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Jin X, Zhu P, Fan S, Dai J. Magnetic resonance imaging for the diagnosis of malignant mixed Mullerian tumor of ovary: Two case reports. Medicine (Baltimore) 2023; 102:e36569. [PMID: 38115369 PMCID: PMC10727683 DOI: 10.1097/md.0000000000036569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 11/15/2023] [Accepted: 11/20/2023] [Indexed: 12/21/2023] Open
Abstract
RATIONALE Malignant mixed Mullerian tumor (MMMT) is also known as carcinosarcoma, mostly occurring in the uterus, and occurred in ovary is very rare. The disease is highly aggressive. Two cases of MMMT of ovary and their imaging characteristics were collected in our study. PATIENT CONCERNS A 77-year-old and an 80-year-old woman were admitted to the obstetrics and gynecology department of our hospital on June 22, 2019, and December 10, 2019, respectively. The first patient presented with abdominal distension with poor appetite without obvious triggers. Another patient had been menopausal for 18 years and presented with vaginal bleeding with dull pain in the left lower abdomen without obvious cause. DIAGNOSES Both patients underwent pelvic magnetic resonance imaging plain and enhanced scan after admission, which indicated pelvic mass. Postoperative pathology confirmed MMMT in the adnexal region. INTERVENTIONS Both patients underwent total hysterectomy and bilateral adnexectomy. OUTCOMES Postoperatively, the first patient developed complications such as renal failure and gastrointestinal bleeding and was sometimes unconscious. Symptomatic treatment was not effective, and the patient died about 1 month after discharge. The other patient recovered well after surgery, and imaging examinations confirmed no evidence of regrowth of the tumor during an average 36-month follow-up. LESSONS The disease is highly malignant and progresses rapidly. The elevation of CA125 should be taken seriously. The imaging findings of MMMT has certain characteristics. Multi-sequence magnetic resonance imaging may help to distinguish this disease from other pelvic tumors. Once found, surgical treatment is needed as soon as possible, followed by postoperative adjuvant radiotherapy and chemotherapy.
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Affiliation(s)
- Xiaofeng Jin
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hang Zhou, Zhejiang, China
| | - Ping Zhu
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hang Zhou, Zhejiang, China
| | - Shufeng Fan
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hang Zhou, Zhejiang, China
| | - Jingru Dai
- Department of Radiology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hang Zhou, Zhejiang, China
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Garza A, Elsherif SB, Faria SC, Sagebiel T, Sun J, Ma J, Bhosale PR. Staging MRI of uterine malignant mixed Müllerian tumors versus endometrial carcinomas with emphasis on dynamic enhancement characteristics. Abdom Radiol (NY) 2020; 45:1141-1154. [PMID: 31190089 DOI: 10.1007/s00261-019-02096-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
PURPOSE To determine whether staging pelvic magnetic resonance imaging (MRI) can distinguish malignant mixed Müllerian tumor (MMMT) from EC. METHODS Thirty-seven treatment-naïve patients with histologically proven uterine MMMT and 42 treatment-naïve patients with EC, treated at our institution, were included in our retrospective study. Staging pelvic MRI scans were reviewed for tumor size, prolapse through cervical os, and other features. Time-intensity curves for tumor and surrounding myometrium regions of interest were generated, and positive enhancement integral (PEI), maximum slope of increase (MSI), and signal enhancement ratio (SER) were measured. The Fisher's exact test or Wilcoxon rank-sum test was used to compare characteristics between disease groups. Multivariate and univariate logistic regression models were used to distinguish MMMT from EC. Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate prediction ability. RESULTS MMMTs were larger than ECs with higher rate of tumor prolapse and more heterogeneous tumor enhancement compared to ECs. During the late phase of contrast enhancement, 100% of ECs, but only 84% of MMMTs, had lower signal intensity than the myometrium. Threshold PEI ratio ≥ 0.67 predict MMMT with 76% sensitivity, 84%, specificity and 0.83 AUC. Threshold SER ≤ 125 predict MMMT with 90% sensitivity, 50% specificity, and 0.72 AUC. CONCLUSION MMMTs may show more frequent tumor prolapse, more heterogeneous enhancement, delayed iso- or hyper-enhancement, higher PEI ratios, and lower tumor SERs compared with EC. MRI can be used as a biomarker to distinguish MMMT from EC based on the enhancement pattern.
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Affiliation(s)
- Alheli Garza
- Radiology Associates of North Texas, Dallas, TX, USA
| | - Sherif B Elsherif
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA.
| | - Silvana C Faria
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Tara Sagebiel
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
| | - Jia Sun
- The Department of Biostatistics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Jingfei Ma
- The Department of Imaging Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX, USA
| | - Priya R Bhosale
- The Department of Diagnostic Radiology, The University of Texas M. D. Anderson Cancer Center, 1400 Pressler St., Houston, TX, 77030, USA
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Abstract
OBJECTIVE To describe the sonographic findings for malignant mixed Müllerian tumors (MMMTs) of the uterus with particular emphasis on their features on saline contrast sonohysterography (SCSH) and color Doppler sonography, and to determine how they relate to pathological findings. METHODS The SCSH and color Doppler findings in 29 histologically proven cases of uterine MMMT were reviewed retrospectively and their relationship to gross and histological findings were investigated. RESULTS Of the 29 uterine tumors, 16 were located only in the corpus, nine only in the fundus and four in both the corpus and fundus. Mean tumor size was 5.4 cm. The most common appearance was a polypoid mass projecting into the endometrial cavity, found in 23 cases. Twenty-eight tumors had an irregular surface, which was papillary in 20 cases and lobulated in eight. Most appeared heterogeneously isoechoic (n = 16) or hypoechoic (n = 12), occasionally with a trabecular appearance, and they often had clefts or fissure-like cystic areas (n = 10), necrosis (n = 4) or hemorrhagic areas (n = 7). Myometrial invasion was present in 27 cases and dilatation of the endometrial cavity was seen in 11. Color Doppler sonography showed moderate to marked vascularity in 20 out of the 24 cases in which it was performed, with a mean resistance index of 0.41, and appeared as feeding (n = 15) or randomly dispersed (n = 9) vessels. CONCLUSIONS Uterine MMMTs have distinct sonographic features that are related to pathological findings. Knowledge of the sonographic appearance of MMMTs may facilitate diagnosis.
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Affiliation(s)
- E J Lee
- Department of Radiology, Ajou University School of Medicine, Suwon, South Korea.
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Song MJ, Lee CW, Seo KJ, Kim JA, Park JS, Hur SY. A case of bilateral ovarian synchronous tumors (left ovarian serous papillary adenocarcinoma and right ovarian malignant mixed Müllerian tumor). EUR J GYNAECOL ONCOL 2011; 32:234-236. [PMID: 21614928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Synchronous bilateral ovarian cancer is extremely rare and there is no established guideline for management. A case of a 58-year-old multiparous woman with bilateral ovarian synchronous malignant tumors is presented. The clinical consideration and treatment of related cases are discussed.
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MESH Headings
- Cystadenocarcinoma, Papillary/diagnostic imaging
- Cystadenocarcinoma, Papillary/pathology
- Cystadenocarcinoma, Papillary/surgery
- Cystadenocarcinoma, Serous/diagnostic imaging
- Cystadenocarcinoma, Serous/pathology
- Cystadenocarcinoma, Serous/surgery
- Fatal Outcome
- Female
- Humans
- Middle Aged
- Mixed Tumor, Mullerian/diagnostic imaging
- Mixed Tumor, Mullerian/pathology
- Mixed Tumor, Mullerian/surgery
- Neoplasms, Multiple Primary/diagnostic imaging
- Neoplasms, Multiple Primary/pathology
- Neoplasms, Multiple Primary/surgery
- Ovarian Neoplasms/diagnostic imaging
- Ovarian Neoplasms/pathology
- Ovarian Neoplasms/surgery
- Radiography
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Affiliation(s)
- M J Song
- Department of Obstetrics and Gynecology, School of Medicine, Catholic University, Seoul St. Mary's Hospital, Seoul, Korea
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Gong J, Yu X, Xu J, Wang X. CT imaging of a primary malignant mixed mullerian tumor arising from the peritoneum. Clin Imaging 2008; 32:390-2. [PMID: 18760728 DOI: 10.1016/j.clinimag.2007.12.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2007] [Accepted: 11/05/2007] [Indexed: 11/18/2022]
Abstract
Primary peritoneal malignant mixed mullerian tumors are very rare. We report the case of a patient presenting with pain in the right upper quadrant of the abdomen and in whom the physical examination demonstrated a peritoneal mass. Computed tomography (CT) confirmed the presence of a mass, with invasion of adjacent organs.
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Affiliation(s)
- Jingshan Gong
- Department of Radiology, Shenzhen People's Hospital- Second Clinical College, School of Medicine, Jinan University, 1017 Dongmenbeilu, Shenzhen 518020, Guangdong Province, China.
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Abstract
Müllerian adenosarcoma is a rare neoplasm that can arise in both uterine and extrauterine locations. This report describes the ultrasound and magnetic resonance imaging findings of one case of ovarian adenosarcoma and reviews the literature as to the previously described imaging findings. Adenosarcoma should be considered in patients with a predominantly solid pelvic mass on imaging, particularly in those with a history of endometriosis or findings compatible with endometriosis on ultrasound or magnetic resonance imaging. A very low resistive index on ultrasound may also be suggestive of this diagnosis.
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Affiliation(s)
- Monisha Shetty
- Division of Abdominal Imaging, Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Cho SB, Park CM, Park SW, Kim SH, Kim KA, Cha SH, Chung IJ, Kim YW, Yoon YK, Kim JS. Malignant mixed müllerian tumor of the ovary: imaging findings. Eur Radiol 2002; 11:1147-50. [PMID: 11471602 DOI: 10.1007/s003300000737] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We describe the imaging findings of malignant mixed müllerian tumor (MMMT) of the ovary, which have not previously been reported. MATERIALS AND METHODS We experienced 13 cases of ovarian MMMT in eight patients. All patients underwent surgical resection and the MMMTs were confirmed pathologically. US (n = 8), CT (n = 8), and MRI (n = 1) examinations were performed before operation. Imaging features were analyzed retrospectively for bilaterality, tumor solidity (cystic or solid), size, and contrast enhancement of the tumor on CT and MRI. Presence of ascites and other evidence of peritoneal seeding, adjacent organ invasion, distant metastasis, and surgical staging were also evaluated. RESULTS There were bilateral ovarian MMMTs in five patients and unilateral MMMTs in three patients. Two of the MMMTs were multiseptated cystic, and 11 were mixed (solid and cystic). The diameter of the largest dimension was less than 5 cm in one case, 5-10 cm in two cases, and larger than 10 cm in 10 cases. Dense homogeneous contrast enhancement of the solid component was seen in 11 mixed masses. Ascites were found in all patients. Other evidence of peritoneal seeding and direct invasion into adjacent organ such as the uterus or sigmoid colon was seen in five patients each. Pleural metastasis was present in one patient. Surgical stages were FIGO classification IIIb and IV in one patient each, and IIIc in six patients. CONCLUSION Ovarian MMMTs usually present as aggressive, bilateral, large, solid and cystic tumors, combined with ascites, frequent peritoneal seeding, and adjacent organ invasion.
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Affiliation(s)
- S B Cho
- Department of Diagnostic Radiology, College of Medicine, Korea University, Seoul
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Meyberg R, Villena-Heinsen C, Axt R, Schmidt W, Friedrich M. Heterologous mullerian mixed tumor after whole body irradiation because of Hodgkin's disease in stage IV. EUR J GYNAECOL ONCOL 2000; 21:160-3. [PMID: 10843476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023]
Abstract
PURPOSE With an incidence of 1.5% of all malignant diseases of the uterus as specified in the literature, the mullerian mixed tumor is a rarity amongst the malignancies of the female genital tract. METHODS A retrospective analysis of an individual case report with the occurrence of heterologous mullerian mixed tumor years after irradiation because of Hodgkin's disease. RESULTS This case reports describes the occurrence of a mullerian mixed tumor 12 years after the treatment of Hodgkin's disease by whole body irradiation. To our knowledge, the incidence of a mullerian mixed tumor after the treatment of Hodgkin's disease has rarely been described up to now in the literature. CONCLUSION This case report appears to indicate the possible carcinogenic potency of radiotherapy when administered many years before. A causal connection between the administration of whole body irradiation and the development of a mullerian mixed tumor cannot be established.
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Affiliation(s)
- R Meyberg
- Department of Gynecology and Obstetrics, University of Homburg/Saar, Germany
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Dallenbach-Hellweg G, Schmidt D, Hellberg P, Bourne T, Kreuzwieser E, Dören M, Rydh W, Rudenstam G, Granberg S. The endometrium in breast cancer patients on tamoxifen. Arch Gynecol Obstet 2000; 263:170-7. [PMID: 10834325 DOI: 10.1007/s004040050276] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We restudied histologically and immunohistochemically 17 endometrial carcinomas, 2 malignant mixed tumors and 180 endometria with benign changes during or after tamoxifen therapy. The carcinomas were subtyped according to the 1994 WHO-classification. Endometrial biopsies were taken only if the endometrial thickness was > 8 mm sonographically, when a polyp was seen, or for postmenopausal bleeding. About half of the endometrial specimens showed simple or cystic atrophy, 55-76% had cystic-atrophic polyps or regressive hyperplasia. Depending upon the dose of tamoxifen, 7-19% (30 mg) to 27-36% (20 mg) showed moderate glandular proliferation. 20-33% had foci of mucinous, clear cell or serous-papillary metaplasia. 68-70% revealed diffuse extensive fibrosis of the endometrial stroma. None of 11 patients biopsied before starting tamoxifen therapy had advanced endometrial glandular proliferation in the second endometrial biopsy after tamoxifen treatment. None of the 19 endometrial neoplasms after tamoxifen therapy was of the endometrioid type: 11 were mucinous adenocarcinomas, 4 clear cell carcinomas, 2 serous-papillary carcinomas, one carcinosarcoma and one malignant Mullerian mixed tumor. The reasons for discrepancies between suspicious sonograms and endometrial atrophy are discussed.
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MESH Headings
- Adenocarcinoma, Clear Cell/chemically induced
- Adenocarcinoma, Clear Cell/diagnostic imaging
- Adenocarcinoma, Clear Cell/pathology
- Adenocarcinoma, Mucinous/chemically induced
- Adenocarcinoma, Mucinous/diagnostic imaging
- Adenocarcinoma, Mucinous/pathology
- Adult
- Aged
- Aged, 80 and over
- Antineoplastic Agents, Hormonal/adverse effects
- Biopsy
- Breast Neoplasms/drug therapy
- Carcinosarcoma/chemically induced
- Carcinosarcoma/diagnostic imaging
- Carcinosarcoma/pathology
- Cystadenocarcinoma, Papillary/chemically induced
- Cystadenocarcinoma, Papillary/diagnostic imaging
- Cystadenocarcinoma, Papillary/pathology
- Endometrial Neoplasms/chemically induced
- Endometrial Neoplasms/diagnostic imaging
- Endometrial Neoplasms/pathology
- Endometrium/diagnostic imaging
- Endometrium/drug effects
- Endometrium/pathology
- Female
- Humans
- Immunohistochemistry
- Middle Aged
- Mixed Tumor, Mullerian/chemically induced
- Mixed Tumor, Mullerian/diagnostic imaging
- Mixed Tumor, Mullerian/pathology
- Polyps
- Retrospective Studies
- Tamoxifen/adverse effects
- Ultrasonography, Doppler, Color
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Abstract
OBJECTIVE This retrospective study analyzed the CT characteristics of mullerian mixed tumors. Clinical aspects, outcomes, and pathologic correlations were also evaluated. CONCLUSION Müllerian mixed tumor is a rapidly growing aggressive tumor with a relatively poor prognosis. Uterine and metastatic masses showed central low attenuation. Metastatic masses often had irregular enhancement centrally and surface enhancement circumferentially. The tendency toward local and lymphatic spread and intraperitoneal seeding was greater than the tendency toward hematogenous metastases. CT was useful before surgery in defining the extent of disease and for follow-up clinical management in identifying metastases and assessing treatment effectiveness.
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Affiliation(s)
- T Smith
- Department of Radiology, Jack D. Weiler University Hospital of the Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Bettini-Papon V, Grataloup C, Delattre C, Hernigou A, Nochy D, Plainfossé MC, Scheffer S. [Müllerian adenosarcoma]. J Radiol 1996; 77:512-4. [PMID: 8760620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
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