma (ER, PR and CD10) in 60 uterine tumors (24 low-, 11 high-grade ESS, 25 adenosarcomas). Protein expression profiles were assessed by unsupervised hierarchical clustering. miRNA expression profiles were examined in a subset of adenosarcoma with/without DICER1 mutations, using the NanoString platform. RESULTS ES/PC markers were variably expressed, and the tumors exhibited limited immunophenotypic resemblance to different ES/PCs. Within the ESSs, the ES/PC marker clustering pattern was prognostic for both overall and disease-free survival. Comparing adenosarcomas and ESSs, most high-grade ESSs clustered with one another, while low-grade ESSs and adenosarcomas tended to cluster with one another. Among the adenosarcomas, the miRNA expression profiles were varied with respect to the DICER1 mutation status, with pathway analysis pointing to dysregulated signal transduction and stem cell biology. CONCLUSIONS ESSs and adenosarcomas exhibit varying immunophenotypic resemblance to ES/PCs. These expression profiles have prognostic implications and may be genetically driven.
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Affiliation(s)
- Ju-Yoon Yoon
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, St. Michael's Hospital, Toronto, ON, Canada.
| | - Leanne de Kock
- Department of Human Genetics, McGill University, Montréal, Québec, Canada; Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Colin J R Stewart
- School for Women's and Infants' Health, University of Western Australia, Perth, WA, Australia
| | - W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, United Kingdom
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montréal, Québec, Canada; Lady Davis Institute, Segal Cancer Centre, Jewish General Hospital, Montréal, Québec, Canada; Research Institute of the McGill University Health Centre, Montréal, Québec, Canada
| | - Blaise A Clarke
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, Toronto General Hospital, Toronto, ON, Canada
| | - Marjan Rouzbahman
- Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, ON, Canada; Department of Pathology, Toronto General Hospital, Toronto, ON, Canada
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12
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[Interdisciplinary S2k guidelines on the diagnosis and treatment of uterine sarcomas-recommendations for surgical pathology]. DER PATHOLOGE 2021; 41:621-633. [PMID: 32940744 DOI: 10.1007/s00292-020-00826-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Uterine sarcomas represent a heterogeneous group of rare malignancies, derived from the myometrium, the endometrial stroma, and very rarely from the nonspecialized uterine soft tissue. The actual incidence is about 1.5 for Caucasian and 3.0 for Afro-American women. There is no grading system for leimoysarcoma defined by the WHO classification; however, if clinicians request, the FNCLCC grading can be specified in analogy to soft tissue sarcomas. Adenosarcomas must be distinguished from adenofibromas (the existence of which is questionable)-with the vast majority of these tumors being uterine adenosarcomas. Within adenosarcomas, deep myometrial invasion (>50%), sarcomatous overgrowth, and a high-grade heterologous component are associated with a higher recurrence rate and poor survival. The immunohistochemical panel represents a very helpful tool for distinguishing low-grade from high grade endometrial stromal sarcomas (ESS) and may be supplemented by molecular analyses. Steroid hormone receptor analysis should be performed for all ESS due to the possible therapeutic relevance. Undifferentiated uterine sarcomas represent a diagnosis of exclusion and have a very poor prognosis. Carcinosarcomas represent a special subtype of endometrial carcinomas and are in fact not uterine sarcomas. Uterine sarcomas may present substantial intratumoral heterogeneity and adequate embedding is mandatory. Lesions ≤2 cm in the largest dimension should be processed completely and larger tumors should be processed with one block per centimeter for the largest tumor dimension.
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13
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Mubeen A, Shahid M, Makary R. Post-radiation Mullerian adenosarcoma with sarcomatous overgrowth: rare presentation of an uncommon malignancy. Pathologica 2020; 112:219-223. [PMID: 33393526 PMCID: PMC8183353 DOI: 10.32074/1591-951x-114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 05/04/2020] [Indexed: 11/30/2022] Open
Abstract
Mullerian adenosarcoma is an uncommon biphasic malignant uterine tumor. It is composed of benign epithelial and malignant stromal elements. We present a case of a 45-year-old woman who presented with post-menopausal bleeding for three months. She had a significant past medical history of pelvic irradiation for squamous carcinoma of cervix 20 years ago. Pathology revealed adenosarcoma with sarcomatous overgrowth. The patient had a recurrence of pure sarcoma three months later and unfortunately succumbed to her disease. The role of radiation in the pathogenesis of adenosarcoma has been uncommonly described compared to its well established role in the development of carcinosarcoma. Our case fulfils the criteria for a radiation induced sarcoma. We review the salient clinical and pathological features of this uncommon lesion highlighting the importance of sarcomatous overgrowth in these lesions and the possible role of radiation in the development of these tumors.
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Affiliation(s)
- Aysha Mubeen
- Department of Pathology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Mohammad Shahid
- Department of Pathology, University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Raafat Makary
- Department of Pathology, University of Florida College of Medicine, Jacksonville, Florida, USA
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14
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Omi M, Tonooka A, Chiba T, Tanaka Y, Fusegi A, Aoki Y, Nomura H, Kanao H, Takazawa Y. Immunohistochemical markers and the clinical course of adenosarcoma: a series of seven cases. Diagn Pathol 2020; 15:119. [PMID: 32972432 PMCID: PMC7513510 DOI: 10.1186/s13000-020-01036-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 09/15/2020] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Uterine adenosarcoma, a rare uterine tumor subtype, is a biphasic tumor consisting of epithelial and mesenchymal elements. To date, there is no research comparing the histopathological features and immunohistochemistry of primary and recurrent tumors; furthermore, the relationship between pathology and the clinical course remains unclear. We reviewed the pathology and immunohistochemical features of patients with adenosarcoma and investigated the relevance of the histomorphological features to the clinical course. We also compared the immunohistochemical features of the primary and recurrent tumors. METHODS The data of seven patients with adenosarcoma who underwent surgery in our hospital were evaluated. We performed immunohistochemical staining for the progesterone receptor, estrogen receptor, p53, and two Switch/Sucrose Non-Fermentable chromatin remodeling proteins (SMARCA4, BCOR), which were recently developed for the undifferentiated sarcoma diagnosis in addition to conventional staining methods. RESULTS All patients had International Federation of Gynecology and Obstetrics stage IB-IC diseases. All tumors were polypoid and every patient presented with abnormal uterine bleeding. Six patients aged over 50 years and were menopausal; one patient aged under 50 years and was non-menopausal (average age: 59.1 years). Histologically, the sarcomatous components were homologous and heterogenous in six and one patient, respectively. Four and three cases were recurrent and non-recurrent, respectively. The recurrent patients showed high-grade morphology with sarcomatous overgrowth and were negative for ER and PR. Three recurrences could be evaluated by imaging, showing recurrence only in a distant area; biopsy specimens from these tissues revealed the identical mesenchymal component found in the primary tumor without a benign epithelial component. Immunohistochemical staining results were also similar to the corresponding of the original tumor, except for the p53 expression in one patient. At the primary site, p53 was overexpressed in two recurrent patients and had a wild-type level in one recurrent patient; however, all three recurrent tissues showed p53 overexpression. None of our patients showed SMARCA4 loss, and BCOR expression was positive in one case. CONCLUSIONS Initial pathological adenosarcoma analysis with appropriate immunohistochemical staining is vital for prognostic assessment. p53 expression might increase at recurrence. SMARCA4 and BCOR might not be an index of malignancy.
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Affiliation(s)
- Makiko Omi
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan.
| | - Akiko Tonooka
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Tomohiro Chiba
- Division of Pathology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
| | - Yuji Tanaka
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan
| | - Atsushi Fusegi
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan
| | - Yoichi Aoki
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan
| | - Hidetaka Nomura
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan
| | - Hiroyuki Kanao
- Department of Gynecologic Oncology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koutouku, Tokyo, 135-8550, Japan
| | - Yutaka Takazawa
- Department of Pathology, Toranomon Hospital, 2-2-2 Toranomon, Minatoku, Tokyo, 105-8470, Japan
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15
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Libertini M, Hallin M, Thway K, Noujaim J, Benson C, van der Graaf W, Jones RL. Gynecological Sarcomas: Molecular Characteristics, Behavior, and Histology-Driven Therapy. Int J Surg Pathol 2020; 29:4-20. [PMID: 32909482 DOI: 10.1177/1066896920958120] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gynecological sarcomas represent 3% to 4% of all gynecological malignancies and 13% of all sarcomas. The uterus is the most frequent primary site (83%); less frequently sarcomas are diagnosed originating from the ovary (8%), vulva and vagina (5%), and other gynecologic organs (2%). As the classification of gynecologic sarcomas continues to diversify, so does the management. Accurate histopathologic diagnosis, utilizing appropriate ancillary immunohistochemical and molecular analysis, could lead to a more personalized approach. However, there are subtypes that require further definition, with regard to putative predictive markers and optimal management. The aim of this review is to highlight the importance of accurate diagnosis and classification of gynecologic sarcoma subtypes by the surgical pathologist in order to provide more tailored systemic treatment, and to highlight the increasing importance of close collaboration between the pathologist and the oncologist.
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Affiliation(s)
| | - Magnus Hallin
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | - Khin Thway
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
| | | | | | | | - Robin L Jones
- Royal Marsden Hospital/Institute of Cancer Research, London, UK
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16
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Ban Y, Fischer JV, Maniar KP, Guo H, Zeng C, Li Y, Zhang Q, Wang X, Zhang W, Bulun SE, Wei JJ. Whole-Genome Sequencing and Target Validation Analysis of Müllerian Adenosarcoma: A Tumor With Complex but Specific Genetic Alterations. Front Oncol 2020; 10:538. [PMID: 32351899 PMCID: PMC7174971 DOI: 10.3389/fonc.2020.00538] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2019] [Accepted: 03/25/2020] [Indexed: 12/16/2022] Open
Abstract
Mullerian adenosarcoma (MAS) is a biphasic tumor with malignant stroma. It is most commonly of endometrial origin but occasionally originates in the cervix, ovary, or other pelvic/peritoneal sites. The typical MAS is low grade with an indolent clinical course; however, tumors with sarcomatous overgrowth (SO) or a high-grade sarcoma tend to be aggressive. Tumor etiology is largely unknown. To better understand the global genome alterations and gene mutations in MAS, whole-genome sequencing (WGS) and target validation analysis were performed. MAS showed remarkable chromosome (chr) copy number variation (CNV), specifically, gains in chr 1q, 5p, 12p, 12q, and 17q and losses in chr 3p, 3q, 9p, and 11q. Gain of chr 12q13-15 was present in 50% of cases. The selected gene products in gain regions were upregulated as measured by immunohistochemistry. HMGA2 overexpression was significantly correlated with SO. While the structural variation (SV) rate was relatively low overall, a disproportionally high rate of break-ends at chr 7 was noted involving 6 in-frame rearrangement fusion genes. Among 40 frequently mutated genes detected by WGS and validated in 29 MAS by next generation sequencing (NGS), KMT2C, and BCOR were frequently seen in MAS both with and without SO, while MAGEC1 and KDM6B were strongly associated with SO. Overall, a higher rate of frequently mutated genes was found in MAS with SO (33%) than MAS without (11%). This study uncovers the complex and specific genetic alterations in this malignancy. The findings provide a tool for future investigation of these molecular changes in tumorigenesis and target therapies.
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Affiliation(s)
- Yanli Ban
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - Jean V. Fischer
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Kruti P. Maniar
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Haiyang Guo
- Department of Biology, Princess Margaret Cancer Centre, Ontario Cancer Institute, Toronto, ON, Canada
| | - Chang Zeng
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Yinuo Li
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Qing Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital, Shandong University, Jinan, China
| | - Xinkun Wang
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Wei Zhang
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Serdar E. Bulun
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jian-Jun Wei
- Department of Pathology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
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17
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Apellaniz‐Ruiz M, Cullinan N, Grant R, Marrano P, Priest JR, Thorner PS, Goudie C, Foulkes WD. DICER1 screening in 15 paediatric paratesticular sarcomas unveils an unusual DICER1-associated sarcoma. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2020; 6:185-194. [PMID: 32222066 PMCID: PMC7339209 DOI: 10.1002/cjp2.164] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Revised: 03/04/2020] [Accepted: 03/06/2020] [Indexed: 12/14/2022]
Abstract
Individuals with DICER1 syndrome, a genetic disorder caused by pathogenic germline variants in DICER1, are at increased risk of developing a wide array of predominantly childhood onset conditions, including genitourinary sarcomas. However, data on DICER1 involvement in paratesticular sarcomas have not been published. Herein, we analyse a series of 15 paediatric paratesticular sarcomas and describe in detail the case of a male infant with a paratesticular myxoid tumour, considered to be a low‐grade sarcoma, who also manifested a cystic nephroma, a classic DICER1 syndrome phenotype. He harboured a pathogenic germline DICER1 variant and different somatic hot‐spot mutations in each tumour. The paratesticular tumour showed strong and diffuse expression for WT1 and CD10, an unusual immunophenotype in paediatric sarcomas, but typical of tumours of Müllerian origin. The tumour was postulated to arise from the appendix testis, a Müllerian remnant located in the paratestis. Such an origin would be analogous to other DICER1‐associated non‐epithelial gynaecological tumours, thought to arise from Müllerian derivatives. These findings point towards a key role of DICER1 in Müllerian‐derived structures. Supporting this hypothesis is the fact that the other paratesticular sarcomas from the series were either negative or focally positive for WT1 and for CD10, and none had any DICER1 mutations. In summary, we present the first case of a paratesticular sarcoma associated with DICER1 syndrome, emphasising that paratesticular tumours with an unusual histological appearance may suggest an underlying DICER1 mutation, especially in the presence of a personal or family history of DICER1‐associated disease. In this context, DICER1 mutation testing could lead to changes in clinical care including implementation of cancer care surveillance strategies.
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Affiliation(s)
- Maria Apellaniz‐Ruiz
- Department of Human GeneticsMcGill UniversityMontréalCanada
- Lady Davis Institute, Segal Cancer CentreJewish General Hospital, McGill UniversityMontréalCanada
| | - Noelle Cullinan
- Division of Hematology‐Oncology, The Hospital for Sick Children, and Department of PediatricsUniversity of TorontoTorontoCanada
| | - Ronald Grant
- Division of Hematology‐Oncology, The Hospital for Sick Children, and Department of PediatricsUniversity of TorontoTorontoCanada
| | - Paula Marrano
- Division of PathologyThe Hospital for Sick ChildrenTorontoCanada
| | | | - Paul S Thorner
- Division of PathologyThe Hospital for Sick ChildrenTorontoCanada
- Department of Laboratory Medicine and PathobiologyUniversity of TorontoTorontoCanada
| | - Catherine Goudie
- Division of Hematology‐Oncology, Montréal Children's Hospital, Department of PediatricsMcGill UniversityMontréalCanada
| | - William D Foulkes
- Department of Human GeneticsMcGill UniversityMontréalCanada
- Lady Davis Institute, Segal Cancer CentreJewish General Hospital, McGill UniversityMontréalCanada
- Program in Cancer Genetics, Department of Oncology and Human GeneticsMcGill UniversityMontréalCanada
- Department of Medical GeneticsResearch Institute of the McGill University Health CentreMontréalCanada
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Abstract
OBJECTIVE This study aimed to identify the hormonal receptor status in uterine adenosarcoma (AS) and uterine AS with sarcomatous overgrowth (AS + SO), including those with high-grade histologic features (nuclear pleomorphism, atypical mitoses, necrosis), with or without heterologous elements. Estrogen receptor (ER) status, including estrogen receptor α (ERα), estrogen receptor β (ERβ), and G protein-coupled estrogen receptor (GPER), and progesterone receptor (PgR) status were examined. METHODS From August 2001 to November 2013, 11 patients with histologic diagnosis of uterine AS were identified. Tumor tissue sections were stained for ERα, ERβ, GPER, and PgR and examined both for percentage of overall cells stained and for intensity of staining. Descriptive statistics were calculated using clinicopathologic data abstracted from the medical record. RESULTS Eight cases of AS and 3 cases of AS with high-grade features were identified. Seven of 8 tumor samples of AS showed strong or moderate intensity immunostaining for ERα; all AS + SO tumor samples showed minimal to no immunoreactivity for ERα. There was a significant decrease in ERα H scores in high-grade tumors when compared with AS (P = 0.01). Lower PgR H scores were observed in high-grade tumors compared with those in AS (P = 0.04). Estrogen receptor β immunostaining was variable, and GPER immunostaining was absent in the majority of tumor samples. CONCLUSIONS Higher expression of ERα and PgR was observed in AS when compared with those with AS + SO and high-grade features. Both tumor subtypes showed similar levels of ERβ and GPER expression, although significant differences in ERβ and GPER expression were not detected. In contrast to our previous findings in uterine carcinosarcoma, ERs ERβ and GPER do not seem to play a significant role in AS in this study.
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Abstract
INTRODUCTION Uterine adenosarcoma is a rare tumor with both epithelial and stromal components. Standard treatment is total abdominal hysterectomy and bilateral salpingo-oophorectomy. There is no defined role for adjuvant or neoadjuvant chemotherapy or radiation. There is a misconception that this is an indolent, low-grade sarcoma. In fact, at least 50% of patients will develop disease recurrence. Establishing prognostic factors is of paramount importance. Areas covered: This article reviews the current literature regarding adenosarcoma prognostic factors from case reports, case series, and retrospective series. An extensive review of the literature was undertaken via PubMed and Medline searches, relevant articles are included in this review. Expert commentary: The most important prognostic factors of uterine adenosarcoma are age, presence of sarcomatous overgrowth, presence of myometrial invasion, presence of lymphovascular invasion, and lymph node involvement. These factors can be used to accurately prognosticate for uterine adenosarcoma patients. Patients at low risk of disease recurrence can be identified. These patients require observation alone. Patients at high risk of disease recurrence can be identified and are candidates for aggressive therapy with adjuvant chemotherapy to reduce the risk of disease recurrence.
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Affiliation(s)
- Michael J Nathenson
- a Center for bone and soft tissue sarcomas , Dana-Farber Cancer Institute , Boston , MA , USA
| | - Anthony P Conley
- b Department of Sarcoma Medical Oncology , The University of Texas MD Anderson Cancer Center , Houston , TX , USA
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The Importance of Lymphovascular Invasion in Uterine Adenosarcomas: Analysis of Clinical, Prognostic, and Treatment Outcomes. Int J Gynecol Cancer 2018; 28:1297-1310. [DOI: 10.1097/igc.0000000000001306] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
ObjectiveThis retrospective study examined the clinicopathologic features of adenosarcoma patients to determine potential prognostic factors and retrospectively evaluated overall survival (OS), disease-free survival (DFS), and local recurrence-free survival (LRFS) after primary treatment of adenosarcoma including surgery, radiation, and chemotherapy.MethodsOne hundred sixty-five patients with adenosarcoma were identified from the MD Anderson Cancer Center tumor registry between 1982 and 2014. Clinical data were collected retrospectively. Pathologic characteristics were examined by sarcoma pathologists. We used the Kaplan-Meier method to estimate OS, DFS, and LRFS. The log-rank test was performed to test the difference in survival between groups. Multivariate regression analyses of survival data were conducted using the Cox proportional hazards model.ResultsMedian OS and DFS for all patients were 8.5 and 4.7 years, respectively. Pathologic characteristics that influence OS and DFS were sarcomatous overgrowth (SO), myometrial invasion (MI), lymphovascular invasion (LVI), tumor size, number of mitosis, estrogen receptor, progesterone receptor, International Federation of Gynecology and Obstetrics (FIGO) stage, age, and resection status. Median OS for adenosarcoma patients with SO was 5.2 versus 14.5 years for patients without SO (P < 0.0001). Median OS for adenosarcoma patients with MI was 5.8 years versus not reached for patients without MI (P = 0.0005). Median OS for adenosarcoma patients with LVI was 1.0 versus 8.9 years for patients without LVI (P = 0.0021). On Cox analysis for OS and DFS and LRFS, only SO, MI, LVI, age, resection status, and FIGO stage remained significant. There was no difference in OS or LRFS for adjuvant radiation versus no adjuvant radiation (P = 0.17, P = 0.076).ConclusionsThis study highlights the importance of LVI as a prognostic factor and confirms the prognostic significance of SO, MI, age, resection status, and FIGO stage for adenosarcoma. Furthermore, this study suggests that there is no additional benefit to adjuvant radiation. The standard-of-care treatment for adenosarcoma should remain total abdominal hysterectomy bilateral salpingo-oophorectomy +/− lymphadenectomy and no adjuvant radiation.
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Patnayak R, Rukmangadha N, Architha P, Reddy GS, Lakshmi AY, Kannan T, Jena A. Metastasizing uterine mullerian adenosarcoma in a young female: Diagnostic enigma. INDIAN J PATHOL MICR 2018; 61:440-442. [PMID: 30004077 DOI: 10.4103/ijpm.ijpm_1_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Uterine adenosarcomas are uncommon tumors. It is a biphasic tumor with both epithelial and mesenchymal component. The epithelial component is benign in nature, and the mesenchymal component is malignant. Metastasis is rare in adenosarcoma. We report a case of adenosarcoma with lymph nodal metastasis. A 20-year-old female presented with history of per vaginal bleeding for 1 month. Per vaginal examination revealed a fungating mass protruding through the cervical os. Ultrasonography and magnetic resonance imaging showed a large intrauterine mass. Biopsy of the mass done at an outside hospital was reported as rhabdomyosarcoma. Hence, she was given one cycle of neoadjuvant chemotherapy. Following this, she had profuse bleeding. Emergency hysterectomy with pelvic lymph nodal dissection was performed. The final histopathology was reported as adenosarcoma. One pelvic lymph node showed metastatic deposit of rhabdomyosarcomatous element. In young females presenting with polypoidal mass, uterine adenosarcoma can be considered in the differential diagnosis.
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Affiliation(s)
- Rashmi Patnayak
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Nandyala Rukmangadha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Pabbu Architha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Gajjala Sivanath Reddy
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amarchala Yadagiri Lakshmi
- Department of Radiology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Thiruvengadaswamy Kannan
- Department of Medical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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Treatment of Recurrent or Metastatic Uterine Adenosarcoma. Sarcoma 2017; 2017:4680273. [PMID: 29445312 PMCID: PMC5763139 DOI: 10.1155/2017/4680273] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Accepted: 11/07/2017] [Indexed: 11/17/2022] Open
Abstract
Purpose This study retrospectively evaluated overall survival (OS) by treatment of recurrent or metastatic uterine adenosarcoma including surgery, radiation, chemotherapy, and hormonal therapy and evaluated OS and progression-free survival (PFS) after 1st line systemic chemotherapy. Methods 78 patients with recurrent or metastatic adenosarcoma comprised the study population. The Kaplan-Meier method was used to estimate OS and PFS. The log-rank test was performed to test the difference in survival between groups. Results Median OS from diagnosis of recurrent or metastatic disease was 1.8 yrs. OS was influenced by pathology on recurrence, p=0.035. Median OS differed by surgery for 1st recurrence 26.3 months versus 15.1 months. OS was not influenced by chemotherapy, p=0.58, palliative radiation, p=0.58, or hormonal therapy, p=0.15. The response rate (CR + PR) per RECIST 1.1 for chemotherapy was 31.2% for doxorubicin-based regimens and 14.3% for gemcitabine/docetaxel. OS since 1st line chemotherapy was not significantly different among chemotherapy regimens. However, the median PFS was superior for doxorubicin/ifosfamide (15.4 months) compared to gemcitabine/docetaxel (5.0 months), platinum-based regimens (5.7 mo), or other doxorubicin-based regimens (6.5 months). Conclusion These results suggest that surgery is an important treatment modality for recurrent or metastatic uterine adenosarcoma, and the most effective chemotherapeutics are doxorubicin/ifosfamide and gemcitabine/docetaxel.
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Abstract
Adenosarcomas are rare malignancies of the female genital tract, accounting for approximately 5 % of uterine sarcomas. Occasionally, adenosarcoma occurs in the ovaries or in extra-uterine tissue, which may be related to endometriosis. These tumors are characterized by benign epithelial elements and a malignant mesenchymal component. Pathologic diagnosis is dependent on the identification of the characteristic morphologic features. The most common immunohistochemical markers for adenosarcoma are CD10 and WT1, but these are not specific. The most frequent presenting symptom is abnormal uterine bleeding. The majority of patients present with stage I disease, with a 5-year overall survival of 60 to 80 %. Survival is influenced by the presence of myometrial invasion, sarcomatous overgrowth, lymphovascular invasion, necrosis, and the presence of heterologous elements including rhabdomyoblastic differentiation. Patients with sarcomatous overgrowth have significantly increased risk of recurrence 23 versus 77 % and decreased 5-year overall survival 50 to 60 %. Standard of care treatment is total hysterectomy with bilateral salpingo-oophorectomy without lymphadenectomy, as the incidence of lymph node metastasis is rare. Retrospective data does not support the use of adjuvant pelvic radiotherapy in uterine adenosarcomas as no survival benefit is seen. Insufficient data exists to recommend routinely neoadjuvant or adjuvant chemotherapy for uterine adenosarcomas. Limited evidence exists for the role of hormonal therapy in uterine adenosarcomas. The PIK3/AKT/PTEN pathway is mutated in ∼70 % of adenosarcomas, and this may represent a possible therapeutic target. This article reviews the current state of knowledge concerning uterine adenosarcoma and discusses the management of this rare tumor.
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Affiliation(s)
- Michael J Nathenson
- Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA, 02215, USA.
| | - Vinod Ravi
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Nicole Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Wei-Lien Wang
- Department of Pathology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
| | - Anthony Conley
- Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX, 77030, USA
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Mukhopadhyay M, Das C, Parvin T, Basu K. Undifferentiated Uterine Sarcoma: An Uncommon Case Report. J Clin Diagn Res 2017; 11:ED03-ED04. [PMID: 28511398 DOI: 10.7860/jcdr/2017/24924.9370] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Accepted: 12/08/2016] [Indexed: 12/15/2022]
Abstract
Endometrial Stromal Sarcomas (ESS) are rare uterine malignancy of mesodermal origin. A 65-year-old female presented with postmenopausal bleeding in the Department of Gynaecology in our hospital. Computed Topography (CT) revealed an enlarged uterus with areas of low attenuation. On gross appearance endometrial cavity was distorted with an irregular friable necrotic mass. Histopathologically, it was diagnosed as undifferentiated uterine sarcoma. Rhabdoid, osteoid and cartilaginous differentiation were found along with osteoclast like giant cells. Immunohistochemistry was strongly positive for CD10.
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Affiliation(s)
| | - Chhanda Das
- Assistant Professor, Department of Pathology, IPGME&R, Kolkata, West Bengal, India
| | - Tamanna Parvin
- Postgraduate Student, Department of Pathology, IPGME&R, Kolkata, West Bengal, India
| | - Keya Basu
- Associate Professor, Department of Pathology, IPGME&R, Kolkata, West Bengal, India
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25
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Case Report of Successful Childbearing after Conservative Surgery for Cervical Mullerian Adenosarcoma. Case Rep Obstet Gynecol 2017; 2017:4187416. [PMID: 28154764 PMCID: PMC5244008 DOI: 10.1155/2017/4187416] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 12/20/2016] [Indexed: 11/18/2022] Open
Abstract
Mullerian adenosarcoma (MA) is a rare tumor variant with low malignancy potential and is reported to account for 8% of all uterine sarcomas. Cervical MAs are reported to occur in relatively younger patients with the mean age of 27 years, while those in the uterine corpus generally present in postmenopausal women. Due to the rarity of cervical MAs, optimal management for these patients (especially younger women) is still under exploration. Here, we describe a case of cervical MA in a woman of reproductive age who was treated by fertility-preserving surgery and successfully delivered a child 18 months later.
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The Impact on Survival of an Extensive Sex Cord-like Component in Mullerian Adenosarcomas: A Study Comprising 6 Cases. Int J Gynecol Pathol 2016; 35:147-52. [PMID: 26535983 DOI: 10.1097/pgp.0000000000000231] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Mullerian adenosarcomas are uncommon tumors of the female genital tract characterized by a synchronous proliferation of benign glands and sarcomatous stroma. In general, uterine Mullerian adenosarcomas are associated with a low risk of recurrence. The presence of "stromal overgrowth" (SO), historically defined by an estimate of the volume of sarcoma growing independently of epithelium, is associated with deep myometrial invasion, presence of heterologous elements, and poor outcomes. Very rarely, the stromal component can harbor foci resembling ovarian sex cord tumors (FROSCT). The aim of this study was to determine whether the presence of an extensive FROSCT component in Mullerian adenosarcomas has an impact on survival, akin to more typical types of SO. Six patients were included in this study. Age ranged from 39 to 71 yr. Five patients presented with uterine lesions (4 intracavitary, 1 isthmic), and 1 was located in the ovary. Tumors ranging in size from 2.5 to 19 cm were all diagnosed as Stage I. Morphologically, all had prominent FROSCT-like components that comprised 60% to 90% of tumor volume. Immunohistochemically, the FROSCT component was positive for CAM 5.2, vimentin, WT1, CD56, α-inhibin, calretinin, androgen and progesterone receptors, α-actin, and desmin. All patients are alive without disease at 26 to 102 mo. Compared with adenosarcomas with typical forms of SO, FROSCT overgrowth is low grade and not associated with recurrence or metastasis in this small series. Therefore, Mullerian adenosarcoma with extensive FROSCT should not be equated with SO.
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Abstract
Müllerian adenosarcoma is an uncommon biphasic tumor composed of malignant stromal and benign epithelial components. Morphologically, adenosarcoma is characterized by a broad leaflike architecture, reminiscent of phyllodes tumors of the breast. Periglandular cuffing of the stromal cells around the compressed or cystically dilated glands is characteristic. The mesenchymal component is typically a low-grade spindle cell sarcoma, whereas the epithelial counterpart is commonly endometrioid with frequent squamous or mucinous metaplasia and may, in some circumstances, show mild to moderate atypia. In all cases, it is important to assess for the presence of sarcomatous overgrowth and myometrial invasion, which are the prognostic factors. In this brief review, we present the clinical, histopathologic, and immunohistochemical features of adenosarcoma, as well as updates on the molecular biology of this neoplasm.
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Affiliation(s)
- Andre Pinto
- From the Division of Women's and Perinatal Pathology, Brigham and Women's Hospital, Boston, Massachusetts (Drs Pinto and Howitt)
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28
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A Sex Cord-stromal Tumor, Specifically a Fibroma, Arising From the Uterine Corpus. Int J Gynecol Pathol 2016; 35:33-7. [DOI: 10.1097/pgp.0000000000000209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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29
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McCluggage WG. A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus. Mod Pathol 2016; 29 Suppl 1:S78-91. [PMID: 26715175 DOI: 10.1038/modpathol.2015.137] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 11/05/2015] [Indexed: 01/29/2023]
Abstract
The current 2014 World Health Organization (WHO) Classification of mixed epithelial and mesenchymal tumours of the uterus includes categories of carcinosarcoma, adenosarcoma, adenofibroma, adenomyoma and atypical polypoid adenomyoma, the last two lesions being composed of an admixture of benign epithelial and mesenchymal elements with a prominent smooth muscle component. In this review, each of these categories of uterine neoplasm is covered with an emphasis on practical tips for the surgical pathologist and new developments. In particular, helpful clues in the distinction between carcinosarcoma and dedifferentiated endometrial carcinoma will be discussed. In addition, salient features to help distinguish between adenofibroma, adenosarcoma, embryonal rhabdomyosarcoma and other mesenchymal neoplasms in the differential diagnosis will be outlined. Finally, a discussion of adenomyoma and its main differential diagnostic considerations will be covered.
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Affiliation(s)
- W Glenn McCluggage
- Department of Pathology, Belfast Health and Social Care Trust, Belfast, UK
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30
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Carroll A, Ramirez PT, Westin SN, Soliman PT, Munsell MF, Nick AM, Schmeler KM, Klopp AH, Fleming ND. Uterine adenosarcoma: an analysis on management, outcomes, and risk factors for recurrence. Gynecol Oncol 2014; 135:455-61. [PMID: 25449308 PMCID: PMC4430193 DOI: 10.1016/j.ygyno.2014.10.022] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Revised: 10/18/2014] [Accepted: 10/21/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES Uterine adenosarcoma is a rare malignancy with little data on optimal management. We aimed to clarify the impact of adjuvant therapy in patients with uterine adenosarcoma and identify risk factors for recurrence and death. METHODS We performed a retrospective review of patients undergoing primary evaluation and treatment for uterine adenosarcoma at a single institution from July 1982 through December 2011. Univariate and multivariate analyses were used to identify prognostic factors for progression-free survival (PFS) and overall survival (OS). RESULTS We identified 100 patients with uterine adenosarcoma, and 74 patients met the inclusion criteria. On multivariate analysis, sarcomatous overgrowth (SO) and lymphovascular space invasion (LVSI) were predictors of worse PFS and OS. Median PFS and OS were 29.4 and 55.4 months for patients with SO, compared to 105.9 and 112.4 months for patients without SO (PFS HR 2.58, 95% CI 1.37-4.84, p=0.003; OS HR 2.45, 95% CI 1.26-4.76, p=0.008). Among patients with stage I disease, 17 of 22 patients (77%) with SO and 8 of 37 patients (22%) without SO had a recurrence (p<0.001). Among patients with stage I disease with SO, adjuvant therapy appeared to be associated with longer PFS and OS, but these differences were not statistically significant (PFS, 46.7 vs. 29.4 months, p=0.28; OS, 97.3 vs. 55.4 months, p=0.18). CONCLUSION In patients with uterine adenosarcoma, the presence of SO or LVSI confers a higher risk of recurrence. We did not identify an optimal treatment strategy for patients with SO, but adjuvant therapy may be associated with prolonged PFS.
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Affiliation(s)
- Amy Carroll
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Pedro T Ramirez
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Shannon N Westin
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Pamela T Soliman
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Mark F Munsell
- Department of Biostatistics, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Alpa M Nick
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Kathleen M Schmeler
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Ann H Klopp
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA
| | - Nicole D Fleming
- Department of Gynecologic Oncology & Reproductive Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX 77030, USA.
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Howitt BE, Sholl LM, Dal Cin P, Jia Y, Yuan L, MacConaill L, Lindeman N, Kuo F, Garcia E, Nucci MR, Quade BJ. Targeted genomic analysis of Müllerian adenosarcoma. J Pathol 2014; 235:37-49. [PMID: 25231023 DOI: 10.1002/path.4442] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 08/04/2014] [Accepted: 09/09/2014] [Indexed: 12/30/2022]
Abstract
Müllerian adenosarcoma (MA) is a rare mixed mesenchymal tumour of the female genital tract, composed of malignant stroma and benign-appearing epithelium. Sarcomatous overgrowth (SO) is the only established histological variable associated with higher stage and shorter survival. Specific molecular or immunohistochemistry (IHC) tools for the diagnosis of MA are lacking. Our goal was to study genomic mutations and copy number variations (CNVs) in MA to understand better its pathobiology, and develop specific diagnostic and prognostic tools. DNA was extracted from 20 samples of MA from 18 subjects (12 without SO and 6 with SO), including two in which areas of both typical MA histology and SO were independently tested. Samples were analysed using a targeted next-generation sequencing assay interrogating exonic sequences of 275 cancer genes for mutations and CNVs as well as 91 introns across 30 genes for cancer-associated rearrangements. The mean number of mutations in MA with SO (mean 9.7; range 3-14) did not differ significantly from that in MA without SO (mean 9.6; range 5-16). MA with SO had significantly higher mean numbers of gene-level CNVs (24.6) compared to MA without SO (5; p = 0.0002). The most frequent amplification involved MDM2 and CDK4 (5/18; 28%), accompanied by focal CDK4 and MDM2 and diffuse HMGA2 expression using immunohistochemistry. MYBL1 amplification was seen in 4/18 (22%), predominantly in SO. Alterations in PIK3CA/AKT/PTEN pathway members were seen in 13/18 (72%). Notably, TP53 mutations were uncommon, present in only two cases with SO. Three out of 18 (17%) had mutations in ATRX, all associated with SO. No chromosomal rearrangements were identified. We have identified a number of recurrent genomic alterations in MA, including some associated with SO. Although further investigation of these findings is needed, confirmation of one or more may lead to new mechanistic insights and novel markers for this often difficult-to-diagnose tumour.
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Affiliation(s)
- Brooke E Howitt
- Women's and Perinatal Pathology Division, Department of Pathology, Brigham and Women's Hospital, and Harvard Medical School, Boston, MA, USA
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Müllerian Adenosarcoma of the Uterus With Low-grade Sarcomatous Overgrowth Characterized by Prominent Hydropic Change Resulting in Mimicry of a Smooth Muscle Tumor. Int J Gynecol Pathol 2014; 33:573-80. [DOI: 10.1097/pgp.0000000000000100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
A group of tumors referred to as atypical fibroxanthoma (AFX) and pleomorphic dermal sarcoma (PDS) predominantly occur in sun-damaged skin of the elderly, particularly in the head and neck region. Although this group of tumors is often regarded as of mesenchymal phenotype, the matter of histogenesis has not been entirely resolved. Evans H and Smith JL reported in 1980 that prognosis was not significantly different irrespective of whether there was a definite squamous cell carcinoma component or not, supporting a view that these are all carcinomata in nature (sarcomatoid carcinoma [SC]). There are a number of clinicopathologic studies of AFX in the literature but information on morphologically similar sarcoma-like tumors with immunohistochemical evidence of epithelial differentiation is sparse. One hundred sarcoma-like tumors (SLTs) of head and neck skin of the elderly, treated by surgical excision, were studied. Clinical information was obtained, and pathology reports and hematoxylin and eosin sections were reviewed to document size (maximum dimension), extent of invasion, mitotic count, vascular and perineural invasion, margin status, ulceration, necrosis, and the presence of actinic keratosis in adjacent/overlying skin. Immunostains examined included: pan-cytokeratins (CKs) (AE1/AE3, MNF116), high-molecular weight CKs (34βE12, CK5/6, CK14), p63, and melanocytic (S100, Melan A, HMB-45, MITF), vascular (CD31, CD34), and muscle markers (SMA, desmin, h-caldesmon) to exclude melanoma and definite sarcoma entities. The tumors were divided into AFX/PDS (G1), the SC group, which was subdivided into SLT with only p63 positivity (G2a) and SLT with CK positivity regardless of p63 status (G2b), and SLT with a minor morphologic squamous cell carcinoma component (G3). Clinicopathologic findings of each group were compared, in relation to outcomes. Age at diagnosis ranged from 51 to 96 years (median, 79 y), with M:F=11.5:1. There were 53 tumors in G1 (19AFX, 34PDS), 37 in G2 (25 in G2a, 12 in G2b), and 10 in G3. There was no statistically significant difference in clinical and pathologic parameters or survival among all 3 groups. CKs and p63 expression, size, extent of invasion, vascular invasion, perineural invasion, mitotic count, and ulcer did not affect outcome, whereas margin status and necrosis did by both univariate and multivariate analysis and by only univariate analysis, respectively. Sixty patients had multiple nonmelanomatous skin cancers. Actinic keratosis was observed in overlying/adjacent epidermis in 51 cases. Eight patients had prior radiotherapy to head skin cancers; 1 patient developed 2 separate tumors (G1 and G3) after radiotherapy. Four patients died of tumor (1 G1, 2 G2b, and 1 G3); of these, 3 cases had positive margin, and 1 had narrow margin. Our results have shown similarities of various clinicopathologic parameters between AFX/PDS and SC, raising the possibility that both entities are related, and some of the former entities may represent complete dedifferentiation (complete loss of epithelial phenotype) with a gain of mesenchymal phenotype. In addition, the difference between AFX and PDS appears to be the extent of invasiveness (stage) rather than a different histogenesis. Further investigations are needed. However, from a practical point of view, efforts should be made to excise this group of tumors with clear margins, as margin status appears to be the most important prognostic factor regardless of the presence or absence of epithelial differentiation.
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Abstract
Immunohistochemistry may be helpful in the diagnosis of mesenchymal uterine tumors. This article reviews the immunoreactions used most frequently in the diagnosis of uterine smooth muscle tumors, endometrial stromal tumors, undifferentiated endometrial sarcomas, UTROSCTs, PEComas, adenomyomas, adenosarcomas and carcinosarcomas.
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Affiliation(s)
- Emanuela D'Angelo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Floor C-2, Sant Quintí, 87-89, 08041 Barcelona, Spain.
| | - Jaime Prat
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Floor C-2, Sant Quintí, 87-89, 08041 Barcelona, Spain.
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Kenny SL, McCluggage WG. Adenomyomatous Polyp of the Endometrium With Prominent Epithelioid Smooth Muscle Differentiation. Int J Surg Pathol 2013; 22:358-63. [DOI: 10.1177/1066896913499630] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
A minor component of smooth muscle may be present in the stroma of benign endometrial polyps and 2 distinctive endometrial polypoid lesions, atypical polypoid adenomyoma and adenomyoma, are characterized by stroma with a predominant smooth muscle component. In this report, we describe 2 unusual endometrial polyps in 43- and 60-year-old women in which the stromal component was predominantly composed of smooth muscle with an epithelioid appearance, a phenomenon which, as far as we are aware, has not been previously reported.
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Affiliation(s)
- Sarah L. Kenny
- Belfast Health and Social Care Trust, Belfast, Northern Ireland
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Li RF, Gupta M, McCluggage WG, Ronnett BM. Embryonal rhabdomyosarcoma (botryoid type) of the uterine corpus and cervix in adult women: report of a case series and review of the literature. Am J Surg Pathol 2013; 37:344-55. [PMID: 23348207 DOI: 10.1097/pas.0b013e31826e0271] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
In its classical form, embryonal rhabdomyosarcoma (ERMS, botryoid type) is a vaginal neoplasm occurring in infants and young girls and is often not considered in the differential diagnosis of uterine corpus and cervical spindle cell tumors in adult women. Clinicopathologic and immunohistochemical features of 25 cases of ERMS in women 20 years of age or older were analyzed. Patient age ranged from 20 to 89 years (mean, 44.4 y; median, 46 y), with 8 patients aged 20 to 39 years, 14 patients aged 40 to 59 years, and 3 patients older than 60 years of age. Tumors originated in the cervix in 20 cases and in the uterine corpus in 5. They were characterized by an edematous hypocellular spindle cell proliferation, typically with cellular condensation beneath epithelial surfaces (cambium layer), in which tightly packed hypercellular foci were scattered. Neoplastic cells had hyperchromatic nuclei and minimal cytoplasm, usually with delicate cytoplasmic processes. Occasionally, elongated or globular cells with eosinophilic cytoplasm (rhabdomyoblasts) were evident, but cytoplasmic cross-striations were only rarely identified. Apoptotic bodies and mitotic figures were usually identified in the hypercellular foci. Hemorrhage was common, often making recognition of the hypercellular foci difficult. Desmin and myogenin were coexpressed in 22 of 23 (95.6%) tumors evaluated. Proliferative activity, as assessed by Ki-67 expression, was notably elevated in all tumors evaluated, typically concentrated in the hypercellular foci. Estrogen and progesterone receptors were expressed focally in only 3 of 12 (25%) and 1 of 8 (12.5%) tumors evaluated, respectively. Follow-up was available in 7 cases. Five patients were alive without evidence of disease with follow-up of 3 to 8 years, and 1 patient was alive with disease at 5 months. One patient died at 5 months with pulmonary nodules, but it was not determined whether this was due to metastatic ERMS or the patient's known ductal breast carcinoma. ERMS has a broader clinical profile than classically expected and should be considered in the differential diagnosis of a uterine corpus or cervical spindle cell tumor, regardless of patient age. Recognition can be rendered difficult by the hypocellular background, which can suggest a benign polyp or low-grade tumor, and hemorrhage, which can obscure the characteristic hypercellular foci. Identification of hypercellular foci in which mitotic activity and apoptotic bodies are found, desmin and myogenin are coexpressed, proliferative activity is notably elevated, and hormone receptor expression is usually absent is very useful for establishing the diagnosis.
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Affiliation(s)
- Rose Fanghong Li
- Department of Pathology, The Johns Hopkins University School of Medicine and Hospital, Baltimore, MD 21231, USA
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Tanner EJ, Toussaint T, Leitao MM, Hensley ML, Soslow RA, Gardner GJ, Jewell EL. Management of uterine adenosarcomas with and without sarcomatous overgrowth. Gynecol Oncol 2012; 129:140-4. [PMID: 23283300 DOI: 10.1016/j.ygyno.2012.12.036] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2012] [Revised: 12/20/2012] [Accepted: 12/20/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES Uterine adenosarcomas (AS) are rare tumors composed of malignant stromal and benign epithelial components. We sought to evaluate the role of primary surgery, adjuvant treatments, and salvage therapies for patients with uterine adenosarcomas. METHODS We identified all patients diagnosed with AS from 1990 to 2009 at our institution. Patient demographics, surgical procedures, sites of metastatic disease, and histologic features (e.g., presence of sarcomatous overgrowth, and heterologous elements) were collected. Treatment regimens and survival outcomes were evaluated. RESULTS Thirty-one patients were evaluable for this study: 19 (61%) received up-front treatment at our institution and 12 (39%) received treatment for recurrent disease. Most of the up-front treated patients (15, 79%) were diagnosed with stage I disease and underwent hysterectomy (100%) with bilateral salpingo-oophorectomy (84%). Of the 19 patients treated at our institution from time of initial diagnosis, 5 (26%) patients recurred (median follow-up, 72.9 months; range, 3-154). In 5 patients with sarcomatous overgrowth (AS+SO), the 2-year progression-free and overall survival rates were both 20% versus 100% for 14 patients without sarcomatous overgrowth. Responses to systemic treatment of measurable disease were observed in patients with and without sarcomatous overgrowth, but no optimal treatment strategy could be identified for either groups. CONCLUSIONS Unlike AS without sarcomatous overgrowth, AS+SO is an aggressive disease with a high recurrence rate. In our series, no optimal adjuvant or systemic treatment strategy was identifiable but standard sarcoma chemotherapy regimens appear to have efficacy in both AS and AS+SO.
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Affiliation(s)
- Edward J Tanner
- Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY 10065, USA
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Uterine adenosarcomas: diagnostic use of the proliferation marker Ki-67 as an adjunct to morphologic diagnosis. Int J Gynecol Pathol 2012; 31:447-52. [PMID: 22833085 DOI: 10.1097/pgp.0b013e318249285b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Adenosarcoma (AS) is a rare biphasic neoplasm of the female genital tract characterized by an admixture of benign glandular and low-grade mesenchymal components. The classic low-power growth pattern is periglandular stromal proliferation accompanied by a variable degree of cytologic atypia and mitotic activity. However, as cytologic atypia is an objective criterion, and the number of mitotic figures required for diagnosis is inversely proportional to stromal cytologic atypia, there is a relatively wide variation in the decisive factors used among pathologists to diagnose an AS. Furthermore, the exact number of microscopic fields sufficient for diagnosis and/or the size of the fields adjusted to a specific microscope are not well established. These uncertainties are still an occasional source of misclassification of AS. Our study was conducted to explore the role of immunohistochemistry in the diagnosis of AS. Eight ASs were retrieved and compared with 14 endometrial polyps and 14 atypical polypoid adenomyomas. Immunohistochemical stains for Ki-67, caldesmon, smooth muscle actin, desmin, and CD10 were performed on all cases. All AS had a polypoid growth pattern with a variable increase in periglandular stromal cellularity and stromal nuclear atypia. The mitotic activity ranged from 1 to 15/10 high-power fields, and all AS demonstrated a distinct increase in Ki-67-positive nuclei in the periglandular zone compared with the adjacent stroma, regardless of the mitotic count. The Ki-67-labeling index in periglandular zones was ∼20% compared with <5% in the adjacent stroma. This zonation was not observed in any case of atypical polypoid adenomyomas or endometrial polyps. None of the other stains (CD10, smooth muscle actin, desmin, and caldesmon) helped to differentiate between these entities. Thus, characteristic zonation by Ki-67-staining pattern is a helpful adjunct to the routine morphology in the diagnosis of AS, particularly in curettage specimens, which may lack some of the classic morphologic diagnostic features.
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Mullerian adenosaroma of the cervix with sarcomatous overgrowth and heterologous elements presenting as a recurrent cervical polyp. Case Rep Obstet Gynecol 2012; 2012:358302. [PMID: 22953093 PMCID: PMC3431066 DOI: 10.1155/2012/358302] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2012] [Accepted: 07/19/2012] [Indexed: 11/18/2022] Open
Abstract
Mullerian adenosarcoma of the cervix is a rare tumor composed of benign epithelial and malignant stromal components. Sarcomatous overgrowth and heterologous elements in cervical adenosarcoma are extremely infrequent. We report the case of a 26-year-old woman admitted at the gynaecology department for a painless mass protruding from her vagina. The initial pathological exam concluded to endocervical polyp. Six months later, the patient was readmitted with a recurrence of the polyp. The pathological exam demonstrated interlacing fascicles of elongated spindle cells with few mitotic activity and no glandular formation. After reviewing of the initial polyp the diagnosis of mullerian adenosarcoma was suggested. A second recurrence of the polyp was noted one month later. Histopathological exam of the recurrent polyp confirmed the diagnosis of adenosarcoma with sarcomatous overgrowth and heterologous elements. The patient was lost for follow-up. Cervical adenosarcoma with sarcomatous overgrowth and heterologous element is a rare tumor that occurs in younger age in contrast to endometrium/corpus uterin mullerian adenosarcoma. In young women with recurrent cervical polyp, mullerian adenosarcoma must be considered and should be excluded by careful histopathological exam. Sarcomatous overgrowth and myometrial invasion are the most important prognostic factors. Treatment strategy is still unclear.
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Abstract
Uterine sarcomas are rare cancers, they comprise only 5% of all uterine malignancies. There are about 2,000 cases of uterine sarcoma diagnosed annually in the United States. Uterine sarcomas may be categorized as either favorable-risk, low-grade malignancies with a relatively good prognosis or as poor-risk, high-grade cancers that carry a high risk for tumor recurrence and disease progression. Expert histologic review is critical for appropriate diagnosis and management. Uterine sarcoma histologies considered to carry a more favorable prognosis include low-grade endometrial stromal sarcomas and adenosarcomas. The high-grade sarcomas include high-grade leiomyosarcomas, high-grade undifferentiated endometrial sarcomas, and adenosarcomas with sarcomatous overgrowth. The favorable histology, low-grade uterine sarcomas may be cured with surgical resection of uterus-limited disease. These tumors are often hormone-sensitive, and treatment with hormonal therapies may be efficacious for patients with advanced, unresectable disease. High-grade uterine leiomyosarcomas and undifferentiated endometrial sarcomas carry a high risk for recurrence, even after complete resection of uterus-limited disease. No adjuvant intervention has been shown to improve survival outcomes. Advanced, metastatic disease is generally treated with systemic cytotoxic therapies, which may result in objective response but is not curative. Selected patients with isolated metastatic disease and a long disease-free interval may benefit from metastatectomy.
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Affiliation(s)
- Martee L Hensley
- From the Memorial Sloan-Kettering Cancer Center, Weill Cornell Medical College, New York, NY
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Abstract
The Wilms tumor gene 1 (WT1) has been reported in normal tissues and many neoplasms of the female genital tract. This review discusses WT1 expression in the female genital tract and its potential utility in the differential diagnosis of neoplasms that occur at this location. WT1 is of value in the differential diagnosis of synchronous serous carcinomas arising in the ovary/fallopian tube/peritoneum and endometrium, as strong WT1 positivity in both tumors points toward an extrauterine origin. In addition, WT1 can be used to distinguish sex cord stromal tumors (WT1 positive) from endometrioid carcinomas (OECs). WT1 expression is not helpful in the differential diagnosis of ovarian serous carcinomas (OSCs) and transitional carcinomas, as both are typically positive and has limited value in the distinction of serous tumors arising in the ovary/fallopian tube/peritoneum from mesotheliomas. WT1 is also not helpful to differentiate small cell carcinoma of hypercalcemic type from juvenile granulosa cell tumor, a common diagnostic problem. Intra-abdominal desmoplastic round cell tumor reacts to WT1 (C-terminal) in contrast to all other tumors discussed which helps to separate this rare tumor from most other small round cell tumors that may involve, primarily or secondarily, the ovary with the exception of small cell carcinoma of hypercalcemic type that typically reacts with the N-terminal of WT1.
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Abstract
Uterine adenosarcomas are uncommon mixed Müllerian neoplasms, most commonly arising in the uterine corpus. A new Federation of International Gynecologic Organization staging system for these tumors has recently been implemented. This staging system is an improvement on the earlier generic application of the 1988 Federation of International Gynecologic Organization staging system for endometrial cancer to adenosarcoma. Herein, we report 3 uterine adenosarcomas with unusual features. For 2 of these, no specific staging guidelines are provided by either the earlier or, more importantly, the new staging system. The first case is of an adenosarcoma arising in the eutopic endometrium with involvement of underlying adenomyosis without myometrial invasion; the second originated in a mural adenomyoma in the absence of eutopic endometrial involvement; and the third case encompassed synchronous endometrial and extrauterine (peritoneal) neoplasms. Such cases are rare, and there is insufficient evidence to be definitive about staging. Thus, we suggest a descriptive reporting strategy for adenosarcomas with these unusual features. We also propose a reporting nomenclature for such cases to ensure standardization such that they can be adequately recorded in synoptic reporting protocols. This will facilitate reliable data collection such that an evidence-based staging system for these scenarios may be derived.
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Tse KY, Crawford R, Ngan HYS. Staging of uterine sarcomas. Best Pract Res Clin Obstet Gynaecol 2011; 25:733-49. [PMID: 21752716 DOI: 10.1016/j.bpobgyn.2011.05.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 05/28/2011] [Indexed: 10/17/2022]
Abstract
Uterine sarcomas comprise leiomyosarcoma, endometrial stromal sarcoma, adenosarcoma, undifferentiated endometrial sarcoma, and their variants. Carcinosarcoma is historically classified as sarcoma, but it is now regarded as a metaplastic carcinoma. Uterine sarcomas are rare, and are traditionally staged in the same way as endometrial carcinoma. Because of their different clinical and biological behaviours, the International Federation of Gynecology and Obstetrics introduced a new staging system in 2009 for leiomyosarcoma, endometrial stromal sarcoma and adenosarcoma, and carcinosarcoma, respectively. Following an extensive literature review no good evidence was found to support the modification of the staging system. This is mainly because of the rarity of the sarcomas and the heterogeneity of the reports, the different diagnostic criteria and treatments changing over the decades the retrospective nature and small sample size in most studies, and the lack of uniform pathological review even in large studies. Currently, evidence is still lacking about the use of preoperative imaging for staging purpose, and uterine sarcomas remain to be surgically staged. Total hysterectomy is the cornerstone for both staging and treatment. Newer evidence shows that routine lymphadenectomy and bilateral salpingo-oophorectomy may not be necessary, unless in the presence of extra-uterine spread, suspicious ovaries or lymph nodes, and certain poor histological types, such as undifferentiated endometrial sarcoma and adenosarcoma with sarcomatous overgrowth. More research and data collection are definitely needed in order to verify and further revise the current staging systems.
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Affiliation(s)
- Ka Yu Tse
- 6/F, Professorial Block, Department of Obstetrics and Gynaecology, Queen Mary Hospital, The University of Hong Kong.
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D'Angelo E, Prat J. Pathology of mixed Müllerian tumours. Best Pract Res Clin Obstet Gynaecol 2011; 25:705-18. [PMID: 21742560 DOI: 10.1016/j.bpobgyn.2011.05.010] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 05/20/2011] [Indexed: 11/29/2022]
Abstract
The term 'mixed Müllerian tumour' applies to uterine tumours composed of epithelial and mesenchymal elements of Müllerian origin. These neoplasms are classified into adenomyomas, adenofibromas, adenosarcomas, and carcinosarcomas (malignant Müllerian mixed tumours) based on whether the epithelial and stromal elements are benign or malignant. The rare atypical polypoid adenomyoma usually involves the lower uterine segment and, on curettings, may be confused with invasive adenocarcinoma. Adenosarcomas are low-grade neoplasms classified halfway along the spectrum of mixed Müllerian tumours, with adenofibromas at one end and carcinosarcomas (malignant Müllerian mixed tumours) at the other. Some tumours currently classified as 'adenofibromas' on the basis of their low mitotic count and lack of nuclear atypia are, in fact, well differentiated adenosarcomas. Carcinosarcoma is composed of admixed but distinctive carcinomatous and sarcomatous elements. On the basis of the clonal origin of both tumour components, carcinosarcomas are currently thought to be metaplastic carcinomas rather than uterine sarcomas.
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Affiliation(s)
- Emanuela D'Angelo
- Department of Pathology, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
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Kim SA, Jung JS, Ju SJ, Kim YT, Kim KR. Mullerian adenosarcoma with sarcomatous overgrowth in the pelvic cavity extending into the inferior vena cava and the right atrium. Pathol Int 2011; 61:445-8. [DOI: 10.1111/j.1440-1827.2011.02682.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Patrelli TS, Gizzo S, Di Gangi S, Guidi G, Rondinelli M, Nardelli GB. Cervical Mullerian adenosarcoma with heterologous sarcomatous overgrowth: a fourth case and review of literature. BMC Cancer 2011; 11:236. [PMID: 21663687 PMCID: PMC3141764 DOI: 10.1186/1471-2407-11-236] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Accepted: 06/11/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine sarcomas are relatively rare tumors that account for approximately 1-3% of female genital tract malignancies and between 4-9% of uterine cancers. Less than 8% of all cases are Mullerian adenosarcoma, a distinctive uterine neoplasm characterized by a benign, but occasionally atypical, epithelial and a malignant, usually low-grade, stromal component, both of which should be integral and neoplastic constituents of the tumor. Mullerian adenosarcoma with sarcomatous overgrowth (MASO) is a very aggressive variant, associated with post-operative recurrence, metastases, even when diagnosed in early stage. CASE PRESENTATION We present a fourth MASO case derived from uterine cervix in a 72-year-old woman with metrorrhagia and a polypoid mass protruding through the cervical ostium. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, systematic pelvic lymph node dissection, omental biopsy and appendectomy were performed. Surgery treatment was associated with adjuvant whole-pelvis radiation (45 Gy) and adjuvant chemotherapy (cisplatin/ifosfamide). After nine months of follow up, the patient was free of tumor. CONCLUSIONS The rarity of MASO of the cervix involves a management difficult. Most authors recommend total abdominal hysterectomy, usually accompanied by bilateral salpingo-oophorectomy. There is no common agreement on staging by lymphadenectomy during primary surgery and adjuvant chemo-radio therapy.
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Affiliation(s)
- Tito Silvio Patrelli
- Department of Gynecological and Human Reproduction Sciences, University of Padua, via Giustiniani 3, 35128 Padua, Italy
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Patrelli TS, Silini EM, Gizzo S, Berretta R, Franchi L, Thai E, Lukanovic A, Nardelli GB, Modena AB. Extragenital Müllerian adenosarcoma with pouch of Douglas location. BMC Cancer 2011; 11:171. [PMID: 21575150 PMCID: PMC3115912 DOI: 10.1186/1471-2407-11-171] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 05/15/2011] [Indexed: 11/23/2022] Open
Abstract
Background Of all female genital tract tumors, 1-3% are stromal malignancies. In 8-10% of cases, these are represented by Müllerian adenosarcoma an extremely rare tumor characterized by a stromal component of usually low-grade malignancy and by a benign glandular epithelial component. Variant that arises in the pouch of Douglas is scarcely mentioned in the medical literature. Case Presentation A 49-year-old para-0 woman, was seen at our OB/GYN-UNIT because she complained vaguely of pelvic pain. She had a mass of undefined nature in the pouch of Douglas. A simple excision of the mass showed low-grade Müllerian adenosarcoma with areas of stromal overgrowth. One and a half year after surgery, at another hospital, a mass was detected in the patient's posterior vaginal fornix and removed surgically. Six months later she came back to our observation with vaginal bleeding and mass in the vaginal fornix. We performed radical surgery. The pathological examination showed recurrent adenosarcoma. Surgical treatment was supplemented by radiation therapy. Conclusions The case of Müllerian adenosarcoma reported here is the third known so far in the literature that was located in the pouch of Douglas. To date, only two other such cases have been reported, including one resulting from neoplastic degeneration of an endometriotic cyst.
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Affiliation(s)
- Tito S Patrelli
- Department of Obstetrics, Gynecological and Perinatology Sciences, University of Parma, Italy.
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Bardarov S, Khachaturov V, Kirtesh P, Jimenez E. Case report of undifferentiated endometrial sarcoma in association with osteoclast-like giant cells. PATHOLOGY RESEARCH INTERNATIONAL 2011; 2011:629840. [PMID: 21559205 PMCID: PMC3090185 DOI: 10.4061/2011/629840] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2010] [Accepted: 02/04/2011] [Indexed: 01/14/2023]
Abstract
We describe the clinical, gross and microscopic features of undifferentiated uterine stromal sarcoma associated with osteoclast-like giant cells. A case of low-grade endometrial stromal sarcoma is already described in association with osteoclast-like giant cells; however, the current case differs in that the tumor was a high grade and did not show any evidence of smooth muscle or epithelioid differentiation and was shown to be strongly positive for CD10 and focally for WT-1 and Inhibin supporting an endometrial stromal origin. The associated osteoclast-like giant cells were abundant, evenly distributed within the tumor and showed strong positivity for CD68. Interestingly, rare (less than 2%) giant cells also showed weak cytoplasmic positivity for b-hCG. The tumor infiltrated deep into the myometrium and had marked lymphovascular invasion. Although the regional lymph nodes and peritoneal washings were negative, the lesion showed a highly aggressive clinical course. Despite treatment, the tumor disseminated within the abdominal cavity and lungs and ultimately led to the patient's demise within 9 months of the diagnosis.
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