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Ghimire S, Shrestha P, Bhandari K. A rare case report of low-grade endometrial sarcoma: A surgical tale from Himalayas. Int J Surg Case Rep 2024; 117:109544. [PMID: 38507940 PMCID: PMC10966147 DOI: 10.1016/j.ijscr.2024.109544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/11/2024] [Accepted: 03/14/2024] [Indexed: 03/22/2024] Open
Abstract
INTRODUCTION In the context of female genital tract malignancy, uterine sarcoma is considered the rarest form of the disease. Despite the inert nature of low-grade endometrial sarcoma, they must be meticulously diagnosed on time, with an exact grading of the severity and staging of the disease, which further guides the treatment modality and prognosis. CASE SUMMARY A married Asian female without any significant past medical and surgical history complained of abdominal distension and discomfort, which was progressive in nature, for which a radiological assessment was made that showed features suggestive of endometrial sarcoma. Total abdominal hysterectomy with sapingoopherectomy was done without any perioperative complications. Histology further confirmed the diagnosis. Post-operatively, the patient had an unremarkable hospital stay and was discharged home. DISCUSSION Endometrial stromal sarcoma is one of the rare malignant entities presenting usually in late adult females, but sometimes it can present at an earlier age as well. Abdominal masses in females, although usually overlooked as benign, can sometimes be associated with a malignant picture. Low-grade endometrial sarcomas have been seen to masquerade other minor benign cases, such as leiomyoma. Despite the rarity of such malignant conditions, diagnosis and management are rather straightforward, and post-operative patient prognosis has been found to be rewarding. CONCLUSION Among the uterine sarcoma cases, endometrial sarcoma comes under the malignant disease of the least occurrence. Compared to other malignant conditions, these patients present with minor symptoms like discomfort, which may go unchecked. The major factor that should be noted is the on-time diagnosis and appropriate choice of treatment modality. Overall, despite a minute prevalence and difficult diagnosis, the prognosis of the patient is rather good.
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Affiliation(s)
- Sagun Ghimire
- Department of Neurosurgery, B & B Hospital, Gwarko, Lalitpur, Nepal
| | - Pratima Shrestha
- Department of Gynecology and Obstetrics, KIST Medical College and Teaching Hospital, Imadol, Lalitpur, Nepal
| | - Kritick Bhandari
- KIST Medical College and Teaching Hospital, Gwarko, Imadol, Lalitpur 44600, Nepal.
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Kim GW, Baek SK, Han JJ, Kim HJ, Sung JY, Maeng CH. Pulmonary Metastasizing Low-Grade Endometrial Stromal Sarcoma: Case Report and Review of Diagnostic Pitfalls. Diagnostics (Basel) 2022; 12:diagnostics12020271. [PMID: 35204363 PMCID: PMC8871004 DOI: 10.3390/diagnostics12020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 01/19/2022] [Indexed: 01/27/2023] Open
Abstract
Pulmonary manifestations of benign metastasizing leiomyoma (BML) usually include multiple well-defined, round, bilateral nodules. Low-grade endometrial stromal sarcoma (LG-ESS) is a rare uterine tumor. A 70-year-old woman visited the clinic complaining of acute cough and dyspnea in April 2017. Chest computed tomography (CT) revealed pneumothorax and multiple pulmonary nodules. She had a history of hysterectomy for uterine leiomyoma 23 years ago. Biopsy revealed that the pulmonary masses were consistent with BML. However, the patient had two subsequent episodes of acute, recurrent respiratory distress, accompanied by massive pleural effusions and hydropneumothorax over the next two years. A chest CT performed for acute dyspnea revealed large and multiple hydropneumothoraces. The size and distribution of pulmonary masses were aggravated along with cystic changes and bilateral pleural effusions. Given this aggressive feature, additional immunohistochemical findings and gynecologic pathologist review confirmed the correct diagnosis to be LG-ESS. After initiating anti-estrogen therapy, the patient achieved a partial response, without recurrence of symptoms, for 28 months. Metastatic LG-ESS responds well to anti-hormonal therapy. If the clinical pattern of a disease is different than expected, the possibility of a correction in the diagnosis should be considered.
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Affiliation(s)
- Geon Woo Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Sun Kyung Baek
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Jae Joon Han
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Hong Jun Kim
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
| | - Ji-Youn Sung
- Department of Pathology, Kyung Hee University Hospital, Kyung Hee University College of Medicine, Seoul 02447, Korea;
| | - Chi Hoon Maeng
- Division of Medical Oncology-Hematology, Department of Medicine, College of Medicine, Kyung Hee University Hospital, Seoul 02447, Korea; (G.W.K.); (S.K.B.); (J.J.H.); (H.J.K.)
- Correspondence: ; Tel.: +82-2-958-2965
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Gupta SK, Jea JDY, Yen L. RNA-driven JAZF1-SUZ12 gene fusion in human endometrial stromal cells. PLoS Genet 2021; 17:e1009985. [PMID: 34928964 PMCID: PMC8722726 DOI: 10.1371/journal.pgen.1009985] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 01/03/2022] [Accepted: 12/08/2021] [Indexed: 12/17/2022] Open
Abstract
Oncogenic fusion genes as the result of chromosomal rearrangements are important for understanding genome instability in cancer cells and developing useful cancer therapies. To date, the mechanisms that create such oncogenic fusion genes are poorly understood. Previously we reported an unappreciated RNA-driven mechanism in human prostate cells in which the expression of chimeric RNA induces specified gene fusions in a sequence-dependent manner. One fundamental question yet to be addressed is whether such RNA-driven gene fusion mechanism is generalizable, or rather, a special case restricted to prostate cells. In this report, we demonstrated that the expression of designed chimeric RNAs in human endometrial stromal cells leads to the formation of JAZF1-SUZ12, a cancer fusion gene commonly found in low-grade endometrial stromal sarcomas. The process is specified by the sequence of chimeric RNA involved and inhibited by estrogen or progesterone. Furthermore, it is the antisense rather than sense chimeric RNAs that effectively drive JAZF1-SUZ12 gene fusion. The induced fusion gene is validated both at the RNA and the genomic DNA level. The ability of designed chimeric RNAs to drive and recapitulate the formation of JAZF1-SUZ12 gene fusion in endometrial cells represents another independent case of RNA-driven gene fusion, suggesting that RNA-driven genomic recombination is a permissible mechanism in mammalian cells. The results could have fundamental implications in the role of RNA in genome stability, and provide important insight in early disease mechanisms related to the formation of cancer fusion genes. Fusion genes resulting from chromosomal translocations are important for understanding cancer mechanisms and developing anti-cancer therapies. Fusion gene are presumed to occur prior to fusion RNA expression. However, studies have reported the presence of fusion RNAs in individuals who were negative for chromosomal translocations. The observation, that fusion RNA could be present prior to fusion gene formation, raises the provocative hypothesis that fusion RNA, or any cellular RNA with sequence compositions resembling that of fusion RNA, could act as a template to mediate genomic rearrangement which leads to the final gene fusion. In this report, we demonstrated that the expression of designed chimeric RNAs in human endometrial stromal cells leads to the formation of JAZF1-SUZ12, a cancer fusion gene found in endometrial stromal sarcomas. The process is specified by the sequence of chimeric RNA involved and inhibited by estrogen or progesterone. Furthermore, it is the antisense rather than sense chimeric RNAs that effectively drive JAZF1-SUZ12 gene fusion. The results could have fundamental implications in the role of RNA in mammalian genome stability, provide important insight in early disease mechanism, as well as developing gene editing technology via mechanisms native to mammalian cells.
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Affiliation(s)
- Sachin Kumar Gupta
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, Texas, United States of America
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, United States of America
| | - Jocelyn Duen-Ya Jea
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, Texas, United States of America
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, United States of America
| | - Laising Yen
- Department of Pathology & Immunology, Baylor College of Medicine, Houston, Texas, United States of America
- Department of Molecular & Cellular Biology, Baylor College of Medicine, Houston, Texas, United States of America
- Dan L. Duncan Cancer Center, Baylor College of Medicine, Houston, Texas, United States of America
- * E-mail:
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Rebegea LF, Firescu D, Anghel RM, Gales L, Ilie AM, Dumitru ME, Craescu M, Niculet E, Tatu AL, Cretu MS, Lungu M, Neagu AI. Clinical, histological and therapeutical aspects in the management of uterine and extrauterine stromal sarcomas: Case reports. Exp Ther Med 2021; 22:1456. [PMID: 34737796 PMCID: PMC8561772 DOI: 10.3892/etm.2021.10891] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Accepted: 09/07/2021] [Indexed: 12/20/2022] Open
Abstract
Endometrial stromal sarcoma (ESS) is a rare tumor, predominantly occurring as a primary tumor of the uterus. Rare cases of primary extrauterine ESS (EESS) have been reported. Low-grade ESS (LG-ESS) is more common than high-grade ESS (HG-ESS). We present five cases of ESS and one case of EESS. All cases received external radiotherapy (EBRT) at the Radiotherapy Department of the Emergency Clinical Hospital ‘Sfantul Apostol Andrei’ Galati, during 2004-2020. Five cases underwent EBRT in two-dimensional (2D) technique and only one patient received EBRT with three-dimensinal conformational radiotherapy (3DCRT) technique with a linear accelerator, Elekta Synergy. Five patients were referred to postoperative radiotherapy after hysterectomy. The median age of the patients was 57.4 years. One patient was referred to radiotherapy with palliative intent. EESS localized in the retroperitoneum, in the para-aortic region, was identified in one 64-year-old patient with a personal history of hysterectomy and bilateral salpingo-oophorectomy in 1997; EESS was complicated with vertebral extension at the L1-L2 level and spinal cord compression syndrome. ESS represents a rare diagnosis and a high- or low-grade tumor profile is distinguished by immunohistochemistry (IHC) tests. Up to 30% of patients have EESS at presentation. The treatment of ESS is multimodal, its management requiring a multidisciplinary team, and it is different according to the primary tumor location and tumor staging. The role of adjuvant radiotherapy remains controversial in high-grade EESS and due to the rarity of these cases there are limited data concerning the efficacy of adjuvant EBRT available from prospective randomized control clinical trials.
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Affiliation(s)
- Laura Florentina Rebegea
- Department of Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Medical Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania.,Research Center in The Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Dorel Firescu
- IInd Clinic of Surgery, 'Sfantul Apostol Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania.,Surgical Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Rodica Marcela Anghel
- Radiology, Oncology and Hematology Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Clinical Department of Radiotherapy II, 'Prof. Dr. Alexandru Trestioreanu' Oncology Institute, 022328 Bucharest, Romania
| | - Laurentia Gales
- Radiology, Oncology and Hematology Department, 'Carol Davila' University of Medicine and Pharmacy, 050474 Bucharest, Romania.,Clinical Department of Radiotherapy II, 'Prof. Dr. Alexandru Trestioreanu' Oncology Institute, 022328 Bucharest, Romania
| | - Ana Maria Ilie
- Department of Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania
| | - Mihaela Emilia Dumitru
- Department of Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania
| | - Mihaela Craescu
- Department of Radiotherapy, 'Sfantul Apostol Andrei' Emergency Clinical Hospital, 800578 Galati, Romania.,Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Elena Niculet
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
| | - Alin Laurentiu Tatu
- Medical Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania.,Research Center in The Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunarea de Jos' University, 800010 Galati, Romania.,Dermatology Department, 'Sfanta Cuvioasa Parascheva' Clinical Hospital of Infectious Diseases, 800179 Galati, Romania
| | - Mariana Stuparu Cretu
- Research Center in The Field of Medical and Pharmaceutical Sciences, ReFORM-UDJ, 'Dunarea de Jos' University, 800010 Galati, Romania.,Family Planning Department, 'Buna Vestire' Clinical Hospital of Obstetrics and Gynecology, 800151 Galati, Romania
| | - Mihaela Lungu
- Medical Clinical Department, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania.,Department of Neurology, 'Sfantul Apostol Andrei' Emergency Clinical Hospital of Galati, 800578 Galati, Romania
| | - Anca Iulia Neagu
- Department of Morphological and Functional Sciences, Faculty of Medicine and Pharmacy, 'Dunarea de Jos' University, 800010 Galati, Romania
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Ayhan A, Toptas T, Oz M, Vardar MA, Kayikcioglu F, Ozgul N, Gokcu M, Simsek T, Tunc M, Meydanli MM. Low-grade endometrial stromal sarcoma: A Turkish uterine sarcoma group study analyzing prognostic factors and disease outcomes. Gynecol Oncol 2020; 160:674-680. [PMID: 33375988 DOI: 10.1016/j.ygyno.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/15/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To investigate factors associated with refractory disease, recurrence, or death as well as disease-free survival (DFS) and overall survival (OS) in low-grade endometrial sarcoma (LGESS). METHODS A multi-institutional, retrospective study was conducted in a total of 124 patients, who received a curative-intent surgery. The exclusion criteria were as follows: i) history of any other invasive disease; ii) neoadjuvant therapy; iii) fertility sparing surgery; iv) a different diagnosis after review of the slides. RESULTS All patients underwent hysterectomy, 96% had bilateral salpingo-oophorectomy, and 65% had lymphadenectomy. Twelve (14.8%) of 81 patients undergoing lymphadenectomy had lymph node (LN) metastasis. Of those, 8 (9.8%) had pelvic LN metastasis whereas 4 (5.6%) had isolated paraaortic LN metastasis. Six of 8 (75%) patients with positive pelvic LNs had concurrent paraaortic LN metastasis. Among 124 patients, 3 patients (2.4%) had refractory disease following primary therapy. During a median follow-up of 45.5 months, 27 (22.3%) of 121 patients who achieved complete remission after primary therapy developed recurrence, and 10 patients (8.1%) died of disease. The 3-year DFS and OS were 76.9% and 93.8%, respectively. Stage was the sole independent prognostic factor in the whole cohort. When analyzing factors within subgroups of stage I and stage ≥II, there was no significant prognostic factor for stage I; however, lymphadenectomy and adjuvant chemotherapy were significantly associated with disease outcomes for stage ≥II. While lymphadenectomy was related with improved DFS, chemotherapy was associated with poor DFS and OS. CONCLUSION The risk of LN metastasis at pelvic as well as paraaortic lymphatic basins is not negligible to omit lymphadenectomy in stage ≥II LGESS. Moreover, lymphadenectomy provides significant DFS advantage in patients with extrauterine disease.
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Affiliation(s)
- Ali Ayhan
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Tayfun Toptas
- Department of Gynecologic Oncology, Saglik Bilimleri University Antalya Research and Training Hospital, Antalya, Turkey.
| | - Murat Oz
- Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey
| | - Mehmet Ali Vardar
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Fulya Kayikcioglu
- Department of Gynecologic Oncology, Saglik Bilimleri University Etlik Zübeyde Hanim Women's Health Training and Research Hospital, Ankara, Turkey
| | - Nejat Ozgul
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Mehmet Gokcu
- Department of Gynecologic Oncology, Saglik Bilimleri University Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| | - Tayup Simsek
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Akdeniz University, Antalya, Turkey
| | - Mehmet Tunc
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Faculty of Medicine, Baskent University, Ankara, Turkey
| | - Mehmet Mutlu Meydanli
- Department of Gynecologic Oncology, Saglik Bilimleri University Ankara City Hospital, Ankara, Turkey
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6
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Zhang Y, Li N, Wang W, Yao H, An J, Li N, Sun Y, Wu L. Long-term impact of lymphadenectomies in patients with low-grade, early-stage uterine endometrial stroma sarcoma. J Obstet Gynaecol Res 2020; 46:654-662. [PMID: 32022392 DOI: 10.1111/jog.14198] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Accepted: 12/31/2019] [Indexed: 11/29/2022]
Abstract
AIM The aim of our study was to investigate the lymph node metastasis (LNM) rate and effect of lymph node dissection (LND) in patients with stage I, low-grade endometrial stromal sarcoma (LGESS). METHODS Patients with stage I LGESS (n = 119) that underwent surgery from July 1969 to July 2017, following up over 48 years at the China National Cancer Center were retrospectively analyzed in this study. RESULTS Surgical records and consulting data for patients with LGESS were analyzed to find that 47 patients received systematic pelvic LND. The number of patients with menopause in the LND(+) group were significantly lower than those in LND(-) group (2.1% vs 22.2%, P = 0.005), meanwhile, patients received bilateral salpingo-oophorectomy procedure in LND(+) group were significantly higher than LND(-) (97.9% vs 58.3%, P < 0.001). Neither progression-free survival nor overall survival was significantly improved in the LND(+) group even after propensity score matching although the progression-free survival has a stronger trend in LND(+) population. CONCLUSION A systematic LND was not significantly associated with prognosis for patients with early-stage LGESS. There is no sufficient indication for a systematic LND for patients with early-stage LGESS. A systematic LND might be necessary if enlarged lymph nodes were detected by image graphology or observation during surgery.
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Affiliation(s)
- Yuanyuan Zhang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ning Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Wenpeng Wang
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jusheng An
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Nan Li
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yangchun Sun
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, National Cancer Center/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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7
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Huang KG, Tantitamit T, Chang SH. Recurrent low-grade endometrial stromal sarcoma presenting as isolated pedunculated vaginal cuff polyp. Gynecol Minim Invasive Ther 2020; 9:251-252. [PMID: 33312874 PMCID: PMC7713651 DOI: 10.4103/gmit.gmit_42_18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/23/2019] [Accepted: 08/04/2020] [Indexed: 11/29/2022] Open
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8
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Xu Y, Liang ZX, Guo JT, Su X, Lu YL, Guan XZ. Cystic and solitary nodular pulmonary metastases in a patient with low-grade endometrial stromal sarcoma: A case report and literature review. Oncol Lett 2019; 18:1133-1144. [PMID: 31423173 PMCID: PMC6607033 DOI: 10.3892/ol.2019.10409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 04/17/2019] [Indexed: 01/24/2023] Open
Abstract
Pulmonary metastases of endometrial stromal sarcoma (ESS) are uncommon and can be difficult to diagnose. The aims of the present study were to investigate the clinical and pathological features, and enhance the awareness of pulmonary metastases in patients with low-grade ESS. The study reports a case of low-grade ESS that resulted in cystic and nodular pulmonary metastases. Furthermore, the PubMed database was searched using 'pulmonary metastases of low-grade endometrial stromal sarcoma' as the key phrase. The literature on pulmonary metastases of low-grade ESS was reviewed and 35 cases were included in the present study. The clinical manifestations, imaging data, pathological features, treatment and prognosis of the 35 previously reported cases and the current case were retrospectively analyzed. The age range of the 36 patients diagnosed with low-grade ESS was 28-65 years. The time period from confirmation of ESS to lung metastases was 1.5-27 years. In 50% of the patients, the pulmonary metastases were asymptomatic. The most common pulmonary symptom was dyspnea, followed by chest pain, pneumothorax and coughing. The most common chest imaging presentation was multiple pulmonary nodules, followed by a solitary nodule or mass. Histology was used to identify that the pulmonary metastases had the pathological features of low-grade ESS. The immunohistochemical results demonstrated strong diffuse immunoreactivity for cluster of differentiation 10, estrogen receptor and progesterone receptor in almost all the specimens. The review of the literature revealed that pulmonary metastases from low-grade ESS are rare but not negligible. Furthermore, the detailed clinical information, imaging findings and immunohistochemical detection are important for making a diagnosis.
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Affiliation(s)
- Yang Xu
- Department of Respiratory Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Zhi-Xin Liang
- Department of Respiratory Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Jun-Tang Guo
- Department of Thoracic Surgery, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
| | - Xin Su
- Department of Respiratory Diseases, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Yun-Long Lu
- Department of Pathology, Hainan Branch of Chinese People's Liberation Army General Hospital, Sanya, Hainan 572013, P.R. China
| | - Xi-Zhou Guan
- Department of Respiratory Diseases, Chinese People's Liberation Army General Hospital, Beijing 100853, P.R. China
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9
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Mangla G, Diwaker P, Gogoi P. Endometrial Stromal Sarcoma: Case Series with Emphasis on Gross Features. Indian J Surg Oncol 2019; 10:91-94. [PMID: 30948880 DOI: 10.1007/s13193-018-0847-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 11/29/2018] [Indexed: 11/21/2022] Open
Affiliation(s)
- Gunjan Mangla
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, 4th Floor, Dilshad Garden, Delhi, 110095 India
| | - Preeti Diwaker
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, 4th Floor, Dilshad Garden, Delhi, 110095 India
| | - Priyanka Gogoi
- Department of Pathology, University College of Medical Sciences & Guru Teg Bahadur Hospital, 4th Floor, Dilshad Garden, Delhi, 110095 India
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10
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Gothwal M, Yadav G, Rao M, Singh P, Nalwa A. Low-Grade Endometrial Stromal Sarcoma in a Postmenopausal Woman with Third-Degree Uterovaginal Prolapse: A Rare Case with Review of the Literature. J Midlife Health 2018; 9:165-167. [PMID: 30294191 PMCID: PMC6166430 DOI: 10.4103/jmh.jmh_90_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Endometrial stromal sarcomas (ESSs) are rare malignant tumors of the uterus that arise from the endometrial stroma, the annual incidence of ESS being 1–2/million women. Patients present with nonspecific complaints of abnormal uterine bleeding, pelvic pain, and pressure symptoms. Postmenopausal women rarely present with a low-grade ESS, as it is more common in younger women. ESS is usually confused with leiomyomas radiologically. Histopathological examination and immunohistochemistry are essential for the diagnosis. We, herein, report a case of a postmenopausal female who presented with something coming out per vagina. The clinical impression was that of a third-degree uterovaginal prolapse that on histopathological examination was diagnosed as a low-grade ESS.
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Affiliation(s)
- Meenakshi Gothwal
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Garima Yadav
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Meenakshi Rao
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Pratibha Singh
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Aasma Nalwa
- Department of Pathology, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
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11
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Abu Jamea GA, Al Rikabi AC, Akkour K. Primary low-grade endometrial stromal sarcoma arising in the vagina: report of an unusual case and literature review. J Surg Case Rep 2017; 2017:rjx238. [PMID: 29218216 PMCID: PMC5710654 DOI: 10.1093/jscr/rjx238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 10/30/2017] [Accepted: 11/14/2017] [Indexed: 11/23/2022] Open
Abstract
Endometrial stromal sarcoma rarely occurs as an extrauterine neoplasm and it is even more unlikely to be found in the vagina. To the best of our knowledge, only six cases of primary vaginal endometrial stromal sarcoma without association with endometriosis have been published to this day. We describe a case of a 58-year-old female with a history of vaginal heaviness caused by a mass lesion. After a biopsy was taken, the histopathological findings and immunohistochemical stains were consistent with low-grade endometrial stromal sarcoma. The patient underwent total hysterectomy and bilateral salpingo-oophorectomy with lymph node dissection followed by hormonal therapy. This line of management was heavily based on the treatment guidelines for endometrial stromal sarcoma.
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Affiliation(s)
- Ghada A Abu Jamea
- Department of Histopathology and Cytology, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Ammar C Al Rikabi
- Department of Histopathology and Cytology, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Khalid Akkour
- Department of Obstetrics Gynaecology, King Khalid University Hospital, King Saud University, Riyadh, Kingdom of Saudi Arabia
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Agarwal R, Rajanbabu A, Nair IR, Satish C, Jose G, Unikrishnan U. Endometrial stromal sarcoma—A retropsective analysis of factors affecting recurrence. Eur J Obstet Gynecol Reprod Biol 2017; 216:92-97. [DOI: 10.1016/j.ejogrb.2017.07.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2017] [Revised: 06/27/2017] [Accepted: 07/04/2017] [Indexed: 12/01/2022]
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Ray M, Singh S, Kumar S. Rare Case of Endometrial Stromal Sarcoma with Omental Metastasis in a 19-Year-Old Girl. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2016. [DOI: 10.1007/s40944-016-0054-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Paul PG, Rengaraj V, Das T, Garg R, Thomas M, Khurd AS. Uterine Sarcomas in Patients Undergoing Surgery for Presumed Leiomyomas: 10 Years' Experience. J Minim Invasive Gynecol 2015; 23:384-9. [PMID: 26677821 DOI: 10.1016/j.jmig.2015.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2015] [Revised: 11/23/2015] [Accepted: 11/26/2015] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To find the incidence of sarcomas in patients undergoing surgery for presumed leiomyomas. DESIGN Retrospective study (Canadian Task Force classification II-3). SETTING Paul's Hospital, Centre for Advanced Laparoscopy and Infertility, Kochi, India. PATIENTS All women who underwent total laparoscopic hysterectomy (TLH), laparoscopic myomectomy (LM), and hysteroscopic myomectomy (HM) at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014 that were then diagnosed as sarcomas on histopathologic examination. INTERVENTIONS TLH, LM, and HM. MEASUREMENTS AND MAIN RESULTS A total of 2678 patients underwent TLH, LM, and HM at Paul's Hospital for presumed leiomyomas from January 1, 2004 to December 31, 2014. Five patients were diagnosed as leiomyosarcoma and 3 patients as endometrial stromal sarcoma on histopathologic examination. Women's ages ranged from 12 to 53 years. Histopathologic diagnosis of leiomyosarcoma was made in 3 patients from the TLH group and 2 patients from the myomectomy group. Two patients from the TLH group and 1 patient from the myomectomy group were diagnosed as endometrial stromal sarcoma on histopathologic examination. The incidence of uterine sarcomas (leiomyosarcoma and endometrial stromal sarcoma) in patients undergoing surgery for presumed leiomyomas was found to be .29% (1 in 335 patients) in our study. CONCLUSION Over a period of 10 years (2004-2014), the incidence of uterine sarcomas in patients undergoing surgery for presumed leiomyomas was found to be .29% in our study.
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Affiliation(s)
- P G Paul
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India.
| | - Varsha Rengaraj
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Tanuka Das
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Reena Garg
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Manju Thomas
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
| | - Aditya S Khurd
- Centre for Advanced Endoscopy and Infertility, Paul's Hospital, Cochin, Kerala, India
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Cardoso PM, Rajan S, Amoncar S, Sheldekar A. An Unusual Missed Case of Endometrial Stromal Sarcoma. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0006-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pecorella I, Faiano P, Ciardi G, Boni T, Panici PB. Uterine Undifferentiated Sarcoma Associated with Primary Adenocarcinoid of Ileum: an Unusual Second Primary Malignancy with Therapeutic Implications. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2015. [DOI: 10.1007/s40944-015-0019-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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18
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Ryu H, Choi YS, Song IC, Yun HJ, Jo DY, Kim S, Lee HJ. Long-term treatment of residual or recurrent low-grade endometrial stromal sarcoma with aromatase inhibitors: A report of two cases and a review of the literature. Oncol Lett 2015; 10:3310-3314. [PMID: 26722331 DOI: 10.3892/ol.2015.3674] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2014] [Accepted: 08/17/2015] [Indexed: 11/06/2022] Open
Abstract
Endometrial stromal sarcoma (ESS) occurs rarely and accounts for only 0.2% of all uterine malignancies. ESS usually expresses estrogen and progesterone receptors, and is regarded as hormone-sensitive. Due to the rarity of these tumors, there are only few case series on the use of aromatase inhibitors in the treatment of low-grade ESS. The present study reports the cases of two patients with residual or recurrent low-grade ESS who experienced long-term disease-free survival following treatment with letrozole. The study also reviews the literature with regard to the data on aromatase inhibitors used in patients with low-grade ESS. In total, 30 patients with recurrent or residual low-grade ESS who were treated with aromatase inhibitors were identified, including the present cases. Among the 30 patients, the overall response rate of advanced low-grade ESS to aromatase inhibitors was 77.4% (complete response, 25.8%; partial response, 51.6%) and the disease control rate was 90.3%. The response rate of first-line treatment was similar to that of second-line therapy or higher (84.6 vs. 72.2%; P=0.453). Duration of aromatase inhibitor treatment ranged from 1.5 to 168 months (median, 26.5 months). The aromatase inhibitors showed minimal adverse effects. In conclusion, aromatase inhibitors, particularly third-generation drugs, are a well-tolerated class of medications that are effective in the treatment of advanced low-grade ESS, with a favorable toxicity profile.
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Affiliation(s)
- Hyewon Ryu
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Yoon-Seok Choi
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Ik-Chan Song
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Hwan-Jung Yun
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Deog-Yeon Jo
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Samyong Kim
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
| | - Hyo Jin Lee
- Division of Hematology-Oncology, Department of Internal Medicine, Chungnam National University Hospital, Daejeon 301-721, Republic of Korea
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Genomic characterization of endometrial stromal sarcomas with array comparative genomic hybridization. Exp Mol Pathol 2015; 98:367-74. [PMID: 25758203 DOI: 10.1016/j.yexmp.2015.03.009] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2015] [Accepted: 03/06/2015] [Indexed: 11/22/2022]
Abstract
INTRODUCTION The endometrial stromal sarcoma (ESS) is a very rare uterine sarcoma, counting for 1-3% of all gynecologic malignancies. ESS represents 0.2-8% of all uterine malignant tumors and accounts for about 10% of all uterine sarcomas. With regard to chromosomal aberrations, very little is known about benign and malignant endometrial stromal tumors. METHODS 30 tumors, consisting of 4 cases of benign endometrial stromal nodule (ESN), 22 cases of low-grade ESS and 4 cases of undifferentiated endometrial sarcoma (UES), were analyzed by array-comparative genomic hybridization (aCGH). RESULTS ESN did not show many copy number changes (CNCs) by aCGH. Frequent losses could be identified on chromosomes 7p and 19, and gains on chromosomes 1q, 6p and 8q. Low-grade ESS presented as a very heterogeneous group. 90% (20/22) of cases displayed aberrations. Most frequent changes were losses on chromosomes 7 and 22, and gains on chromosome 1q or 11. UES showed a high number of chromosomal aberrations and on every chromosome CNCs were detected. Most frequent changes were losses on chromosomes 1q, 2q (3/4, 75%) and 13, and gains on chromosomes 1q and 17p. CONCLUSION Our data shows an increasing number of CNCs from ESN to low-grade ESS and to UES. However, the chromosomal aberrations differ considerably between the investigated ESN-, low-grade ESS- and UES cases and thus, a linear tumor progression seems to be unlikely.
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20
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Jain R, Batra S, Ahmad A, Elahi AA, Gupta M, Saith P. Low grade endometrial stromal sarcoma: a case report. IRANIAN JOURNAL OF MEDICAL SCIENCES 2015; 40:81-4. [PMID: 25648534 PMCID: PMC4300487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2013] [Revised: 06/17/2013] [Accepted: 07/21/2013] [Indexed: 11/30/2022]
Abstract
Endometrial stromal sarcoma (ESS) is a rare malignant tumor of the endometrium, occurring in the age group of 40-50 years. We report a case of low-grade ESS in a 39-year-old woman, presenting as rapid enlargement of a uterine fibroid polyp associated with irregular and excessive vaginal bleeding. Polypectomy followed by pan hysterectomy was performed. Histopathological examination and immunohistochemistry confirmed LGESS. As the tumor is rarely encountered, management protocols are still questionable. In our case, we tried a different post-surgical protocol and the patient is being closely followed up. Although rare, ESS should be considered in the differential diagnosis of all women who present with a rapid enlargement of a uterine leiomyoma.
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21
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El-Khalfaoui K, du Bois A, Heitz F, Kurzeder C, Sehouli J, Harter P. Current and future options in the management and treatment of uterine sarcoma. Ther Adv Med Oncol 2014; 6:21-8. [PMID: 24381658 DOI: 10.1177/1758834013513314] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Uterine sarcomas are rare aggressive mesenchymal tumours with limited prognosis. They encompass various histological subtypes such leiomyosarcoma, endometrial stromal sarcoma and undifferentiated sarcomas with different surgical and medical strategies. Current evidence of surgery, adjuvant and palliative therapy is reported.
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Affiliation(s)
- Khalid El-Khalfaoui
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen Mitte (KEM), Evang. Huyssens-Stiftung/Knappschaft GmbH, Henricistr. 92, 45136 Essen, Germany
| | - Andreas du Bois
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen Germany
| | - Florian Heitz
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen Germany
| | - Christian Kurzeder
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen Germany
| | - Jalid Sehouli
- Department of Gynecology, Charité Medical University of Berlin, Berlin, Germany
| | - Philipp Harter
- Department of Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen Germany
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22
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Harter P, El-Khalfaoui K, Heitz F, du Bois A. Operative and Conservative Treatment of Uterine Sarcomas. Geburtshilfe Frauenheilkd 2014; 74:267-270. [PMID: 24882876 DOI: 10.1055/s-0034-1368204] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 02/13/2014] [Accepted: 02/14/2014] [Indexed: 01/01/2023] Open
Abstract
Uterine sarcomas are rare, aggressive mesenchymal tumours with a relatively poor prognosis. The term comprises various histological subtypes, such as leiomyosarcoma, endometrial stromal sarcomas as well as undifferentiated uterine sarcomas, which require different operative and systemic/radiation therapy strategies accordingly. The evidence on operative, adjuvant and palliative treatment currently available is presented here.
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Affiliation(s)
- P Harter
- Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen
| | - K El-Khalfaoui
- Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen
| | - F Heitz
- Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen
| | - A du Bois
- Gynecology & Gynecologic Oncology, Kliniken Essen-Mitte, Essen
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23
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Yoon A, Park JY, Park JY, Lee YY, Kim TJ, Choi CH, Bae DS, Kim BG, Lee JW, Nam JH. Prognostic factors and outcomes in endometrial stromal sarcoma with the 2009 FIGO staging system: A multicenter review of 114 cases. Gynecol Oncol 2014; 132:70-5. [DOI: 10.1016/j.ygyno.2013.10.029] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Revised: 10/22/2013] [Accepted: 10/24/2013] [Indexed: 02/04/2023]
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24
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Feng W, Malpica A, Skaland I, Gudlaugsson E, Robboy SJ, Dalen I, Hua K, Zhou X, Baak JPA. Can proliferation biomarkers reliably predict recurrence in World Health Organization 2003 defined endometrial stromal sarcoma, low grade? PLoS One 2013; 8:e75899. [PMID: 24146786 PMCID: PMC3795675 DOI: 10.1371/journal.pone.0075899] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2013] [Accepted: 08/19/2013] [Indexed: 01/27/2023] Open
Abstract
An estimated 1500–3000 invasive Endometrial Stromal Sarcomas (ESS) cases annually occur worldwide. Before 2003, ESS was divided as low and high grade ESS based on mitotic activity. In 2003 the WHO changed the names, excluded mitoses and made nuclear atypia and necrosis the essential diagnostic criteria to distinguish ESS, Low Grade (ESS-LG, recurrence-free survival >90%) and Undifferentiated Endometrial Sarcoma (UES, poor prognosis). We have evaluated in WHO2003 defined ESS-LG whether proliferation biomarkers predict recurrence. Using survival analysis, the prognostic value of classical mitosis counts (Mitotic Activity Index, MAI) in haematoxyllin-eosin (H&E) sections, and immunohistochemical proliferation biomarkers (Ki-67 and PhosphoHistone-3 (PPH3)) were examined in 24 invasive endometrial stromal sarcomas. Three of 24 (12.5%) ESS-LG recurred. The MAI, PPH3 and Ki-67 were all prognostic (P = 0.001, 0.002 and 0.03). MAI values were >3 in the recurrent cases, but never exceeded 10 (the classical threshold for low and high grade). Non-recurrent cases had 0≤MAI≤3. PPH3 and Ki67 counts can be easier to perform than MAI and therefore helpful in the diagnosis of ESS, Low Grade. In conclusion, in this small study of WHO2003 defined ESS-LG, high levels of proliferation as measured by MAI, PPH3 and Ki-67 are predictive of recurrence. Larger studies are required to confirm these results.
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Affiliation(s)
- Weiwei Feng
- Department of Gynecology and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
- * E-mail: (WF); (JPAB)
| | - Anais Malpica
- Departments of Pathology and Gynecologic Oncology, The University of Texas M.D. Anderson Cancer Center, Houston, Texas, United States of America
| | - Ivar Skaland
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Einar Gudlaugsson
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
| | - Stanley J. Robboy
- Departments of Pathology and Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina, United States of America
| | - Ingvild Dalen
- Department of Research, Stavanger University Hospital, Stavanger, Norway
| | - Keqin Hua
- Department of Gynecology and Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Xianrong Zhou
- Department of Pathology, Obstetrics and Gynecology Hospital of Fudan University, Shanghai, China
| | - Jan P. A. Baak
- Department of Pathology, Stavanger University Hospital, Stavanger, Norway
- Clinical Institute, Medical-Odontologic Faculty, University of Bergen, Bergen, Norway
- * E-mail: (WF); (JPAB)
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Ramia JM, De la Plaza R, Garcia I, Perna C, Veguillas P, García-Parreño J. Liver metastasis of endometrial stromal sarcoma. World J Hepatol 2012; 4:415-8. [PMID: 23355923 PMCID: PMC3554809 DOI: 10.4254/wjh.v4.i12.415] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Revised: 11/07/2011] [Accepted: 11/14/2012] [Indexed: 02/06/2023] Open
Abstract
Resection of liver metastases from gynaecological tumours is uncommon. Endometrial stromal sarcomas (ESS) are low incidence gynecological tumours which can originate in previous sites of endometriosis or following metaplasia of the pelvic peritoneal wall, and which are exceptionally associated with liver metastasis. We present a 68-year-old woman with a ESS and metachronic liver metastasis treated by liver resection. There is very little literature on clinical management about liver metastasis from ESS, but extrapolating the data obtained with liver metastasis from sarcomas and uterine tumours, we should recommend resection as this is considered a resectable extrauterine metastasis. In cases with more sites of extrauterine disease, liver resection should also be performed if the other sites are resectable.
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Affiliation(s)
- Jose M Ramia
- Jose M Ramia, Roberto De la Plaza, Pilar Veguillas, Jorge García-Parreño, Department of Surgery, Hepatopancreatobiliary Surgical Unit, Hospital Universitario de Guadalajara, Guadalajara, 28020 Madrid, Spain
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26
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Dasari P. Endometrial Stromal Sarcoma Diagnostic Problems: Two Case Reports. J Gynecol Surg 2012. [DOI: 10.1089/gyn.2010.0109] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Papa Dasari
- Department of Obstetrics and Gynecology, JIPMER, Puducherry, India
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27
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Jassal CD, Patnaik BL, Divya A, Prasad S. Low-grade endometrial stromal sarcoma in young age: a clinicopathological report. J Obstet Gynaecol India 2012; 62:73-5. [PMID: 23372296 DOI: 10.1007/s13224-012-0137-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2007] [Accepted: 10/28/2009] [Indexed: 10/28/2022] Open
Affiliation(s)
- Chhindo Devi Jassal
- Department of Obstetrics and Gynecology, Maulana Azad Medical College, Bahadur Shah Zafar Marg, New Delhi, 110 002 India ; Department of Obstetrics and Gynecology, Saroj Hospital and Heart Institute, Madhuban Chowk, Rohini, New Delhi, 110 085 India ; A1 block, House No. 171A, Lawrence Road, Keshav Puram, Delhi, 110035 India
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Qiu LL, Yu RS, Chen Y, Zhang Q. Sarcomas of abdominal organs: computed tomography and magnetic resonance imaging findings. Semin Ultrasound CT MR 2012; 32:405-21. [PMID: 21963162 DOI: 10.1053/j.sult.2011.04.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Sarcomas originating from abdominal organs are extremely rare, and literature in which investigators focus on their imaging features is scarce. This article aims to review the computed tomography and magnetic resonance imaging features of these rare tumors and to help in clinical diagnosis. Various sarcomas (eg, angiosarcoma, undifferentiated embryonal sarcoma, leiomyosarcoma, carcinosarcoma, rhabdomyosarcoma) originating, respectively, from different abdominal visceral organs (liver, pancreas, spleen, kidney, adrenal gland, uterus, and prostate gland) are reviewed along with cases we encountered.
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Affiliation(s)
- Ling-Ling Qiu
- Department of Radiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
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Abstract
Endometrial stromal sarcomas are rare malignant tumors of the uterus, and most of the information available in literature is based on small series or case reports. A proper preoperative diagnosis is difficult and in most cases the diagnosis is confirmed after hysterectomy for a presumed benign disease. Endometrial sampling, ultrasound, and magnetic resonance imaging can provide diagnostic clues. Total hysterectomy with bilateral salpingo-oopherectomy is the main line of management and for early disease complete cure is a reality. Ovarian conservation may be possible in young women with early stage disease and the role of lymphadenectomy is controversial. Adjuvant hormone therapy in the form of progesterone, gonadotropin releasing hormone analogues, and aromatase inhibitors are found to be effective in preventing recurrences. Hormone therapy, radiotherapy and surgical excision of the metastasis are recommended for recurrences.
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Affiliation(s)
- Geetha Puliyath
- Department of Obstetrics and Gynaecology, SUT Academy of Medical Sciences, Trivandrum, Kerala, India
| | - M. Krishnan Nair
- Department of Obstetrics and Gynaecology, SUT Institute of Oncology, Pattom, Trivandrum, Kerala, India
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Nam JH. Surgical treatment of uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011; 25:751-60. [PMID: 21764388 DOI: 10.1016/j.bpobgyn.2011.05.009] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Accepted: 05/18/2011] [Indexed: 01/31/2023]
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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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Park JY, Kim DY, Kim JH, Kim YM, Kim YT, Nam JH. The impact of tumor morcellation during surgery on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma of the uterus. Ann Surg Oncol 2011; 18:3453-61. [PMID: 21541824 DOI: 10.1245/s10434-011-1751-y] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2011] [Indexed: 12/18/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate the impact of tumor morcellation on the outcomes of patients with apparently early low-grade endometrial stromal sarcoma (LGESS). METHODS Outcomes were retrospectively compared between patients with apparently early LGESS who did not (group A, n=27) or did (group B, n=23) undergo tumor morcellation. RESULTS There were no between-group differences in age, menopausal status, parity, body mass index, and preoperative presumptive diagnosis, nor were there between-group differences in tumor stage, tumor size, myometrial invasion, lymphovascular space invasion, frequency of ovarian preservation, adjuvant therapy, or follow-up time. More patients in group A underwent lymph node dissection (51.9 vs. 21.7%; P=0.029). Only 1 patient in each group had distant recurrence. There were 2 patients (7.4%) in group A and 7 (31.4%) in group B who had abdominopelvic recurrence. The risk of abdominopelvic recurrence was significantly higher in group B than in group A (odds ratio [OR], 5.47; 95% confidence interval [95% CI], 1.04-29.70; P=0.035). The 5-year disease-free survival (DFS) rates were 84% for group A and 55% for group B (P=0.028) and the 5-year abdominopelvic DFS rates were 89 and 58% (P=0.023), respectively. Multivariate analysis showed that tumor morcellation were significantly associated with poorer DFS (OR, 4.03; 95% CI, 1.06-15.30; P=0.040) and abdominopelvic DFS (OR, 5.06; 95% CI, 1.02-25.04; P=0.047). CONCLUSIONS Inadvertent tumor morcellation during surgery has an adverse impact on the outcomes of patients with early LGESS.
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Affiliation(s)
- Jeong-Yeol Park
- Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Bartosch C, Exposito MI, Lopes JM. Low-Grade Endometrial Stromal Sarcoma and Undifferentiated Endometrial Sarcoma: A Comparative Analysis Emphasizing the Importance of Distinguishing Between These Two Groups. Int J Surg Pathol 2009; 18:286-91. [DOI: 10.1177/1066896909337600] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Endometrial stromal sarcomas (ESSs) are rare tumors whose classification is still controversial. In this study, the authors studied 19 patients diagnosed with ESS at the Hospital S João, Porto, Portugal; reviewed their files and material; and performed immunohistochemical study for CD10, desmin, and smooth muscle actin markers, aiming to compare low-grade endometrial stromal sarcomas (LG-ESSs) and undifferentiated endometrial sarcomas (UESs) using the World Health Organization (WHO) classification. Twelve cases (63%) were classified as LG-ESS and 7 (37%) as UES. The median age at diagnosis was 49 years, and women with LG-ESS tended to be younger than those with UES. Most cases (7/11) had a previous echographic diagnosis of leiomyoma. A biopsy or curettage was performed in 6 cases, providing a definitive diagnosis of malignancy in 4. Frozen section was performed in 4 patients. The majority (63%) of patients were FIGO stage I. Twelve (63%) cases showed diffuse or focal expression of CD10. Desmin and smooth muscle actin expression was focal in 4 (21%) tumors. Patients with LG-ESS had a significant better overall survival than those with UES ( P = .026). Mitotic count had no prognostic significance. Our data emphasize the clinical importance of the WHO classification in ESS. It is of utmost importance to establish a proper classification to increase the consistency of data that may be useful for improving clinical and therapeutic management of patients with ESS.
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Affiliation(s)
| | - Maria Isabel Exposito
- Department of Pathology, Hospital São Joao, Department of Pathology, Medical Faculty, University of Porto
| | - José Manuel Lopes
- Department of Pathology, Hospital São Joao, , Department of Pathology, Medical Faculty, University of Porto, IPATIMUP, Institute of Molecular Pathology and Immunology, University of Porto, Porto, Portugal
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Dahhan T, Fons G, Buist MR, Ten Kate FJW, van der Velden J. The efficacy of hormonal treatment for residual or recurrent low-grade endometrial stromal sarcoma. A retrospective study. Eur J Obstet Gynecol Reprod Biol 2009; 144:80-4. [PMID: 19269732 DOI: 10.1016/j.ejogrb.2009.02.005] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2008] [Revised: 12/22/2008] [Accepted: 02/02/2009] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Low-grade endometrial stromal sarcoma (EES) is a rare tumour with a high recurrence rate but a very good prognosis. Responses to hormonal treatment of these recurrences have been published in case reports. The aim of this study was to determine the objective response rate and response duration of hormonal treatment for recurrent or residual low-grade ESS in a consecutive series of patients. STUDY DESIGN Thirteen consecutive patients with residual or recurrent disease were retrieved from the files. Eleven patients with measurable disease were treated with hormones and form the basis of this study. The following data were collected: age, date of primary diagnosis, type of primary treatment, the presence and localization of residual or recurrent disease, type of treatment, response, duration of response and survival. RESULTS After hormonal treatment 9 (82%) patients showed an objective response (4 complete response; 5 partial response), one showed stable disease (26+ months) and one progressive disease. Response duration was from 4+ to 252+ months (median 48+ months). CONCLUSION Hormonal treatment for measurable residual or recurrent low-grade ESS has a high response rate and should be considered as the treatment of choice for patients in which recurrent disease cannot easily be resected.
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Affiliation(s)
- Taghride Dahhan
- Department of Gynecologic Oncology, Academic Medical Centre, Amsterdam, The Netherlands
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Gabal S, Ashour Z, Hamada G, Aziz SA, Khairy H, Badawy H, Hamada EM, Saied K. Low-grade endometrial stromal sarcoma with intravenous extension to the heart. MEDSCAPE JOURNAL OF MEDICINE 2009; 11:23. [PMID: 19295944 PMCID: PMC2654702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Endometrial stromal sarcoma (ESS) is a rare neoplasm of uterine origin. Intracardiac metastasis from this tumor is extremely infrequent. This report describes a 24-year-old woman from Yemen who had irregular vaginal bleeding shortly after spontaneous abortion. She developed left-lower-limb swelling, diagnosed by duplex scanning and magnetic resonance imaging as deep venous thrombosis in the inferior vena cava (IVC) that extended into the iliac veins on both sides, as well as the left femoral vein and right atrium. She developed acute respiratory distress, from which she recovered after transfer to the intensive care unit. Transesophageal echocardiography showed a large mass occupying the right atrium and ventricle and another mass in the right ventricular outflow tract with areas of cavitations. The tumor appeared to come from the IVC and extended through the right atrium and right ventricle into the pulmonary artery, ending in several digit-like projections. After surgical resection of the intracardiac mass, pathologic examination revealed a low-grade ESS that was confirmed by immunohistochemistry. The patient underwent panhysterectomy and IVC debridement. Pathologic examination revealed infiltrating low-grade endometrial sarcoma invading the myometrium and left adnexa, with intravenous extension into the pelvic veins and the IVC to the right side of the heart. This case shows that despite its well-known good prognostic nature, low-grade ESS may behave as an aggressive malignancy.
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Affiliation(s)
- Samia Gabal
- Faculty of Medicine, Cairo University, Cairo, Egypt.
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Hrzenjak A, Kremser ML, Strohmeier B, Moinfar F, Zatloukal K, Denk H. SAHA induces caspase-independent, autophagic cell death of endometrial stromal sarcoma cells by influencing the mTOR pathway. J Pathol 2008; 216:495-504. [PMID: 18850582 DOI: 10.1002/path.2434] [Citation(s) in RCA: 79] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Endometrial stromal sarcomas are rare and molecular mechanisms involved in their pathogenesis are poorly understood. Covalent modifications of histone proteins, in particular de/acetylation of lysine residues, play an important role in the regulation of gene transcription in normal and neoplastic cells, but there are only limited data about these processes in solid mesenchymal tumours. We treated endometrial stromal sarcoma cells (ESS-1) and non-malignant human endometrial stromal cells (HESCs) with suberoylanilide hydroxamic acid (SAHA), a histone deacetylase inhibitor. SAHA was able to mediate the cell cycle and expression of genes related to the malignant phenotype of endometrial stromal tumours, eg p21(WAF1) and HDAC7. SAHA led to dose-dependent differentiation and death of ESS-1 cells but not of HESCs. Exposure of HESCs to SAHA resulted only in slightly decreased cell proliferation. SAHA also increased the p21(WAF1) expression and caused significant changes in the cell cycle by inhibiting the G1/S transition in ESS-1 cells. Recovery experiments indicated that these changes became irreversible when the tumour cells were treated with SAHA for longer than 24 h. In our experimental system, not apoptotic but autophagic processes were responsible for the cell death. Monodansyl cadaverine accumulation in treated ESS-1 cells and decreased expression of the mTOR and phospho-S6 ribosomal protein (S6rp) additionally supported this observation. Taken together, our study indicates that HDACs might be considered as potential drug targets in the therapy of stromal sarcomas and that SAHA might be a promising therapeutic agent for endometrial stromal sarcoma.
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Affiliation(s)
- A Hrzenjak
- Saldow Research Unit for Molecular Pathology of Gynecologic Tumors, Department of Pathology, Medical University of Graz, Graz, Austria.
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Detection of complete response to imatinib mesylate (Glivec®/Gleevec®) with 18F-FDG PET/CT for low-grade endometrial stromal sarcoma. Cancer Chemother Pharmacol 2008; 63:555-9. [DOI: 10.1007/s00280-008-0786-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 06/16/2008] [Indexed: 10/21/2022]
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