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Tang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, Qiu M. Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open 2023; 13:e077974. [PMID: 38101828 PMCID: PMC10729011 DOI: 10.1136/bmjopen-2023-077974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Accepted: 12/01/2023] [Indexed: 12/17/2023] Open
Abstract
OBJECTIVES Carcinosarcoma (CS) is a rare and biphasic malignancy characterised by a highly invasive biological nature and poor prognosis. This study explored the epidemiology, site-specific characteristics and survival outcome of CS. DESIGN We conducted a retrospective study in the Surveillance, Epidemiology and End Results (SEER) database (1975-2018) for primary CS. SETTING AND PARTICIPANTS SEER database includes publicly available information from regional and state cancer registries in the US centres. A total of 5042 CS patients were identified. We selected the top five anatomic CS (uterus, double adnexa, lung, bladder and breast) patients for further analysis. PRIMARY OUTCOME MEASURES Incidence was estimated by geographical region, age, sex, race, stage and primary site. Trends were calculated using joinpoint regression. The cancer-specific survival (CSS) rate and initial treatment were summarised. RESULTS Nearly 80% of CS occurred in the uterus and double adnexa, followed by lung, bladder and breast. The elderly and black population presented the highest age-adjusted rate of CS. The rates of distant metastasis in CS progressively increased from 1989 to 2018. Atlanta was the area with the highest incidence at 0.7 per 100 000. Pulmonary and bladder CS more frequently occurred in men and were diagnosed with regional stage. Distant metastasis was mostly found in ovary/fallopian tube CS. Radiotherapy was more commonly applied in uterine CS, while adnexa CS cases were more likely to receive chemotherapy. Multiple treatments were more used in breast CS. Pulmonary CS seemed to suffer worse CSS (median: 9.92 months), for which radiotherapy might not provide survival benefits (HR 0.60, 95% CI 0.42 to 0.86). Compared with the common histological types in each site, CS had the shortest survival. CONCLUSIONS CS has unique clinical features in each primary site. Substantial prognosis variances exist based on tumour locations. The aggressive course is the common feature in CS at all sites.
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Affiliation(s)
- Lian-Sha Tang
- West China Hospital of Sichuan University, Chengdu, China
| | - Yu-Wen Zhou
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Jia-Ling Wang
- West China Hospital of Sichuan University, Chengdu, China
| | - Guo-Xu Zhang
- West China Hospital of Sichuan University, Chengdu, China
| | - Chen-Hao Xu
- West China Hospital of Sichuan University, Chengdu, China
| | - Ji-Yan Liu
- Department of Biotherapy, West China Hospital of Sichuan University, Chengdu, China
| | - Meng Qiu
- Department of Abdominal Oncology, West China Hospital of Sichuan University, Chengdu, China
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Makk E, Bohonyi N, Oszter A, Éles K, Tornóczky T, Tóth A, Kálmán E, Kovács K. Comparative analysis of EZH2, p16 and p53 expression in uterine carcinosarcomas. Pathol Oncol Res 2023; 29:1611547. [PMID: 38146588 PMCID: PMC10749357 DOI: 10.3389/pore.2023.1611547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Accepted: 11/28/2023] [Indexed: 12/27/2023]
Abstract
Introduction: The role of p16 and p53 immunohistochemistry in the diagnosis of rare and aggressive uterine carcinosarcoma (UCS) has been well established. However, enhancer of zeste homolog 2 (EZH2), a histone methyltransferase and a member of the polycomb group family is a relatively new biomarker, with limited published data on its significance in this tumor type. The goal of this study was to examine EZH2 expression in UCS and its components, in correlation with morphological features, and p16 and p53 staining patterns. Methods: Twenty-eight UCSs were included in the study. EZH2, p16 and p53 immunoreactivity were assessed independently by two pathologists in both tumor components (epithelial and mesenchymal). EZH2 and p16 immunostains were scored semiquantitatively: based on the percentage and intensity of tumor cell staining a binary staining index ("high- or low-expressing") was calculated. The p53 staining pattern was evaluated as wild-type or aberrant (diffuse nuclear, null, or cytoplasmic expression). Statistical tests were used to evaluate the correlation between staining patterns for all three markers and the different tumor components and histotypes. Results: High EZH2 and p16 expression and aberrant p53 patterns were present in 89.3% 78.6% and 85.7% of the epithelial component and in 78.6%, 62.5% and 82.1% of the mesenchymal component, respectively. Differences among these expression rates were not found to be significant (p > 0.05). Regarding the epithelial component, aberrant p53 pattern was found to be significantly (p = 0.0474) more frequent in the serous (100%) than in endometrioid (66.6%) histotypes. Within the mesenchymal component, p53 null expression pattern occurred significantly (p = 0.0257) more frequently in heterologous sarcoma components (71.4%) compared to the homologous histotype (18.8%). Conclusion: In conclusion, EZH2, p16 and p53 seem to play a universal role in the pathogenesis of UCS; however, a distinctive pattern of p53 expression appears to exist between the serous and endometrioid carcinoma components and also between the homologous and heterologous sarcoma components.
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Affiliation(s)
- Evelin Makk
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Noémi Bohonyi
- Department of Obstretrics and Gynaecology, University of Pécs Medical School, Pécs, Hungary
| | - Angéla Oszter
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Klára Éles
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Tamás Tornóczky
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Arnold Tóth
- Department of Medical Imaging, University of Pécs Medical School, Pécs, Hungary
| | - Endre Kálmán
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
| | - Krisztina Kovács
- Department of Pathology, University of Pécs Medical School, Pécs, Hungary
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Kim SI, Kim JH, Lee C, Ha J, Jung KW, Lim MC. Incidence and survival rates of primary uterine carcinosarcoma in Korea: a National Cancer Registry study. J Gynecol Oncol 2023; 34:e9. [PMID: 36366811 DOI: 10.3802/jgo.2023.34.e9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 08/12/2022] [Accepted: 09/24/2022] [Indexed: 12/29/2022] Open
Abstract
OBJECTIVE To investigate the incidence and survival rates of primary uterine carcinosarcoma (UCS) in Korea. METHODS From the Korea Central Cancer Registry, we identified patients diagnosed with primary UCS between 1999 and 2018 and collected their information, including age at diagnosis, Surveillance, Epidemiology, and End Results (SEER) summary stage, and treatment. Age-standardized incidence rates (ASRs) and annual percent changes (APCs) were calculated. Baseline characteristics and overall survival (OS) were compared by study periods, ages, and stages at initial diagnosis. RESULTS Overall, the incidence rate of primary UCS increased markedly during the time period: ASRs, 0.02 per 100,000 in 1999 and 0.25 per 100,000 in 2018 (APC, 13.9%; p<0.001). No difference in OS was observed between patients diagnosed in 1999-2008 and those diagnosed in 2009-2018 (5-year survival rate, 46.0% vs. 48.6%; p=0.871). Considering the mean patient age at diagnosis of UCS, we divided the study population into 2 groups. Patients aged ≥60 years had a more frequent prior radiation history, received less multi-modality treatment, and showed worse OS than those aged <60 years (5-year survival rate, 42.7% vs. 53.6%; p=0.001). In multivariate analysis, both old age at diagnosis (≥60 years) and the SEER summary stage were identified as independent poor prognostic factors for OS, whereas radiation history before the diagnosis of UCS was not. CONCLUSION The incidence rate of UCS in Korea increased significantly from 1999 to 2018. Advanced stage and old age (≥60 years) at diagnosis might be poor prognostic factors for survival, but not prior radiation history.
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Affiliation(s)
- Se Ik Kim
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Hyun Kim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea
| | - Cheol Lee
- Department of Pathology, Seoul National University College of Medicine, Seoul, Korea
| | - Johyun Ha
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea.,Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kyu-Won Jung
- Korea Central Cancer Registry, National Cancer Center, Goyang, Korea.,Division of Cancer Registration and Surveillance, National Cancer Control Institute, National Cancer Center, Goyang, Korea.
| | - Myong Cheol Lim
- Center for Gynecologic Cancer, National Cancer Center, Goyang, Korea.,Department of Cancer Control and Policy, National Cancer Center Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.,Rare & Pediatric Cancer Branch and Immuno-oncology Branch, Division of Rare and Refractory Cancer, Research Institute, National Cancer Center, Goyang, Korea.
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Inter‑component immunohistochemical assessment of proliferative markers in uterine carcinosarcoma. Oncol Lett 2022; 24:363. [PMID: 36238851 PMCID: PMC9494350 DOI: 10.3892/ol.2022.13483] [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: 05/07/2022] [Accepted: 07/28/2022] [Indexed: 11/12/2022] Open
Abstract
In the scientific literature, a selected number of reports have investigated the impact of proliferative activity on the development and progression of uterine carcinosarcomas (UC). The aim of the present retrospective study was to compare the immunohistochemical proliferation markers [Ki67, proliferating cell nuclear antigen (PCNA), minichromosome maintenance complex component 3 (MCM3), and topoisomerase IIα (topoIIα)] assessment in both components of UC. A total of 30 paraffin-embedded slides of UCs, obtained from patients who underwent surgery between January 1, 2006, and December 31, 2020, were analyzed. Medical records and clinicopathological data of patients were reviewed. Formalin-fixed, paraffin-embedded tissue sections were immunostained with monoclonal antibodies against Ki67, PCNA, MCM3 and topoIIα. Ki67-positive nuclear immunoreactivity was reported in 20 (67%) and 16 (53%) UC carcinomatous and sarcomatous components, respectively. In the epithelial component, Ki67 positive staining was related to the International Federation of Gynecology and Obstetrics (FIGO) stage (P=0.025), and histological grade (G1 vs. G2/G3, P=0.031). Nuclear PCNA reactivity was observed in 18 (60%) and 16 (53%) carcinomatous and sarcomatous components, respectively. Notably, all four cases with omental metastases were PCNA-positive, and a relationship between staining pattern and the existence of metastases was of significant value (P=0.018). MCM3-positive nuclear staining was found nearly twice as high in the carcinomatous (n=19; 63%), compared with the sarcomatous (n=11; 37%) component, respectively, and MCM3 expression in the epithelial component was related to clinical stage (P=0.030), and the existence of omental metastasis (P=0.012). In addition, out of the 30 UCs, 17 (57%) and 13 (43%) showed topoIIα positivity in the carcinomatous and sarcomatous UC components, respectively. A significant relationship between protein immunoreactivity and FIGO stage (P=0.049), and omental metastasis (P=0.026) was revealed to exist. However, no significant differences between expression of proliferation markers and clinicopathological features in the sarcomatous UC component were identified. Finally, a significant correlation between each protein immunohistochemical staining was demonstrated, particularly in the sarcomatous UC component. Collectively, a combined analysis of Ki67, PCNA, MCM3, and topoIIα may provide more detailed information of cell-cycle alterations determining the heterogeneity of uterine carcinosarcomas.
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Khoiwal K, Zaman R, Gill P, Joshi P, Gaurav A, Chaturvedi J. Acute non-puerperal uterine inversion ascribed to malignant mixed Mullerian tumor of uterus: a rare presentation. Women Health 2022; 62:439-443. [DOI: 10.1080/03630242.2022.2084213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Kavita Khoiwal
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
| | - Rabia Zaman
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
| | - Poonam Gill
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
| | - Prashant Joshi
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
| | - Amrita Gaurav
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
| | - Jaya Chaturvedi
- Department of Obs &Gynae, All India Institute of Medical Sciences, Rishikesh, India
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Qureshi S, Patel NA, Patel N, Ghassibi MP, Tse DT, Dubovy SR. Metastatic Uterine Carcinosarcoma to the Orbit. Ophthalmic Plast Reconstr Surg 2021; 37:e198-e202. [PMID: 34284421 PMCID: PMC8597944 DOI: 10.1097/iop.0000000000002006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Metastases of solid tumors to the eye and ocular adnexa are rare. Herein, the authors describe the clinical, histologic, and immunohistochemical findings of a patient with a history of adenocarcinoma of the colon and a uterine carcinosarcoma (malignant mixed Müllerian tumor) who presented with proptosis and decreased vision. Positive staining with PAX-8, p16 and negative reaction for CK20 and CDX2 helped to establish the uterine origin of the metastasis. This rare case demonstrates the utility of immunohistochemical probes, especially in patients with a complex oncological history, where multiple primary sources of the metastasis are in the differential diagnosis.
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Affiliation(s)
| | - Nimesh A. Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL 33136
| | - Nish Patel
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL 33136
| | - Mark P. Ghassibi
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL 33136
| | - David T. Tse
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL 33136
| | - Sander R. Dubovy
- Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, FL 33136
- Florida Lions Ocular Pathology Laboratory, Miami, FL, 33136
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7
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Castro L, Liu J, Yu L, Burwell AD, Saddler TO, Santiago LA, Xue W, Foley JF, Staup M, Flagler ND, Shi M, Birnbaum LS, Darlene D. Differential Receptor Tyrosine Kinase Phosphorylation in the Uterus of Rats Following Developmental Exposure to Tetrabromobisphenol A. TOXICOLOGY RESEARCH AND APPLICATION 2021; 5. [PMID: 35071781 DOI: 10.1177/23978473211047164] [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: 11/16/2022] Open
Abstract
Tetrabromobisphenol A (TBBPA) is a brominated flame retardant that induces endometrial adenocarcinoma and other uterine tumors in Wistar Han rats; however, early molecular events or biomarkers of TBBPA exposure remain unknown. We investigated the effects of TBBPA on growth factor receptor activation (phospho-RTK) in uteri of rats following early-life exposures. Pregnant Wistar Han rats were exposed to TBBPA (0, 0.1, 25, 250 mg/kg/day) via oral gavage on gestation day 6 through weaning of pups (PND 21). Pups were exposed in utero, through lactation, and by daily gavage from PND 22 to PND 90. Uterine horns were collected (at PND 21, PND 33, PND 90) and formalin-fixed or frozen for histologic, immunohistochemical, phospho-RTK arrays, or western blot analysis. At PND 21, the phosphor-RTKs, FGFR2, FGFR3, TRKC and EPHA1 were significantly increased at different treatment concentrations. Several phospho-RTKs were also significantly overexpressed at PND 33 which included epithelial growth factor receptor (EGFR), Fibroblast Growth Factor Receptor 3-4 (FGFR2, FGFR3, FGFR4), insulin-like growth factor receptor 1 (IGF1R), INSR, AXL, MERTK, PDGFRa and b, RET, Tyrosine Kinase with Immunoglobulin Like and EGF Like Domains 1 and 2 (TIE1; TIE2), TRKA, VEGFR2 and 3, and EPHA1 at different dose treatments. EGFR, an RTK overexpressed in endometrial cancer in women, remained significantly increased for all treatment groups at PND 90. Erb-B2 Receptor Tyrosine Kinase 2 (ERBB2) and IGF1R were overexpressed at PND 33 and remained increased through PND 90, although ERBB2 was statistically significant at PND 90. The phospho-RTKs, FGFR3, AXL, DTK, HGFR, TRKC, VEGFR1 and EPHB2 and 4 were also statistically significant at PND 90 at different dose treatments. The downstream effector, phospho-MAPK44/42 was also increased in uteri of treated rats. Our findings show RTKs are dysregulated following early life TBBPA exposures and their sustained activation may contribute to TBBPA-induced uterine tumors observed in rats later in life.
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Affiliation(s)
- Lysandra Castro
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Jingli Liu
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Linda Yu
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Alanna D Burwell
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Trey O Saddler
- Office of Data Science, DNTP, NIEHS, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Lindsay A Santiago
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - William Xue
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Julie F Foley
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Michael Staup
- Charles River Laboratories, Inc., Durham, NC 27703, USA
| | - Norris D Flagler
- Cellular and Molecular Pathogenesis Branch, DNTP, NIEHS, 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Min Shi
- Biostatistics and Computational Biology Branch, Division of the Intramural Program, National Institute of Environmental Health Sciences (NIEHS), Research Triangle Park, NC 27709, USA
| | - Linda S Birnbaum
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
| | - Dixon Darlene
- Mechanistic Toxicology Branch, Division of the National Toxicology Program (DNTP), National Institute of Environmental Health Sciences (NIEHS), 111 TW Alexander Drive, Research Triangle Park, NC 27709, USA
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Rezaieseresht H, Shobeiri SS, Kaskani A. Chenopodium Botrys Essential Oil as A Source of Sesquiterpenes to Induce Apoptosis and G1 Cell Cycle Arrest in Cervical Cancer Cells. IRANIAN JOURNAL OF PHARMACEUTICAL RESEARCH : IJPR 2020; 19:341-351. [PMID: 33224241 PMCID: PMC7667537 DOI: 10.22037/ijpr.2019.1100671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Conducting cell apoptosis pathways is a novel strategy in cancer treatment. This study aimed to explain that C. botrys essential oil could induce apoptosis and arrest the cell cycle in HeLa cells. Cytotoxic and apoptogenic effects of the essential oil of Jerusalem-oak (Chenopodium botrys L.), which was obtained from the aerial parts of the plant, were evaluated in HeLa cells. Cell viability was assessed by MTT and LDH assays, and the mechanism of cell apoptosis was investigated using flow cytometry. Expression of the apoptosis-related genes was assessed using real-time polymerase chain reaction (PCR). GC-MS analysis of the herbal essential oil revealed 37 components. The major components were α-Eudesmol (16.81%), Elemol acetate (13.2%), Elemol (9.0%), and α-Chenopodiol-6-acetate (7.9%). The essential oil inhibited the growth of HeLa cells and increased the expression of p21 and p53. In addition, essential oil treatment increased the sub-G1 DNA content and induced apoptosis due to the increased Bax/Bcl-2 ratio and up-regulation of caspase-3 gene expression. According to the results, C. botrys essential oil exhibited anticancer effects through intrinsic apoptosis pathways and arresting cell proliferation.
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Affiliation(s)
- Hasan Rezaieseresht
- Traditional and Complementary Medicine Research Center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
| | - Saeideh Sadat Shobeiri
- Cellular and Molecular Research center, Sabzevar University of Medical Sciences, Sabzevar, Iran.
- Immunology Research Center, Bu-Ali Research Institute, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Arezou Kaskani
- Department of Chemistry, Sabzevar Branch, Islamic Azad University, Sabzevar, Iran.
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Immunohistochemical Markers With Potential Diagnostic, Prognostic, and Therapeutic Significance in Uterine Carcinosarcoma: A Clinicopathologic Study of 43 Cases. Int J Gynecol Pathol 2019; 40:84-93. [PMID: 31855950 DOI: 10.1097/pgp.0000000000000662] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Uterine carcinosarcomas (UCS) are rare and highly aggressive tumors. Although it is currently accepted that the majority of UCS are metaplastic carcinomas, their aggressive behavior is unparalleled to that of any other high-grade endometrial neoplasms. Therefore, the search for the distinct immunohistochemical and molecular features that could help in the development of new treatment strategies continues. We evaluated the expression of PDL-1, growth hormone releasing hormone receptor, p53, WT1, PAX-8, estrogen receptor, HNF-1, and mismatch repair proteins in 43 UCS. Tumors were selected from the archives of the Magee-Womens Hospital University of Pittsburgh Medical Center Department of Pathology. Seventeen were stage I, 4 were stage II, 15 were stage III, and 7 were stage IV. The median age was 67 yr and median overall survival was 3.2 yr. Immunostaining for PAX8, HNF-1, and estrogen receptor showed statistically significant difference between epithelial and stromal components. Expression of p53 was significantly associated with clinical high stage, but other markers did not correlate with stage or survival. Immunostaining for programmed death ligand-1 was strongly positive in 30 UCS (70%), including 24 cases with tumor cell positivity, 12 cases with tumor cell and tumor-infiltrating immune cell positivity, and 6 cases with tumor-infiltrating immune cell positivity only. Of 27 tumors tested for mismatch repair expression, 12 (44%) showed loss of expression, 7 of which were PDL-1 positive. Growth hormone releasing hormone receptor was positive in 38 tumors (88%) and predominantly expressed in the epithelial component. The range of positivity for programmed death ligand-1 and growth hormone releasing hormone receptor suggests a possible potential adjuvant treatment that may be considered for UCS.
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Histologic Appearance and Immunohistochemistry of DNA Mismatch Repair Protein and p53 in Endometrial Carcinosarcoma. Am J Surg Pathol 2019; 43:1493-1500. [DOI: 10.1097/pas.0000000000001353] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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11
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Leskela S, Pérez-Mies B, Rosa-Rosa JM, Cristobal E, Biscuola M, Palacios-Berraquero ML, Ong S, Matias-Guiu Guia X, Palacios J. Molecular Basis of Tumor Heterogeneity in Endometrial Carcinosarcoma. Cancers (Basel) 2019; 11:cancers11070964. [PMID: 31324031 PMCID: PMC6678708 DOI: 10.3390/cancers11070964] [Citation(s) in RCA: 48] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 06/28/2019] [Accepted: 07/02/2019] [Indexed: 02/08/2023] Open
Abstract
Endometrial carcinosarcoma (ECS) represents one of the most extreme examples of tumor heterogeneity among human cancers. ECS is a clinically aggressive, high-grade, metaplastic carcinoma. At the morphological level, intratumor heterogeneity in ECS is due to an admixture of epithelial (carcinoma) and mesenchymal (sarcoma) components that can include heterologous tissues, such as skeletal muscle, cartilage, or bone. Most ECSs belong to the copy-number high serous-like molecular subtype of endometrial carcinoma, characterized by the TP53 mutation and the frequently accompanied by a large number of gene copy-number alterations, including the amplification of important oncogenes, such as CCNE1 and c-MYC. However, a proportion of cases (20%) probably represent the progression of tumors initially belonging to the copy-number low endometrioid-like molecular subtype (characterized by mutations in genes such as PTEN, PI3KCA, or ARID1A), after the acquisition of the TP53 mutations. Only a few ECS belong to the microsatellite-unstable hypermutated molecular type and the POLE-mutated, ultramutated molecular type. A common characteristic of all ECSs is the modulation of genes involved in the epithelial to mesenchymal process. Thus, the acquisition of a mesenchymal phenotype is associated with a switch from E- to N-cadherin, the up-regulation of transcriptional repressors of E-cadherin, such as Snail Family Transcriptional Repressor 1 and 2 (SNAI1 and SNAI2), Zinc Finger E-Box Binding Homeobox 1 and 2 (ZEB1 and ZEB2), and the down-regulation, among others, of members of the miR-200 family involved in the maintenance of an epithelial phenotype. Subsequent differentiation to different types of mesenchymal tissues increases tumor heterogeneity and probably modulates clinical behavior and therapy response.
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Affiliation(s)
- Susanna Leskela
- Department of Pathology, Institute Ramón y Cajal for Health Research, 28034 Madrid, Spain.
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain.
| | - Belen Pérez-Mies
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Pathology, Hospital Ramón y Cajal, 28034 Madrid, Spain
| | - Juan Manuel Rosa-Rosa
- Department of Pathology, Institute Ramón y Cajal for Health Research, 28034 Madrid, Spain
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
| | - Eva Cristobal
- Department of Pathology, Institute Ramón y Cajal for Health Research, 28034 Madrid, Spain
| | - Michele Biscuola
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Pathology, Instituto de Biomedicina de Sevilla (IBiS), 41013 Seville, Spain
- Hospital Universitario Virgen del Rocío/CSIC/Universidad de Sevilla, 41013 Seville, Spain
| | | | - SuFey Ong
- NanoString Technologies, Inc, Seattle, WA 98109, USA
| | - Xavier Matias-Guiu Guia
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain
- Department of Pathology, Hospital U Arnau de Vilanova, 25198 Lleida, Spain
- Department of Pathology, Hospital U de Bellvitge, L'Hospitalet de Llobregat, 08907 Barcelona, Spain
- IRBLLEIDA, IDIBELL, University of Lleida, 25003 Lleida, Spain
| | - José Palacios
- Department of Pathology, Institute Ramón y Cajal for Health Research, 28034 Madrid, Spain.
- CIBER-ONC, Instituto de Salud Carlos III, 28029 Madrid, Spain.
- Faculty of Medicine, University of Alcalá de Henares, Alcalá de Henares, 28801 Madrid, Spain.
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Abstract
RATIONALE Malignant mixed Müllerian tumor (MMMT) of extragenital organs is rare, especially in male. To our knowledge, this is the first reported case of primary MMMT at the mediastinum in male. PATIENT CONCERNS A 54-year-old male was admitted to the hospital due to repeated stimulating dry cough for 2 years. His systemic examination was unremarkable. Laboratory workup revealed that all blood indicators were within normal limits. But subsequent computerized tomography (CT) scans of chest showed an abnormal soft tissue density in the area of its left, measuring approximately 4 cm in anterior-posterior dimension and 7 cm in maximum transverse dimension. DIAGNOSES AND INTERVENTIONS The pathogenesis of these tumors remains controversial. The diagnosis is combined with biopsy and immunohistochemical staining. So, the patient underwent radical surgical resection and pathologic examination of the excised specimen was consistent with the diagnosis of MMMT. After surgery, he was treated by sequential chemoradiotherapy. OUTCOMES The patient died from tumor recurrence 16 months later. LESSONS MMMT is a rare, highly aggressive tumor associated with interesting embryological origin, a definite diagnosis of which is only confirmed on pathological assessment. Due to its high degree of malignancy and high rate of recurrence, complete macroscopic excision of the tumor is recommended as soon as possible.
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Affiliation(s)
| | - Riqiang Liu
- Departments of Hepatobiliary and Endocrine Surgery, the People's Hospital of Guangxi Zhuang Autonomous Region
| | | | - Haiming Wei
- Departments of Pathology, the People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, China
| | - Lei Yu
- Departments of Intervention
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Zhu Y, Gong Y, Li A, Chen M, Kang D, Liu J, Yuan Y. Differential Proteomic Analysis Reveals Protein Networks and Pathways that May Contribute to Helicobacter pylori FKBP-Type PPIase-Associated Gastric Diseases. Proteomics Clin Appl 2017; 12:e1700127. [PMID: 29148176 DOI: 10.1002/prca.201700127] [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: 09/02/2017] [Revised: 10/21/2017] [Indexed: 12/18/2022]
Abstract
PURPOSE Though Helicobacter pylori (H. pylori) has been classified as class I carcinogen, key virulence factor generated by H. pylori that causes gastric cancer remains to be fully determined. Recently, we identified a gastric cancer-associated H. pylori gene, peptidylprolyl isomerase-FK506 binding protein (PPIase-FKBP), and showed that PPIase-FKBP was capable of inducing oncogenic transformation of gastric epithelial cells. But its mechanism was unclear. EXPERIMENTAL DESIGN We carried out a comparative proteomic analysis of human gastric epithelial cells that either express PPIase-FKBP or green fluorescent protein using 2-DE and then MALDI-TOF-MS/MS. RESULTS Our results identified 28 differentially expressed proteins induced by PPIase-FKBP. These proteins participate in some cellular biological processes, such as cell proliferation, cell apoptosis and DNA replication, mRNA splicing, and protein biosynthesis. Ingenuity Pathway Analysis categorized the 28 proteins into two molecular interaction networks, involved primarily in cancer and gastrointestinal diseases. CONCLUSIONS AND CLINICAL RELEVANCE Our results provided insight on the protein interaction networks and signaling pathways that may contribute to PPIase-FKBP-associated gastric diseases and may lead to a better understanding of the mechanisms indicating the oncogenic effects of H. pylori PPIase-FKBP.
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Affiliation(s)
- Yanmei Zhu
- Department of Pathology, Cancer Hospital of China Medical University, Liaoning Cancer Hospital and Institute, Shenyang, China.,Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China.,West Virginia University Cancer Institute, West Virginia University, Morgantown, WV, USA
| | - Yuehua Gong
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China
| | - Aodi Li
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China
| | - Moye Chen
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China
| | - Dan Kang
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China
| | - Jun Liu
- West Virginia University Cancer Institute, West Virginia University, Morgantown, WV, USA
| | - Yuan Yuan
- Tumor Etiology and Screening Department of Cancer Institute and General Surgery, The First Affiliated Hospital of China Medical University, Key Laboratory of Cancer Etiology and Prevention, Liaoning Provincial Education Department, China Medical University, Shenyang, China
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14
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Almond LM, Warfield AT, Desai A, Gourevitch D, Ford SJ. Biphasic malignant tumours of the abdominal cavity. Int J Clin Oncol 2017; 22:635-640. [PMID: 28656498 DOI: 10.1007/s10147-017-1153-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2017] [Accepted: 06/12/2017] [Indexed: 01/04/2023]
Abstract
Carcinosarcomas (CS) are uncommon, highly aggressive, biphasic tumours consisting of both sarcomatous and carcinomatous elements. They appear to originate from a common cell of origin, either via transformation from a single premature precursor or conversion of a mature epithelial cell through an epithelial-mesenchymal transition. CS should be considered a unique cancer subtype with cells typically displaying diffuse mitotic activity and widespread atypical mitoses predisposing to early metastasis and a tendency to local recurrence following resection. This review addresses the pathophysiology of CS and discusses its presentation, natural history and management at a variety of sites within the abdominal cavity and retroperitoneum.
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Affiliation(s)
- L Max Almond
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK.
| | - Adrian T Warfield
- Department of Cellular Pathology, University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Anant Desai
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - David Gourevitch
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
| | - Samuel J Ford
- Midlands Abdominal and Retroperitoneal Sarcoma Unit (MARSU), University Hospitals Birmingham NHS Foundation Trust, Mindelsohn Way, Birmingham, B15 2TH, UK
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15
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Loss of CDKN2A Promoter Methylation Coincides With the Epigenetic Transdifferentiation of Uterine Myosarcomatous Cells. Int J Gynecol Pathol 2016; 35:309-15. [DOI: 10.1097/pgp.0000000000000181] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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16
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Sanders JM, Coulter SJ, Knudsen GA, Dunnick JK, Kissling GE, Birnbaum LS. Disruption of estrogen homeostasis as a mechanism for uterine toxicity in Wistar Han rats treated with tetrabromobisphenol A. Toxicol Appl Pharmacol 2016; 298:31-9. [PMID: 26988606 DOI: 10.1016/j.taap.2016.03.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2015] [Revised: 03/10/2016] [Accepted: 03/12/2016] [Indexed: 01/01/2023]
Abstract
Chronic oral treatment of tetrabromobisphenol A (TBBPA) to female Wistar Han rats resulted in increased incidence of cell proliferation at 250mg/kg and tumor formation in the uterus at higher doses. The present study was designed to test the hypothesis that disruption of estrogen homeostasis was a major mode-of-action for the observed effects. Biological changes were assessed in serum, liver, and the proximal (nearest the cervix) and distal (nearest the ovaries) sections of the uterine horn of Wistar Han rats 24h following administration of the last of five daily oral doses of 250mg/kg. Expression of genes associated with receptors, biosynthesis, and metabolism of estrogen was altered in the liver and uterus. TBBPA treatment also resulted in changes in expression of genes associated with cell division and growth. Changes were also observed in the concentration of thyroxine in serum and in expression of genes in the liver and uterus associated with thyroid hormone receptors. Differential expression of some genes was tissue-dependent or specific to tissue location in the uterus. The biological responses observed in the present study support the hypothesis that perturbation of estrogen homeostasis is a major mode-of-action for TBBPA-mediated cell proliferation and tumorigenesis previously observed in the uterus of TBBPA-treated Wistar Han rats.
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Affiliation(s)
- J Michael Sanders
- Laboratory of Toxicology and Toxicokinetics, National Cancer Institute at the National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States.
| | - Sherry J Coulter
- Laboratory of Toxicology and Toxicokinetics, National Cancer Institute at the National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States
| | - Gabriel A Knudsen
- Laboratory of Toxicology and Toxicokinetics, National Cancer Institute at the National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States
| | - June K Dunnick
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States
| | - Grace E Kissling
- National Toxicology Program, National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States
| | - Linda S Birnbaum
- Laboratory of Toxicology and Toxicokinetics, National Cancer Institute at the National Institute of Environmental Health Sciences, Research Triangle Park, NC 27709, United States
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17
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Williamson JML, Stevens M, Mahon D. Metachronous small bowel metastasis from a mixed Müllerian mesodermal tumour. Ann R Coll Surg Engl 2016; 98:e26-8. [PMID: 26741677 DOI: 10.1308/rcsann.2016.0032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
A mixed Müllerian mesodermal tumour (MMMT) is a rare aggressive carcinosarcoma. Metastatic progression is uncommon, and occurs via haematological, lymphatic and intraperitoneal spread. Although the latter is seen most frequently, the small intestine seems to be relatively preserved from disease progression with only one reported case of synchronous involvement. We report a case of metachronous MMMT involvement of the small bowel presenting with subacute obstruction that was successfully resected at operation.
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Affiliation(s)
| | - M Stevens
- Taunton and Somerset NHS Foundation Trust , UK
| | - D Mahon
- Taunton and Somerset NHS Foundation Trust , UK
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18
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Dunnick JK, Sanders JM, Kissling GE, Johnson CL, Boyle MH, Elmore SA. Environmental chemical exposure may contribute to uterine cancer development: studies with tetrabromobisphenol A. Toxicol Pathol 2015; 43:464-73. [PMID: 25476797 PMCID: PMC6706771 DOI: 10.1177/0192623314557335] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Tetrabromobisphenol A (TBBPA), a widely used flame retardant, caused uterine tumors in rats. In this study, TBBPA was administered to male and female Wistar Han rats and B6C3F1/N mice by oral gavage in corn oil for 2 years at doses up to 1,000 mg/kg. TBBPA induced uterine epithelial tumors including adenomas, adenocarcinomas, and malignant mixed Müllerian tumors (MMMTs). In addition, endometrial epithelial atypical hyperplasia occurred in TBBPA-treated rats. Also found to be related to TBBPA treatment, but at lower incidence and at a lower statistical significance, were testicular tumors in rats, and hepatic tumors, hemangiosarcomas (all organs), and intestinal tumors in male mice. It is hypothesized that the TBBPA uterine tumor carcinogenic mechanisms involve altered estrogen levels and/or oxidative damage. TBBPA treatment may affect hydroxysteroid-dehydrogenase-17β (HSD17β) and/or sulfotransferases, enzymes involved in estrogen homeostasis. Metabolism of TBBPA may also result in the formation of free radicals. The finding of TBBPA-mediated uterine cancer in rats is of concern because TBBPA exposure is widespread and endometrial tumors are a common malignancy in women. Further work is needed to understand TBBPA cancer mechanisms.
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Affiliation(s)
- J K Dunnick
- National Institute of Environmental Health Sciences, National Toxicology Program, Research Triangle Park, North Carolina, USA
| | - J M Sanders
- National Cancer Institute, National Institutes of Health, Research Triangle Park, North Carolina, USA
| | - G E Kissling
- National Institute of Environmental Health Sciences, National Toxicology Program, Research Triangle Park, North Carolina, USA
| | - C L Johnson
- Charles River Laboratories, Pathology Associates, Research Triangle Park, North Carolina, USA
| | - M H Boyle
- Integrated Laboratory Systems, Research Triangle Park, North Carolina, USA
| | - S A Elmore
- National Institute of Environmental Health Sciences, National Toxicology Program, Research Triangle Park, North Carolina, USA
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19
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Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol 2015; 137:581-8. [PMID: 25805398 DOI: 10.1016/j.ygyno.2015.03.041] [Citation(s) in RCA: 153] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Accepted: 03/16/2015] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Uterine carcinosarcomas (UCSs) are aggressive tumors previously considered to be sarcomas, but now recognized as malignancies composed of metaplastic transformation of epithelial elements. Much of the management for UCS has been extrapolated from studies of endometrial carcinomas and sarcomas. This article critically reviews the literature pertinent to the pathology, pathogenesis, diagnosis and management of women with UCS. METHODS MEDLINE was searched for English language literature on UCS with a focus on the past 20years. Given the rarity of this tumor, studies were not limited by design or number of reported patients. RESULTS UCS is biologically a de-differentiated endometrial carcinoma with its own pathogenesis and molecular profile. It commonly presents with extrauterine disease which can be identified by comprehensive surgical staging. Most UCS patients are candidates for adjuvant chemotherapy. The role of radiation is less clear. Combination therapy, while commonly used, has not been studied in depth. The high recurrence rate and poor overall survival for UCS suggest an ongoing need for clinical trials for UCS specifically. CONCLUSIONS UCS represents a distinct subtype of uterine malignancy, and should be studied as such via focused clinical trials.
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Affiliation(s)
- Leigh A Cantrell
- University of Virginia, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Charlottesville, VA 22908, United States
| | - Stephanie V Blank
- New York University Langone Medical Center, New York, NY 10016, United States
| | - Linda R Duska
- University of Virginia, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Charlottesville, VA 22908, United States.
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Semczuk A, Ignatov A, Obrzut B, Reventos J, Rechberger T. Role of p53 Pathway Alterations in Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumors). Oncology 2014; 87:193-204. [DOI: 10.1159/000363574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/07/2014] [Indexed: 01/10/2023]
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21
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BAŁON BEATA, KAZNOWSKA EWA, IGNATOV ATANAS, STEĆ ANNA, SEMCZUK-SIKORA ANNA, SCHNEIDER-STOCK REGINE, JÓŹWIK MACIEJ, SULKOWSKI STANISŁAW, CYBULSKI MAREK, SZUMIŁO JUSTYNA, SEMCZUK ANDRZEJ. p53 is not related to Ki-67 immunostaining in the epithelial and mesenchymal components of female genital tract carcinosarcomas. Oncol Rep 2013; 30:1661-8. [DOI: 10.3892/or.2013.2615] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Accepted: 06/03/2013] [Indexed: 12/21/2022] Open
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22
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Cyclin D1 as a diagnostic immunomarker for endometrial stromal sarcoma with YWHAE-FAM22 rearrangement. Am J Surg Pathol 2012; 36:1562-70. [PMID: 22982899 DOI: 10.1097/pas.0b013e31825fa931] [Citation(s) in RCA: 125] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Endometrial stromal sarcoma (ESS) characterized by YWHAE-FAM22 genetic fusion is histologically higher grade and clinically more aggressive than ESS with JAZF1-SUZ12 or equivalent genetic rearrangements, hence it is clinically important to recognize this subset of ESS. To identify diagnostic immunomarkers for this biologically defined ESS subset, we compared gene expression profiles between YWHAE-FAM22 ESS and JAZF1-rearranged ESS. These studies showed consistent upregulation of cyclin D1 in YWHAE-FAM22 ESS compared with JAZF1-SUZ12 ESS. Immunohistochemically, the high-grade round cell component of all 12 YWHAE-FAM22 ESS demonstrated diffuse (≥70%) moderate to strong nuclear cyclin D1 staining, and this diffuse positivity was not seen in 34 ESSs with JAZF1 and equivalent genetic rearrangements or in 21 low-grade ESS with no demonstrable genetic rearrangements. In a series of 243 non-ESS pure uterine mesenchymal and mixed epithelial-mesenchymal tumors, only 2 of 8 undifferentiated endometrial sarcomas with nuclear uniformity and 1 of 80 uterine leiomyosarcomas demonstrate diffuse cyclin D1 immunoreactivity. Both cyclin D1-positive undifferentiated endometrial sarcomas showed diffuse strong CD10 staining, which is consistently absent in the high-grade round cell component of YWHAE-FAM22 ESS. The low-grade spindle cell component of YWHAE-FAM22 ESS showed a spatially heterogenous cyclin D1 staining pattern that was weaker and less diffuse overall. Our findings indicate that cyclin D1 is a sensitive and specific diagnostic immunomarker for YWHAE-FAM22 ESS. When evaluating high-grade uterine sarcomas, cyclin D1 can be included in the immunohistochemical panel as an indicator of YWHAE-FAM22 ESS.
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23
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Voutsadakis IA. Epithelial to mesenchymal transition in the pathogenesis of uterine malignant mixed Müllerian tumours: the role of ubiquitin proteasome system and therapeutic opportunities. Clin Transl Oncol 2012; 14:243-53. [PMID: 22484631 DOI: 10.1007/s12094-012-0792-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Malignant mixed Müllerian tumours (malignant mixed mesodermal tumours, MMMT) of the uterus are metaplastic carcinomas with a sarcomatous component and thus they are also called carcinosarcomas. It has now been accepted that the sarcomatous component is derived from epithelial elements that have undergone metaplasia. The process that produces this metaplasia is epithelial to mesenchymal transition (EMT), which has recently been described as a neoplasia-associated programme shared with embryonic development and enabling neoplastic cells to move and metastasise. The ubiquitin proteasome system (UPS) regulates the turnover and functions of hundreds of cellular proteins. It plays important roles in EMT by being involved in the regulation of several pathways participating in the execution of this metastasis-associated programme. In this review the specifi c role of UPS in EMT of MMMT is discussed and therapeutic opportunities from UPS manipulations are proposed.
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Affiliation(s)
- I A Voutsadakis
- Centre Pluridisciplinaire d'Oncologie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
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Uterine carcinosarcomas (malignant mixed müllerian tumours): a review with special emphasis on the controversies in management. Obstet Gynecol Int 2011; 2011:470795. [PMID: 22007228 PMCID: PMC3189599 DOI: 10.1155/2011/470795] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2011] [Accepted: 08/02/2011] [Indexed: 11/17/2022] Open
Abstract
Uterine carcinosarcomas (MMMT-malignant mixed Müllerian tumours) are highly aggressive, rare, biphasic tumours composed of epithelial and mesenchymal elements believed to arise from a monoclonal origin. While hysterectomy with bilateral salpingo-oophorectomy remains the mainstay treatment, high rates of recurrence and metastases suggest a need for lymphadenectomy and postoperative adjuvant treatment. There are no established consensus guidelines for therapeutic patient management. Though well recognized that it improves locoregional control, the role of radiation in improving overall survival outcomes remains undecided. Although various combinations of chemotherapy have been explored, an optimal therapeutic modality is yet to be determined. As overall survival rates have not improved in thirty years, it is suggested that targeted chemotherapy and/or a multimodality approach may yield better outcomes. This paper provides a summary of the aetiopathogenesis of carcinosarcomas (MMMT) limited to the uterus with special emphasis on the controversies in the management of these patients.
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