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Lewis D, Liang A, Mason T, Ferriss JS. Current Treatment Options: Uterine Sarcoma. Curr Treat Options Oncol 2024:10.1007/s11864-024-01214-3. [PMID: 38819624 DOI: 10.1007/s11864-024-01214-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2024] [Indexed: 06/01/2024]
Abstract
OPINION STATEMENT The cornerstone of treatment for uterine sarcoma, regardless of histologic type, remains en bloc surgical resection with total hysterectomy. In the case of incidental diagnosis during another procedure, such as myomectomy, where a hysterectomy was not performed initially, completion hysterectomy or cervical remnant removal is recommended. The completion of additional surgical procedures, including bilateral salpingo-oophorectomy and lymphadenectomy, remains nuanced. Bilateral salpingo-oophorectomy remains controversial in the setting of most subtypes of uterine sarcoma, except in the case of hormone-receptor positivity, such as in low grade endometrial stromal sarcoma, where it is indicated as part of definitive surgical treatment. In the absence of apparent nodal involvement, we do not recommend performing universal lymphadenectomy for patients with sarcoma. We recommend systemic therapy for patients with extra-uterine or advanced stage disease, high-grade histology, and recurrence. The most active chemotherapy regimens for advanced, high-grade disease remain doxorubicin or gemcitabine and docetaxol combination therapy. A notable exception is low grade endometrial stromal sarcoma, where we recommend anti-hormonal therapy in the front-line setting. Radiation therapy is reserved for selected cases where it can aid in palliating symptoms.
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Affiliation(s)
- Dana Lewis
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Angela Liang
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA
| | - Terri Mason
- Division of Gynecologic Pathology, Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - James Stuart Ferriss
- Kelly Gynecologic Oncology Division, Department of Gynecology and Obstetrics, Johns Hopkins University School of Medicine, 600 N. Wolfe Street, Baltimore, MD, 21287, USA.
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Mixed Epithelial and Mesenchymal Neoplasms of Female Genital Tract: Case Series in a Tertiary Cancer Centre. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2022. [DOI: 10.1007/s40944-022-00671-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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3
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Terblanche L, Botha MH. Uterine carcinosarcoma: A 10-year single institution experience. PLoS One 2022; 17:e0271526. [PMID: 35862371 PMCID: PMC9302809 DOI: 10.1371/journal.pone.0271526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 06/29/2022] [Indexed: 11/19/2022] Open
Abstract
Objective
This study aimed to determine 5-year progression-free and overall survival in patients with uterine carcinosarcoma, to determine clinical and surgical-pathologic features, to recognize patterns of recurrence and to identify prognostic factors influencing progression-free survival (PFS) and overall survival (OS).
Design
This was a single institution, retrospective 10-year review of patients treated at Tygerberg Hospital in South Africa with pathologically confirmed uterine carcinosarcoma.
Methods
A total of 61 patients were studied. Demographic, clinicopathological, treatment and outcome information were obtained. Kaplan-Meier survival analysis and Cox proportional hazards models were used to determine the effects of variables on PFS and OS.
Results
Eighteen patients (29%) presented as FIGO stage I disease, 5 patients (8%) as stage II, 16 patients (26%) as stage III and 22 patients (36%) as stage IV disease. Fifty of the 61 patients (82%) had surgery. Five-year PFS and 5-year OS were 17.3% (CI 8.9%-27.9%) and 19.7% (CI 10.6%-30.8%), respectively. Seventeen patients presented with recurrence of which 5 (29.4%) were local and 12 (70.6%) were outside the pelvis.
In the univariate analysis, tumour diameter ≥ 100mm (HR 4.57; 95% CI 1.59–13.19; p-value 0.005) was associated with 5-year PFS and in univariate analysis of OS, a positive family history (HR 0.42; 95% CI 0.18–0.99; p-value 0.047), receiving a full staging operation (HR 0.37; 95% CI 0.18–0.78; p-value 0.008) and receiving any other modality of treatment, with or without surgery, (HR 0.48; 95% CI 0.27–0.85; p-value 0.012) were associated with better survival. An abnormal cervical smear (HR 2.4; 95% CI 1.03–5.6; p-value 0.041), late-stage disease (HR 3.48; 95% CI 1.79–6.77; p-value < 0.001), presence of residual tumour (HR 3.66; 95% CI 1.90–7.02; p-value < 0.001), myometrial invasion more than 50% (HR 2.29; 95% CI 1.15–4.57; p-value 0.019), cervical involvement (HR 3.38; 95% CI 1.64–6.97; p-value 0.001) and adnexal involvement (HR 3.21; 95% CI 1.56–6.63; p-value 0.002) were associated with a higher risk of death.
In the multivariate analysis, full staging operation was associated with a risk of progression of disease (HR 3.49; 95% CI 1.17–10.41; p-value 0.025). Advanced stage (HR 4.2; 95% CI 2.09–8.44; p-value < 0.001) was associated with a higher risk of death. Any other modality of treatment (HR 0.28; 95% CI 0.15–0.53; p-value < 0.001) and full staging laparotomy (HR 0.27; 95% CI 0.12–0.59; p-value 0.001) was a protective factor for death.
Conclusions
Carcinosarcoma is an aggressive cancer with poorer survival in this specific cohort than has been described in other contemporary cohorts. Biological or genetic factors are a possible explanation for lower overall survival in this population. Although it is also possible that later diagnosis and poor access to health care contribute to poorer survival. Most recurrences occur outside of the pelvis. Full staging surgery (including pelvic lymphadenectomy) and additional use of other modalities (either for radical or palliative intent) improve survival.
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Affiliation(s)
- Leana Terblanche
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
- * E-mail:
| | - Matthys H. Botha
- Department of Obstetrics and Gynaecology and Unit for Gynaecological Oncology, Tygerberg Hospital, Stellenbosch University, Cape Town, South Africa
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van der Horst RL, van der Hel O, Lutgens L, van der Aa M, Slangen B, Kruitwagen R, Lalisang RI. The role of multimodal adjuvant therapy for FIGO I-II carcinosarcoma of the uterus: a systematic review. Crit Rev Oncol Hematol 2022; 175:103701. [PMID: 35533817 DOI: 10.1016/j.critrevonc.2022.103701] [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: 01/11/2022] [Revised: 03/07/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022] Open
Abstract
The uterine carcinosarcoma (UCS) is a rare entity with poor prognosis. Treatment of FIGO I-II UCS usually consists of surgery with or without adjuvant treatment. Due to the high metastatic potential, aggressive combined modality adjuvant treatment approaches, consisting of chemo- and radiotherapy, have been of interest. Our systematic review aims to compare survival, disease control and toxicity profiles in patients receiving adjuvant chemoradiation to other adjuvant strategies (e.g.observation, chemotherapy or radiotherapy). A total of ten studies were included for a combined cohort size of 6,520 patients. Generally, the studies showed a trend towards improved disease control and survival in patients undergoing adjuvant multimodal treatment, although statistical significance was often not reached. Selection bias and non-randomized treatment allocation pose serious challenges to extrapolate these outcomes to clinical practice. We recommend additional prospective research on the role of adjuvant chemoradiation in FIGO I-II UCS.
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Affiliation(s)
- R L van der Horst
- Division Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht the Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - O van der Hel
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - L Lutgens
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Radiation Oncology, MAASTRO Clinic, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - M van der Aa
- Department of Research and Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, the Netherlands
| | - B Slangen
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - R Kruitwagen
- GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Department of Obstetrics and Gynecology, Maastricht University Medical Centre, Maastricht, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
| | - R I Lalisang
- Division Medical Oncology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht the Netherlands; GROW-School for Oncology and Reproduction, Maastricht University, the Netherlands; Maastricht UMC+ Comprehensive Cancer Center, Maastricht, the Netherlands
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Beckmann K, Selva-Nayagam S, Olver I, Miller C, Buckley ES, Powell K, Buranyi-Trevarton D, Gowda R, Roder D, Oehler MK. Carcinosarcomas of the Uterus: Prognostic Factors and Impact of Adjuvant Treatment. Cancer Manag Res 2021; 13:4633-4645. [PMID: 34140809 PMCID: PMC8203298 DOI: 10.2147/cmar.s309551] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 05/15/2021] [Indexed: 12/23/2022] Open
Abstract
Background Uncertainties remain about the most effective treatment for uterine carcinosarcoma (UCS), a rare but aggressive uterine cancer, due to the limited scope for randomized trials. This study investigates whether nodal excision or adjuvant therapies after hysterectomy offer a survival benefit, using multi-institutional clinical registry data from South Australia. Methods Data for all consecutive cases of UCS from 1980 to 2019 were extracted from the Clinical Cancer Registry. Clinical and treatment-related factors associated with disease-specific mortality (DSM) and all-cause mortality (ACM) were determined using multivariable Cox proportional hazards regression, with subgroup analyses by stage. Results Median follow-up for the 140 eligible cases was 21 months. 94% underwent hysterectomy, and 72% had an additional pelvic lymph node dissection (PLND). Furthermore, 16% received adjuvant chemotherapy; 11% adjuvant radiotherapy and 16% multimodal chemoradiotherapy, with an increase in the latter two modalities over time. DSM was reduced among those who underwent PLND (HR: 0.41; 95%CI: 0.23–0.74), adjuvant chemotherapy (HR: 0.39; 95%CI: 0.18–0.84) or multimodality treatment (HR: 0.11; 95%CI: 0.06–0.30) compared with hysterectomy alone for the whole cohort and for late stage disease (FIGO III/IV) but not for earlier stage disease, except for reduced DSM with multimodal therapy. Findings were similar for ACM. Conclusion Our findings indicate better survival among those who received PLND, chemotherapy and multimodal adjuvant therapy, with the latter applying to early and late stage disease. However, cautious interpretation is warranted, due to potential “indication bias” and limited power. Further research into effective treatment modalities, ideally using prospective study designs, is needed.
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Affiliation(s)
- Kerri Beckmann
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
| | | | - Ian Olver
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Caroline Miller
- South Australian Health and Medical Research Institute, Adelaide, Australia.,School of Public Health, University of Adelaide, Adelaide, Australia
| | - Elizabeth S Buckley
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
| | - Kate Powell
- South Australian Health and Medical Research Institute, Adelaide, Australia
| | | | - Raghu Gowda
- Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - David Roder
- Cancer Epidemiology and Population Health Research, University of South Australia, Adelaide, Australia
| | - Martin K Oehler
- Gynaecological Oncology, Royal Adelaide Hospital, Adelaide, Australia
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6
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Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K. Uterine carcinosarcoma: Contemporary clinical summary, molecular updates, and future research opportunity. Gynecol Oncol 2020; 160:586-601. [PMID: 33183764 DOI: 10.1016/j.ygyno.2020.10.043] [Citation(s) in RCA: 45] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2020] [Accepted: 10/31/2020] [Indexed: 12/16/2022]
Abstract
Uterine carcinosarcoma (UCS) is a biphasic aggressive high-grade endometrial cancer in which the sarcoma element has de-differentiated from the carcinoma element. UCS is considered a rare tumor, but its incidence has gradually increased in recent years (annual percent change from 2000 to 2016 1.7%, 95% confidence interval 1.2-2.2) as has the proportion of UCS among endometrial cancer, exceeding 5% in recent years. UCS typically affects the elderly, but in recent decades patients became younger. Notably, a stage-shift has occurred in recent years with increasing nodal metastasis and decreasing distant metastasis. The concept of sarcoma dominance may be new in UCS, and a sarcomatous element >50% of the uterine tumor is associated with decreased survival. Multimodal treatment is the mainstay of UCS. Lymphadenectomy, chemotherapy, and brachytherapy have increased in the past few decades, but survival outcomes remain dismal: the median survival is less than two years, and the 5-year overall survival rate has not changed in decades (31.9% in 1975 to 33.8% in 2012). Carboplatin/paclitaxel adjuvant chemotherapy improves progression-free survival compared with ifosfamide/paclitaxel, particularly in stages III-IV disease (GOG-261 trial). Twenty-six clinical trials previously examined therapeutic effectiveness in recurrent/metastatic UCS. The median response rate and progression-free survival were 37.5% and 5.9 months, respectively, after first-line therapy, but after later therapies, the outcomes were far worse (5.5% and 1.8 months, respectively). One significant discovery was that epithelial-mesenchymal transition (EMT) plays a pivotal role in the pathogenesis of sarcomatous dedifferentiation in UCS and that heterologous sarcoma is associated with a higher EMT signature compared with homologous sarcoma. Furthermore, next-generation sequencing has revealed that UCS tumors are serous-like and that common somatic mutations include those in TP53, PIK3CA, FBXW7, PTEN, and ARID1A. This contemporary review highlights recent clinical and molecular updates in UCS. A possible therapeutic target of EMT in UCS is also discussed.
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Affiliation(s)
- Shinya Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Maximilian Klar
- Department of Obstetrics and Gynecology, University of Freiburg, Freiburg, Germany
| | - Satoko Matsuzaki
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Department of Obstetrics and Gynecology, Osaka University, Osaka, Japan
| | - Lynda D Roman
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA
| | - Anil K Sood
- Department of Gynecologic Oncology and Reproductive Medicine, University of Texas, MD-Anderson Cancer Center, Houston, TX, USA
| | - Koji Matsuo
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA, USA; Norris Comprehensive Cancer Center, University of Southern California, Los Angeles, CA, USA.
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Hrudka J, Rosová B, Halaška MJ. Squamous cell carcinoma with sarcomatoid differentiation or carcinosarcoma of the uterine cervix associated with HPV33 infection: report of a rare case. Diagn Pathol 2020; 15:12. [PMID: 32035484 PMCID: PMC7007670 DOI: 10.1186/s13000-020-00934-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/05/2020] [Indexed: 01/01/2023] Open
Abstract
Background Squamous cell carcinoma is the most common malignant tumor of the uterine cervix with a well-documented link to infection with human papillomaviruses (HPV). According to a recent classification, there are several morphological variants of cervical squamous carcinoma, without reference to sarcomatoid squamous cell carcinoma, which is well described in other organs. Case presentation In this paper, we describe an extremely rare case of a 77-year-old woman with primary malignant cervical tumor displaying biphasic histomorphology with an epithelioid and sarcomatoid part; the latter was immunohistochemistry positive for cytokeratin and vimentin. The association with a high-grade squamous intraepithelial lesion and molecular proof of HPV33 infection in the tumor tissue supported our diagnosis of carcinoma with partial sarcomatoid differentiation. Conclusion We report a rare case of a primary cervical epithelial tumor with a partial sarcomatoid phenotype, an unequivocal HPV infection, and an associated precancerous lesion in the cervical mucosa. This is the first description of an HPV33 infection underlying a biphasic epithelioid-sarcomatous tumor of the uterine cervix. The terminology overlap between sarcomatoid carcinoma and carcinosarcoma is also discussed.
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Affiliation(s)
- Jan Hrudka
- Department of Pathology, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Ruská 87, 100 00, Praha, 10, Prague, Czechia.
| | - Blanka Rosová
- Department of Pathology and Molecular Medicine, 3rd Faculty of Medicine, Charles University and Thomayer Hospital, Prague, Czechia
| | - Michael J Halaška
- Department of Gynecology and Obstetrics, 3rd Faculty of Medicine, Charles University and Kralovske Vinohrady University Hospital, Prague, Czechia
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Predictive Histologic Factors in Carcinosarcomas of the Uterus: A Multi-institutional Study. Int J Gynecol Pathol 2019; 38:205-215. [PMID: 30958427 DOI: 10.1097/pgp.0000000000000497] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Uterine carcinosarcomas are rare aggressive biphasic neoplasms. Because of its rarity, limited data are available on potential prognostic parameters. While several studies support that carcinomatous components predict outcomes, others do not. In this study, we evaluated the clinical and histopathologic features of 196 uterine carcinosarcomas to identify potential prognostic factors. Patients' ages ranged from 34 to 95 yr (median, 68 yr). Seventy-three (38%) patients experienced tumor recurrence during follow-up. Tumors ≥5 cm, outer half myometrial invasion, lymphovascular invasion, lymph node metastasis, advanced stage (International Federation of Gynecology and Obstetrics stages III-IV), sarcomatous component on recurrence, sarcoma dominance, and positive cytology were significantly associated with shorter disease-free interval (P<0.05). In addition, serous histology and rhabdomyoblastic differentiation was significantly associated with worse 3-yr overall survival. Our data supports that both carcinomatous and sarcomatous components play a role in tumor progression and survival of uterine carcinosarcoma patients, suggesting their equal importance in guiding management decisions.
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Sagebiel TL, Bhosale PR, Patnana M, Faria SC, Devine CE. Uterine Carcinosarcomas. Semin Ultrasound CT MR 2019; 40:295-301. [PMID: 31375170 DOI: 10.1053/j.sult.2019.03.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Uterine carcinosarcoma (UCS) is a rare and aggressive variant of endometrial cancer, distinguished by its containment of both epithelial and sarcomatous elements. This article reviews the epidemiology, pathologic classification and staging of UCS, along with the typical findings seen on different imaging modalities. Prognosis and therapies will also be discussed.
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Affiliation(s)
- T L Sagebiel
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX.
| | - P R Bhosale
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - M Patnana
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - S C Faria
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
| | - C E Devine
- The University of Texas MD Anderson Cancer Center, Diagnostic Radiology, T. Boone Pickens Academic Tower (FCT15.5023), Houston, TX
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Recurrence Pattern in Carcinosarcoma of the Uterus: A Case Series from a Tertiary Cancer Care Center from South India. INDIAN JOURNAL OF GYNECOLOGIC ONCOLOGY 2018. [DOI: 10.1007/s40944-018-0223-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Brasky TM, Felix AS, Cohn DE, McMeekin DS, Mutch DG, Creasman WT, Thaker PH, Walker JL, Moore RG, Lele SB, Guntupalli SR, Downs LS, Nagel CI, Boggess JF, Pearl ML, Ioffe OB, Park KJ, Ali S, Brinton LA. Nonsteroidal Anti-inflammatory Drugs and Endometrial Carcinoma Mortality and Recurrence. J Natl Cancer Inst 2017; 109:1-10. [PMID: 28376204 DOI: 10.1093/jnci/djw251] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 09/26/2016] [Indexed: 12/21/2022] Open
Abstract
Background Recent data suggest that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be associated with reductions in endometrial cancer risk, yet very few have examined whether their use is related to prognosis among endometrial cancer patients. Methods Study subjects comprised 4374 participants of the NRG Oncology/Gynecology Oncology Group 210 Study with endometrial carcinoma who completed a presurgical questionnaire that assessed history of regular prediagnostic NSAID use and endometrial cancer risk factors. Recurrences, vital status, and causes of death were obtained from medical records and cancer registries. Fine-Gray semiproportional hazards regression estimated adjusted subhazard ratios (HRs) and 95% confidence intervals (CIs) for associations of NSAID use with endometrial carcinoma-specific mortality and recurrence. Models were stratified by endometrial carcinoma type (ie, type I [endometrioid] vs type II [serous, clear cell, or carcinosarcoma]) and histology. Results Five hundred fifty endometrial carcinoma-specific deaths and 737 recurrences occurred during a median of five years of follow-up. NSAID use was associated with 66% (HR = 1.66, 95% CI = 1.21 to 2.30) increased endometrial carcinoma-specific mortality among women with type I cancers. Associations were statistically significant for former and current users, and strongest among former users who used NSAIDs for 10 years or longer (HR = 2.23, 95% CI = 1.19 to 4.18, two-sided P trend = .01). NSAID use was not associated with recurrence or endometrial carcinoma-specific mortality among women with type II tumors. Conclusions In this study, use of NSAIDs was associated with increased endometrial carcinoma-specific mortality, especially in patients with type I tumors. Barring a clear biologic mechanism by which NSAIDs would increase the risk of cause-specific mortality, cautious interpretation is warranted.
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Affiliation(s)
- Theodore M Brasky
- Division of Cancer Prevention and Control, Ohio State University, Columbus, OH, USA
| | - Ashley S Felix
- College of Medicine, and Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA.,Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA.,Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
| | - David E Cohn
- Division of Gynecologic Oncology, Ohio State University, Columbus, OH, USA
| | - D Scott McMeekin
- Stephenson Oklahoma Cancer Center, Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, University of Oklahoma, USA
| | - David G Mutch
- Washington University School of Medicine, St. Louis, MO, USA
| | - William T Creasman
- Department of Obstetrics and Gynecology, Medical University of South Carolina, Charleston, SC, USA
| | - Premal H Thaker
- Washington University School of Medicine, St. Louis, MO, USA
| | - Joan L Walker
- Department of Obstetrics and Gynecology, University of Oklahoma, Oklahoma City, OK, USA
| | - Richard G Moore
- Program in Women's Oncology, Department of Obstetrics and Gynecology, Women and Infants Hospital/Brown University, Providence, RI, USA
| | - Shashikant B Lele
- Gynecologic Oncology, Roswell Park Cancer Institute, Buffalo, NY, USA
| | | | - Levi S Downs
- Gynecologic Oncology, University of Minnesota, Minneapolis, MN, USA
| | - Christa I Nagel
- Division of Gynecologic Oncology, Case Western Reserve University, Cleveland, OH, USA
| | - John F Boggess
- Gynecologic Oncology Program, University of North Carolina, Chapel Hill, NC, USA
| | - Michael L Pearl
- Gynecologic Oncology, State University of New York at Stonybrook, Stonybrook, NY , USA
| | - Olga B Ioffe
- Anatomical Pathology, University of Maryland, College Park, MD, USA
| | - Kay J Park
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Shamshad Ali
- NRG Statistics and Data Management Center, Roswell Park Cancer Institute, Buffalo, NY, USA
| | - Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Bethesda, MD, USA
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12
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Gupta D. Clinical Behavior and Treatment of Endometrial Cancer. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2017; 943:47-74. [PMID: 27910064 DOI: 10.1007/978-3-319-43139-0_2] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Endometrial cancer is the most common gynecologic malignancy diagnosed in women in the developed nations. It affects a disproportionate number of reproductive-aged women. While the overall prognosis is good compared to other cancers affecting women, the pathogenesis and clinical behavior of endometrial cancer are heterogeneous. The risk factors associated with the type I and type II endometrial cancers and their pathogenesis will be discussed, as well as the evaluation and primary treatment of women with endometrial cancer. The chapter will also focus on risk stratification for recurrence after surgery and role of adjuvant treatments. Finally, the treatment of recurrent endometrial cancer will be presented.
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Affiliation(s)
- Divya Gupta
- University of Connecticut, St. Francis Hospital & Medical Center, Comprehensive Women's Health Center, 114 Woodland Hospital, Hartford, CT, 06105, USA.
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13
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Inoue H, Takahashi H, Hashimura M, Eshima K, Akiya M, Matsumoto T, Saegusa M. Cooperation of Sox4 with β-catenin/p300 complex in transcriptional regulation of the Slug gene during divergent sarcomatous differentiation in uterine carcinosarcoma. BMC Cancer 2016; 16:53. [PMID: 26841870 PMCID: PMC4739330 DOI: 10.1186/s12885-016-2090-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2015] [Accepted: 01/28/2016] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Uterine carcinosarcoma (UCS) represents a true example of cancer associated with epithelial-mesenchymal transition (EMT), which exhibits cancer stem cell (CSC)-like traits. Both Sox and β-catenin signal transductions play key roles in the regulation of EMT/CSC properties, but little is known about their involvement in UCS tumorigenesis. Herein, we focused on the functional roles of the Sox/β-catenin pathway in UCSs. METHODS EMT/CSC tests and transfection experiments were carried out using three endometrial carcinoma (Em Ca) cell lines. Immunohistochemical investigation was also applied for a total of 32 UCSs. RESULTS Em Ca cells cultured in STK2, a serum-free medium for mesenchymal stem cells, underwent changes in morphology toward an EMT appearance through downregulation of E-cadherin, along with upregulation of Slug, known as a target gene of β-catenin. The cells also showed CSC properties with an increase in the aldehyde dehydrogenase (ALDH) 1(high) activity population and spheroid formation, as well as upregulation of Sox4, Sox7, and Sox9. Of these Sox factors, overexpression of Sox4 dramatically led to transactivation of the Slug promoter, and the effects were further enhanced by cotransfection of Sox7 or Sox9. Sox4 was also able to promote β-catenin-mediated transcription of the Slug gene through formation of transcriptional complexes with β-catenin and p300, independent of TCF4 status. In clinical samples, both nuclear β-catenin and Slug scores were significantly higher in the sarcomatous elements as compared to carcinomatous components in UCSs, and were positively correlated with Sox4, Sox7, and Sox9 scores. CONCLUSIONS These findings suggested that Sox4, as well as Sox7 and Sox9, may contribute to regulation of EMT/CSC properties to promote development of sarcomatous components in UCSs through transcriptional regulation of the Slug gene by cooperating with the β-catenin/p300 signal pathway.
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Affiliation(s)
- Hisako Inoue
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Hiroyuki Takahashi
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Miki Hashimura
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Koji Eshima
- Department of Immunology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Masashi Akiya
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Toshihide Matsumoto
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
| | - Makoto Saegusa
- Department of Pathology, 1-15-1 Kitasato, Minami-ku, Sagamihara, Kanagawa, 252-0374, Japan.
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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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15
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Unusual Cutaneous Metastasis of Uterine Carcinosarcoma: A Case Report and Review of the Literature. Am J Dermatopathol 2015; 38:366-9. [PMID: 26675357 DOI: 10.1097/dad.0000000000000476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cutaneous metastasis of uterine cancer is rare and is often associated with late-stage disease. Most uterine malignancies are endometrial adenocarcinomas, but a small subset is uterine carcinosarcoma, also known as malignant mixed Mullerian tumors. Uterine carcinosarcomas are highly aggressive tumors with an average 5-year survival rate of 26%-34%. Metastases most commonly occur in the abdominal wall, lung, and bone. Cutaneous metastasis is exceedingly rare and may pose a diagnostic challenge. The authors report a 57-year-old woman with multiple subcutaneous nodules on the face and trunk. A biopsy revealed similar morphology and staining characteristics as the sarcomatous component of the primary uterine carcinosarcoma. Histopathological features and immunophenotypical characteristics of the metastatic tumor are detailed in comparison with the original tumor. A review of the literature is also provided.
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16
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Zhu J, Wen H, Bi R, Wu X. Clinicopathological characteristics, treatment and outcomes in uterine carcinosarcoma and grade 3 endometrial cancer patients: a comparative study. J Gynecol Oncol 2015; 27:e18. [PMID: 26463439 PMCID: PMC4717223 DOI: 10.3802/jgo.2016.27.e18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Revised: 07/24/2015] [Accepted: 07/31/2015] [Indexed: 11/30/2022] Open
Abstract
Objective Uterine carcinosarcoma (UCS) shared the same staging system with endometrial carcinoma in the International Federation of Gynecology and Obstetrics 2009. The aim of the present study was to compare the clinicopathological and prognostic characteristics between UCS and grade 3 endometrioid endometrial carcinoma (G3EC). Methods A retrospective analysis of 60 UCS and 115 G3EC patients with initial treatment at the Department of Gynecology in the Fudan University Shanghai Cancer Center between February 2006 and August 2013. Chi-square analysis was used to compare differences between variables. Prognostic factors were determined using univariate/multivariate analysis, and the survival rates were assessed using the Kaplan-Meier method. The Cox regression model was used to assess the independent prognostic factor. Results UCS had significantly worse overall survival (OS) compared with G3EC. Carcinosarcoma subtype was an independent factor (hazard ratio [HR], 2.4; 95% confidence interval [CI], 1.0 to 5.8; p=0.039), stratified based on stage. Compared with G3EC, UCS patients had a greater incidence of ascites fluid (55.0% vs. 15.7%, p<0.001) and adnexal involvement (20.0% vs. 8.7%, p=0.048) and larger median tumor volume (4.6 cm vs. 4.0 cm, p=0.046). Subgroup analysis of the prognostic factors revealed that UCS patients exhibited worse OS than G3EC patients in such specific subgroups as patients at younger ages, with postmenopausal status, without ascites fluid, with early stage diseases, without vagina invasion, without lymph node metastases and receiving adjuvant chemo/radiotherapy. Adjuvant radiotherapy with chemotherapy was predictive of better survival in UCS patients compared with chemotherapy or radiotherapy alone (5-year OS, 71.0% vs. 35.8%, p=0.028). Multivariate Cox regression revealed that tumor mesenchymal component (HR, 4.6; 95% CI, 1.4 to 15.8; p=0.014) was an independent prognostic factor for UCS, whereas advanced stages (HR, 5.9; 95% CI, 1.0 to 33.9; p=0.046) and ascites fluid (HR, 5.1; 95% CI, 1.1 to 22.7; p=0.032) were independently correlated with poor prognosis for G3EC patients. Conclusion The distinctions in both clinicopathological and prognostic characteristics between UCS and G3EC suggest that this subtype should be treated separately from high-risk epithelial endometrial carcinoma.
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Affiliation(s)
- Jun Zhu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Hao Wen
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Rui Bi
- Department of Pathology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xiaohua Wu
- Department of Gynecologic Oncology, Fudan University Shanghai Cancer Center, Shanghai, China.,Department of Oncology, Shanghai Medical College, Fudan University, Shanghai, China.
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Hanley KZ, Oprea-Ilies G, Ormenisan C, Seydafkan S, Mosunjac MB. Atypical Findings on Cervicovaginal Smears Correlate with Cervical Involvement by Malignant Mixed Müllerian Tumors of the Uterus. Acta Cytol 2015; 59:319-24. [PMID: 26315658 DOI: 10.1159/000439159] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 08/03/2015] [Indexed: 11/19/2022]
Abstract
OBJECTIVE A malignant mixed müllerian tumor (MMMT) is a high-grade neoplasm commonly arising from the uterus. Patients present with bleeding and a mass protruding from the cervix. This study was designed to correlate Papanicolaou (Pap) smear findings with histological findings in women diagnosed with MMMT. STUDY DESIGN Women diagnosed with MMMT were identified. Preoperative Pap tests were correlated with histological findings. Statistical analysis was performed to assess associations between abnormal Pap tests and histological findings. RESULTS Forty patients with MMMT were included in the study. Age ranged from 37-85 years and tumor size ranged from 1.2 to 21 cm. In presurgical Pap tests (4 conventional and 36 liquid based), 11 smears (27.5%) were diagnosed as negative, 5 (12.5%) as atypical squamous cells of undetermined significance, 6 (15%) as atypical glandular cells, 16 (40%) as malignant and 2 (5%) as high-grade squamous intraepithelial lesion. Malignant cells detected on Pap smears showed a strong correlation with endocervical involvement by MMMT (p = 0.002). Larger tumors were more likely to involve the cervix (p = 0.0115). CONCLUSIONS The Pap test can predict cervical involvement by MMMT. On Pap smears, MMMT cells showed no correlation with other adverse histological features (lymphovascular invasion, myoinvasion or adnexal involvement).
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Affiliation(s)
- Krisztina Z Hanley
- Department of Pathology and Laboratory Medicine, Emory University Hospital, Atlanta, Ga., USA
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18
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Gupta M, Kiruthiga KG. Malignant mixed Mullerian tumour of uterus secondary to tamoxifen therapy for hormone responsive breast cancer. BMJ Case Rep 2015; 2015:bcr-2015-209981. [PMID: 26123463 DOI: 10.1136/bcr-2015-209981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Tamoxifen is used in the treatment of hormone responsive breast cancer because of its antiestrogenic effect. However, it also has an estrogenic effect on the uterus, thereby increasing the risk of endometrial hyperplasia, endometrial polyp and endometrial neoplasms such as endometrial adenocarcinoma and malignant mixed Mullerian tumour (MMMT). This case describes the possible pathogenesis and risk of developing MMMT due to long-term tamoxifen intake in hormone responsive breast cancer.
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Affiliation(s)
- Mayank Gupta
- Department of General Pathology, Christian Medical College, Vellore, Tamil Nadu, India
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McConechy MK, Hoang LN, Chui MH, Senz J, Yang W, Rozenberg N, Mackenzie R, McAlpine JN, Huntsman DG, Clarke BA, Gilks CB, Lee CH. In-depth molecular profiling of the biphasic components of uterine carcinosarcomas. JOURNAL OF PATHOLOGY CLINICAL RESEARCH 2015; 1:173-85. [PMID: 27499902 PMCID: PMC4939881 DOI: 10.1002/cjp2.18] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/26/2015] [Indexed: 12/14/2022]
Abstract
Uterine carcinosarcoma is a clinically aggressive malignancy composed of a mix of carcinomatous and sarcomatous elements. We performed targeted next-generation sequencing of 27 uterine cancer and sarcoma genes together with immunohistochemical analyses of selected proteins in 30 uterine carcinosarcomas. This included 13 cases in which the distinct carcinoma and sarcoma components were sequenced separately and 10 cases where the metastatic tumours were analysed in addition to the primary tumours. We identified non-synonymous somatic mutations in 90% of the cases, with 27 of 30 cases (90%) harbouring TP53 alterations. The PI3K pathway was the most commonly mutated signalling pathway with mutations identified in PIK3CA, PTEN, PIK3R1, and/or PIK3R2 in two-thirds of the cases. Mutations in FBXW7, PPP2R1A, ARID1A and KRAS were demonstrated in a minority of cases. In cases where the carcinomatous and sarcomatous components were separately analysed, most of the mutations identified were present in both components, indicating a common origin for the two components. Furthermore, the same TP53 alterations and/or PI3K pathway mutations seen in the primary tumours were also identified in the metastatic sites. Overall, carcinosarcomas exhibited heterogeneous molecular features that resemble the heterogeneity seen in endometrial carcinomas, with some showing endometrioid carcinoma-like and others showing serous carcinoma-like mutation profiles. While patients with serous-like tumours presented more frequently with advanced-stage disease compared to patients with endometrioid-like tumours, there was no statistical difference in outcome between the two groups. Our results provide insights into the oncogenesis of uterine carcinosarcoma and identify targetable mutations that represent early oncogenic events. The findings of the different molecular types of uterine carcinosarcoma that parallel the different molecular types in endometrial carcinoma may have future treatment implications with targeted therapies.
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Affiliation(s)
- Melissa K McConechy
- Department of Pathology and Laboratory Medicine BC Cancer Agency and University of British Columbia Vancouver Canada
| | - Lien N Hoang
- Department of Pathology and Laboratory Medicine BC Cancer Agency and University of British Columbia Vancouver Canada
| | - Michael Herman Chui
- Department of Laboratory Medicine and Pathobiology University of Toronto Toronto Canada
| | - Janine Senz
- Department of Pathology and Laboratory Medicine BC Cancer Agency and University of British Columbia Vancouver Canada
| | - Winnie Yang
- Department of Pathology and Laboratory Medicine BC Cancer Agency and University of British Columbia Vancouver Canada
| | | | - Robertson Mackenzie
- Department of Pathology and Laboratory Medicine BC Cancer Agency and University of British Columbia Vancouver Canada
| | - Jessica N McAlpine
- Department of Gynecology and Obstetrics University of British Columbia Vancouver British Columbia Canada
| | - David G Huntsman
- Department of Pathology and Laboratory MedicineBC Cancer Agency and University of British ColumbiaVancouverCanada; Department of Pathology and Laboratory MedicineGenetic Pathology Evaluation CenterVancouver General Hospital and University of British ColumbiaVancouverBritish ColumbiaCanada
| | | | - Cyril Blake Gilks
- Department of Pathology and Laboratory Medicine Genetic Pathology Evaluation Center Vancouver General Hospital and University of British Columbia Vancouver British Columbia Canada
| | - Cheng-Han Lee
- Department of Laboratory Medicine and Pathology Royal Alexandra Hospital and University of Alberta Edmonton Canada
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Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: Carcinosarcomas. Review from histology to treatment. Crit Rev Oncol Hematol 2015; 94:98-104. [DOI: 10.1016/j.critrevonc.2014.10.013] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 09/11/2014] [Accepted: 10/28/2014] [Indexed: 12/23/2022] Open
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Ren CE, Zhu X, Li J, Lyle C, Dowdy S, Podratz KC, Byck D, Chen HB, Jiang SW. Microarray analysis on gene regulation by estrogen, progesterone and tamoxifen in human endometrial stromal cells. Int J Mol Sci 2015; 16:5864-85. [PMID: 25782154 PMCID: PMC4394510 DOI: 10.3390/ijms16035864] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2014] [Revised: 01/29/2015] [Accepted: 02/25/2015] [Indexed: 02/05/2023] Open
Abstract
Epithelial stromal cells represent a major cellular component of human uterine endometrium that is subject to tight hormonal regulation. Through cell-cell contacts and/or paracrine mechanisms, stromal cells play a significant role in the malignant transformation of epithelial cells. We isolated stromal cells from normal human endometrium and investigated the morphological and transcriptional changes induced by estrogen, progesterone and tamoxifen. We demonstrated that stromal cells express appreciable levels of estrogen and progesterone receptors and undergo different morphological changes upon hormonal stimulation. Microarray analysis indicated that both estrogen and progesterone induced dramatic alterations in a variety of genes associated with cell structure, transcription, cell cycle, and signaling. However, divergent patterns of changes, and in some genes opposite effects, were observed for the two hormones. A large number of genes are identified as novel targets for hormonal regulation. These hormone-responsive genes may be involved in normal uterine function and the development of endometrial malignancies.
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Affiliation(s)
- Chun-E Ren
- Department of Obstetrics and Gynecology, Center of Reproductive Medicine, Affiliated Hospital of Weifang Medical University, Weifang 261043, China.
| | - Xueqiong Zhu
- Department of Obstetrics and Gynecology, the Second Affiliated Hospital of Wenzhou Medical University, Wenzhou 325001, China.
| | - Jinping Li
- Department of Biomedical Science, Mercer University School of Medicine, Savannah, GA 31404, USA.
- Department of Obstetrics and Gynecology, Memorial Health University Medical Center, Savannah, GA 31404, USA.
- Department of Biochemistry and Molecular Biology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Christian Lyle
- Department of Biology, Savannah State University, Savannah, GA 31419, USA.
| | - Sean Dowdy
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA.
| | - Karl C Podratz
- Department of Obstetrics and Gynecology, Mayo Clinic, Rochester, MN 55905, USA.
| | - David Byck
- Department of Obstetrics and Gynecology, Memorial Health University Medical Center, Savannah, GA 31404, USA.
| | - Hai-Bin Chen
- Department of Histology and Embryology, Shantou University Medical College, Shantou 515041, China.
| | - Shi-Wen Jiang
- Department of Biomedical Science, Mercer University School of Medicine, Savannah, GA 31404, USA.
- Department of Obstetrics and Gynecology, Memorial Health University Medical Center, Savannah, GA 31404, USA.
- Curtis and Elizabeth Anderson Cancer Institute, Department of Laboratory Oncology Research, Memorial University Medical Center, Savannah, GA 31404, USA.
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Abstract
ObjectivesType II endometrial carcinomas—uterine carcinosarcomas or uterine malignant mesodermal mixed tumors (UMMMTs), clear cell carcinomas (UCCs), and uterine serous carcinomas (USCs)—are aggressive malignancies that present with advanced disease and have high mortality rates.PIK3CAmutations are commonly found in endometrial cancers. The objective of the study was to characterize molecular alterations in thePIK3CAgene in these tumors.MethodsA total of 84 cases (20 UMMMTs, 18 UCCs, and 46 USCs) were selected from the surgical pathology files of Weill Cornell Medical College and Johns Hopkins Hospital. The diagnoses were confirmed by gynecologic pathologists (L.H.E. and A.Y.). DNA was extracted from paraffin-embedded tissue. Polymerase chain reaction was performed for mutational analysis. All the studies were performed in accordance with approved Institutional Review Board protocols.ResultsMutations in thePIK3CAgene were identified in 3 (15%) of 20 UMMMT, 3 (16.7%) of 18 UCC, and 10 (21.7%) of 46 USC cases. We report novel mutations inPIK3CAin uterine carcinosarcoma.ConclusionsA significant percentage of UMMMTs, UCCs, and USCs have mutations inPIK3CA. Further investigation is needed to develop targeted therapies for these aggressive uterine cancers.
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24
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Bhargava R. Clinical utility of immunohistochemistry and other ancillary techniques in assessment of uterine tumors. Semin Diagn Pathol 2014; 31:193-4. [PMID: 24933036 DOI: 10.1053/j.semdp.2014.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Rohit Bhargava
- Magee-Womens Hospital of University of Pittsburgh Medical Center, 300 Halket Street, Pittsburgh, Pennsylvania 15213.
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Abstract
PURPOSE OF REVIEW To summarize the clinical characteristics, epidemiology, and treatment of uterine carcinosarcoma. RECENT FINDINGS Recent studies have suggested that uterine carcinosarcomas are aggressive neoplasms that carry a poor prognosis even when diagnosed at an early stage. Treatment is typically surgical. The ideal adjuvant treatment remains unknown. A number of recent studies have examined the influence of radiation, chemotherapy, and combinations of chemotherapy and radiation for uterine carcinosarcoma. SUMMARY Carcinosarcoma is an aggressive neoplasm. A number of studies are underway to determine the optimal adjuvant therapy for these tumors.
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Vasconcelos ALC, Nunes B, Duarte C, Mendonça V, Ribeiro J, Jorge M, Monteiro Grillo I. Tamoxifen in breast cancer ipse dixit in uterine malignant mixed Müllerian tumor and sarcoma-A report of 8 cases and review of the literature. Rep Pract Oncol Radiother 2013; 18:251-60. [PMID: 24416561 DOI: 10.1016/j.rpor.2013.06.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 05/15/2013] [Accepted: 06/30/2013] [Indexed: 11/17/2022] Open
Abstract
AIM Report the outcome of 8 patients (pts) with breast cancer (BC) treated with Tamoxifen (TAM) that developed malignant mixed Müllerian tumor (MMMT) and rare uterine sarcoma (RUS). PATIENTS AND METHODS Retrospective study based on data collected from the department medical records between April 1999 and September 2010 among 583 pts with endometrial cancer, 36 pts with MMMT and RUS histopathology. Among them, 8 pts underwent TAM between 4 and 10 years due to a previous diagnosis of BC; all pts were post-menopausal with regular gynecological surveillance; 6 pts (75%) with abnormal uterine bleeding. The diagnosis of 6 pts (MMMT) and 2 pts (RUS) occurred at median interval of 8 years (range 4-12) after initial BC treatment. Pts underwent surgical treatment and were staged as stage I (3pts), IIIA (3pts) and IIIC (2 pts) (FIGO 1988); followed by whole pelvis irradiation (50 Gy) and intracavitary HDR brachytherapy boost (24 Gy). Two pts underwent chemotherapy (CT). Overall and disease free survival was calculated by Kaplan Meier method. RESULTS With a median follow-up of 47 months (range 17-130), 3 pts remain alive recurrence-free of BC and RUS. Four pts died with distant metastasis within the first follow-up year, without BC. One pt died from non-related cancer cause. No evidence of local recurrence was found in the whole group of pts. At two years, DFS and OS were 40% and 80%, respectively. CONCLUSION As reported in the literature, TAM administration and causal effect on MMMT and RUS in BC pts is still unknown. No reports about outcome from these specific pts were found.
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Affiliation(s)
- Ana Luisa Cardoso Vasconcelos
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Beatriz Nunes
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Catarina Duarte
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Vera Mendonça
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Joana Ribeiro
- Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Marília Jorge
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
| | - Isabel Monteiro Grillo
- Serviço de Radioterapia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Serviço de Oncologia Hospital Santa Maria, CHLN, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal ; Instituto de Medicina Molecular, FMUL, Serviço de Radioterapia do Hospital Santa Maria, Av. Prof. Egas Moniz, 1649-035 Lisboa, Portugal
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Koussidis GA, Douridas IA, Sotiropoulou M, Kioses E. Pathogenesis and origin of extragenital Müllerian carcinosarcoma: evident or still vague? J OBSTET GYNAECOL 2013; 33:427. [PMID: 23654339 DOI: 10.3109/01443615.2013.773296] [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]
Affiliation(s)
- G A Koussidis
- Gyneeworks Cambridge Gynaecology Healthcare, Cambridge, UK.
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Galaal K, van der Heijden E, Godfrey K, Naik R, Kucukmetin A, Bryant A, Das N, Lopes AD. Adjuvant radiotherapy and/or chemotherapy after surgery for uterine carcinosarcoma. Cochrane Database Syst Rev 2013; 2013:CD006812. [PMID: 23450572 PMCID: PMC6457622 DOI: 10.1002/14651858.cd006812.pub3] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND Uterine carcinosarcomas are uncommon with about 35% not confined to the uterus at diagnosis. The survival of women with advanced uterine carcinosarcoma is poor with a pattern of failure indicating greater likelihood of upper abdominal and distant metastatic recurrence. OBJECTIVES To evaluate the effectiveness and safety of adjuvant radiotherapy and/or systemic chemotherapy in the management of uterine carcinosarcoma. SEARCH METHODS We searched the Cochrane Gynaecological Cancer Group Trials Register, Cochrane Central Register of Controlled Trials (CENTRAL), 2012, Issue 10, MEDLINE and EMBASE up to November 2012. We also searched registers of clinical trials, abstracts of scientific meetings, reference lists of included studies and contacted experts in the field. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing adjuvant radiotherapy and/or chemotherapy in women with uterine carcinosarcoma. DATA COLLECTION AND ANALYSIS Two review authors independently abstracted data and assessed risk of bias. Hazard ratios (HRs) for overall survival (OS) and progression-free survival (PFS) and risk ratios (RRs) comparing adverse events in women who received radiotherapy and/or chemotherapy were pooled in random-effects meta-analyses. MAIN RESULTS Three trials met the inclusion criteria and these randomised 579 women, of whom all were assessed at the end of the trials. Two trials assessing 373 participants with stage III to IV persistent or recurrent disease, found that women who received combination therapy had a significantly lower risk of death and disease progression than women who received single agent ifosfamide, after adjustment for performance status (HR = 0.75, 95% confidence interval (CI): 0.60 to 0.94 and HR = 0.72, 95% CI: 0.58 to 0.90 for OS and PFS respectively). There was no statistically significant difference in all reported adverse events, with the exception of nausea and vomiting, where significantly more women experienced these ailments in the combination therapy group than the Ifosamide group (RR = 3.53, 95% CI: 1.33 to 9.37).In one trial there was no statistically significant difference in the risk of death and disease progression in women who received whole body irradiation and chemotherapy, after adjustment for age and FIGO stage (HR = 0.71, 95% CI: 0.48 to 1.05 and HR = 0.79, 95% CI: 0.53 to 1.18 for OS and PFS respectively). There was no statistically significant difference in all reported adverse events, with the exception of haematological and neuropathy morbidities, where significantly less women experienced these morbidities in the whole body irradiation group than the chemotherapy group (RR= 0.02, 95% CI: 0.00 to 0.16) for haematological morbidity and all nine women in the trial experiencing neuropathy morbidity were in the chemotherapy group). AUTHORS' CONCLUSIONS In advanced stage metastatic uterine carcinosarcoma as well as recurrent disease adjuvant combination, chemotherapy with ifosfamide should be considered. Combination chemotherapy with ifosfamide and paclitaxel is associated with lower risk of death compared with ifosfamide alone. In addition, radiotherapy to the abdomen is not associated with improved survival.
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Affiliation(s)
- Khadra Galaal
- Gynaecological Oncology, Princess Alexandra Wing, Royal Cornwall Hospital, Truro, UK.
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Brinton LA, Felix AS, McMeekin DS, Creasman WT, Sherman ME, Mutch D, Cohn DE, Walker JL, Moore RG, Downs LS, Soslow RA, Zaino R. Etiologic heterogeneity in endometrial cancer: evidence from a Gynecologic Oncology Group trial. Gynecol Oncol 2013; 129:277-84. [PMID: 23485770 DOI: 10.1016/j.ygyno.2013.02.023] [Citation(s) in RCA: 143] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 02/12/2013] [Accepted: 02/17/2013] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Although the epidemiology of typical endometrial carcinomas (grades 1-2 endometrioid or Type I) is well established, less is known regarding higher grade endometrioid or non-endometrioid carcinomas (Type II). Within a large Gynecologic Oncology Group trial (GOG-210), which included central pathology review, we investigated the etiologic heterogeneity of endometrial cancers by comparing risk factors for different histologic categories. METHODS Based on epidemiologic questionnaire data, risk factor associations, expressed as odds ratios (OR) with 95% confidence intervals (CI), were estimated comparing grade 3 endometrioid and Type II cancers (including histologic subtypes) to grades 1-2 endometrioid cancers. RESULTS Compared with 2244 grades 1-2 endometrioid cancers, women with Type II cancers (321 serous, 141 carcinosarcomas, 77 clear cell, 42 mixed epithelial with serous or clear cell components) were older; more often non-white, multiparous, current smokers; and less often obese. Risk factors for grade 3 endometrioid carcinomas (n=354) were generally similar to those identified for Type II cancers, although patients with grade 3 endometrioid tumors more often had histories of breast cancer without tamoxifen exposure while those with Type II tumors were more frequently treated with tamoxifen. Patients with serous cancers and carcinosarcomas more frequently had breast cancer histories with tamoxifen treatment compared to patients with other tumors. CONCLUSIONS Risk factors for aggressive endometrial cancers, including grade 3 endometrioid and non-endometrioid tumors, appear to differ from lower grade endometrioid carcinomas. Our findings support etiologic differences between Type I and II endometrial cancers as well as additional heterogeneity within Type II cancers.
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Affiliation(s)
- Louise A Brinton
- Hormonal and Reproductive Epidemiology Branch, National Cancer Institute, Rockville, MD 20852, USA.
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Devor EJ, DE Mik JN, Ramachandran S, Goodheart MJ, Leslie KK. Global dysregulation of the chromosome 14q32 imprinted region in uterine carcinosarcoma. Exp Ther Med 2012; 3:677-682. [PMID: 22969950 DOI: 10.3892/etm.2012.458] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2011] [Accepted: 12/20/2011] [Indexed: 12/12/2022] Open
Abstract
Uterine carcinosarcoma (UCS) is a rare but very aggressive cancer of the female reproductive tract with an extremely poor prognosis. With the goal of understanding the role of microRNA (miRNA) dysregulation in these tumors, we profiled the expression of 667 human miRNAs in a panel of eight UCS patients and five benign control primary tissue samples. These expression profiles revealed two important characteristics of UCS. First, compared with the two most common uterine cancers, endometrial endometrioid adenocarcinoma and endometrial serous adenocarcinoma, UCS samples display a virtually unique pattern of miRNA dysregulation with an overlap of only 5% among the three tumor types. In addition, nearly one-third of the miRNAs significantly dysregulated in UCS tissues compared with benign endometrium (32 of 114) lie in a single small (250-kb) imprinted region of chromosome 14q32. These data suggest that the presence of such a global, region-specific disruption substantially contributes to the unique histology and poor outcome of this type of cancer.
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TONG SY, LEE JM, CHOI YJ, LEE JK, KIM JW, CHO CH, KIM SM, PARK SY, PARK CY, KIM KT. The comparison of clinicopathological characteristics in primary malignant mixed műllerian tumour with epithelial endometrial carcinoma. Aust N Z J Obstet Gynaecol 2011; 52:44-8. [DOI: 10.1111/j.1479-828x.2011.01389.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Comparison of survival outcomes between patients with malignant mixed mullerian tumors and high-grade endometrioid, clear cell, and papillary serous endometrial cancers. Int J Gynecol Cancer 2011; 21:877-84. [PMID: 21666484 DOI: 10.1097/igc.0b013e31821a62dd] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
INTRODUCTION Malignant mixed mullerian tumors (MMMTs) are an aggressive subtype of endometrial cancer (EC). Previous studies compare survival between high-grade endometrioid (EM), clear cell (CC), and papillary serous (PS) ECs; yet few studies compare MMMTs to these aggressive subtypes. The goal of this study was to compare recurrence-free survival (RFS), disease-specific survival (DSS), and overall survival (OS) among EC subtypes. METHODS We conducted a retrospective cohort study of EC cases treated at Magee-Women's Hospital between 1996 and 2008. Kaplan-Meier estimates of RFS, DSS, and OS as well as and log-rank tests were used to compare survival distributions between histologic subtypes. Cox regression was used to estimate hazard ratios for histologic subtypes, adjusted for other significant prognostic factors. Interactions between histologic subtype and prognostic factors were examined to assess effect modification. RESULTS This cohort included 81 MMMT (15%), 254 high-grade EM (46%), 73 CC (13%), and 147 PS (26%) cases. Compared to high-grade EM (6%) and CC (7%) cases, relatively more MMMT (12%) and PS (12%) cases were nonwhite. Stage differed significantly among the subtypes, with 36%, 34%, 37%, and 51% of MMMT, high-grade EM, CC, and PS cases, respectively, diagnosed at advanced late stage (P<0.001). Kaplan-Meier curves and log-rank tests showed similar RFS, DSS, and OS between MMMT, high-grade EM, CC, and PS cases stratified by stage. In adjusted Cox regression models, RFS and DSS were not significantly different between MMMT and other subtypes. High-grade EM cases had a significantly better OS compared to MMMT cases (HR, 0.63; 95% confidence interval [CI], 0.41-0.98). CONCLUSIONS This is the first retrospective study to suggest that certain survival outcomes are similar among MMMT, high-grade EM, CC, and PS subtypes. Other large-scale studies are needed to confirm these findings.
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Chiyoda T, Tsuda H, Tanaka H, Kataoka F, Nomura H, Nishimura S, Takano M, Susumu N, Saya H, Aoki D. Expression profiles of carcinosarcoma of the uterine corpus-are these similar to carcinoma or sarcoma? Genes Chromosomes Cancer 2011; 51:229-39. [PMID: 22072501 DOI: 10.1002/gcc.20947] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 10/06/2011] [Indexed: 01/07/2023] Open
Abstract
Uterine carcinosarcoma (CS) is usually classified as uterine endometrial carcinoma (EC). However, CS is more aggressive even compared with high grade EC. CS is also reported to undergo epithelial to mesenchymal transition (EMT). In this study, we compared the gene expression profiles of CS, EC, and uterine sarcoma (US) and evaluated the role of EMT and chromosomal aberrations in CS tumor formation. Frozen tissues of 46 patients (14 CS, 24 EC, and 8 US) were included. The similarity was examined by Gene Set Enrichment Analysis (GSEA), Fisher's exact test, and clustering using "intrinsic gene set". We examined the expression of 39 EMT-related genes and evaluated TGF-beta signaling by phospho-SMAD2/3 (p-SMAD2/3) staining. Chromosomal regions differing between CS and EC were identified by chromosomal GSEA and comparative genomic hybridization (CGH) microarrays. Three statistical methods confirmed that CS resembled US rather than EC. Acquired markers of EMT were upregulated and attenuated markers of EMT were downregulated in CS. Immunohistochemistry showed that carcinomatous region of CS have higher expression of p-SMAD2/3 than EC (P = 0.008). Chromosomal GSEA showed that genes located at 19q13 had higher expression in CS. Furthermore, CGH microarray indicated that the TGFB1 locus at 19q13.1 was amplified in 4 of 7 samples. Based on the expression profile, CS resembles US rather than EC. TGF-beta signaling is activated in CS and chromosomal gains at 19q13, which includes the TGFB1 locus, suggest that this may contribute to high expression of TGF-beta and thereby EMT phenotype of CS.
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Affiliation(s)
- Tatsuyuki Chiyoda
- Department of Obstetrics and Gynecology, School of Medicine, Keio University, Tokyo, Japan
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Song T, Choi CH, Lee YY, Kim TJ, Lee JW, Kim BG, Bae DS. Which is worse: uterine papillary serous carcinomas or carcinosarcomas? J Gynecol Oncol 2011; 22:83-8. [PMID: 21860733 PMCID: PMC3152760 DOI: 10.3802/jgo.2011.22.2.83] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2010] [Revised: 11/28/2010] [Accepted: 12/06/2010] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE It is clear that uterine carcinosarcomas and uterine papillary serous carcinomas (UPSC) have an adverse impact on outcome, but whether carcinosarcomas are worse than UPSC is unclear. The purpose of this study is to compare the pathology, survival, and disease recurrence of patients with carcinosarcomas to patients with UPSC. METHODS The medical records of patients diagnosed with carcinosarcomas and UPSC between 1996 and 2009 at Samsung Medical Center were retrospectively analyzed. Information from pathology reports, site of relapse, time to recurrence, and death was obtained. The survival analysis was performed using the Kaplan-Meier method. RESULTS Thirty seven patients with carcinosarcomas and 38 patients with UPSC were identified during the study period. There was no significant difference in clinical characteristics including age, body mass index, proportion with advanced stage disease, rate of optimal debulking, and adjuvant treatment used. In addition, the pathology showed no significant difference in tumor size, myometrial involvement, lymphovascular invasion, peritoneal cytology, cervical invasion, and lymph node involvement. Patients with carcinosarcomas had similar patterns of relapse as the patients with UPSC. There was no difference in the progression-free and overall survival between the carcinosarcomas and UPSC patients (p=0.804 and p=0.651, respectively). CONCLUSION Patients with carcinosarcomas had similar clinicopathological features compared to the patients with UPSC.
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Affiliation(s)
- Taejong Song
- Department of Obstetrics and Gynecology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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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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Kurshumliu F, Rung-Hansen H, Skovlund VR, Gashi-Luci L, Horn T. Primary malignant mixed müllerian tumor of the peritoneum a case report with review of the literature. World J Surg Oncol 2011; 9:17. [PMID: 21294883 PMCID: PMC3039619 DOI: 10.1186/1477-7819-9-17] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2010] [Accepted: 02/04/2011] [Indexed: 11/23/2022] Open
Abstract
Malignant mixed Müllerian tumor is a rare malignancy of the genital tract and extremely uncommon in extragenital sites. This report describes a case of malignant mixed Müllerian tumor arising in the lower peritoneum of a 72-year-old female patient. The patient presented with ascites, lower abdominal mass and pleural effusion. The serum level of CA125 was elevated. At operation a diffuse carcinosis associated with tumor mass measuring 20 × 15 × 10 cm in the vesicouterine and Duglas' pouch were found. The uterus and the adnexa were unremarkable. Histopathology revealed a typical malignant mixed Müllerian tumor, heterologous type. The epithelial component was positive for cytokeratin 7 and vimentin whereas the mesenchymal component was positive for Vimentin, S100 and focally for CK7. The histogenesis of this tumor arising from the peritoneum is still speculative. Based on the previous reports and the immunohistochemical analysis of our case, we believe that this is a monoclonal tumor with carcinoma being the "precursor" element. Nevertheless, further molecular and genetic evidence is needed to support such a conclusion.
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Affiliation(s)
- Fisnik Kurshumliu
- Institute of Anatomic Pathology, Medical School, University Clinical Center, Prishtina, Kosovo
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Giraudet G, Collinet P, Farine MO, Narducci F, Poncelet E, Baranzelli MC, Vinatier D. [Twenty-two cases of uterine carcinosarcomas]. ACTA ACUST UNITED AC 2010; 40:22-8. [PMID: 21112160 DOI: 10.1016/j.jgyn.2010.10.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2010] [Revised: 10/09/2010] [Accepted: 10/18/2010] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Twenty-two uterine carcinosarcomas were treated and followed in two centers over 10 years. We wanted to describe them and review the literature on the subject. PATIENTS AND METHODS We describe all uterine carcinosarcomas treated in Lille, over 10 years, both in department of gynecology, Hospital Jeanne-de-Flandre (11 patients), and in department of gynecologic oncology of Centre Oscar-Lambret (11 patients). RESULTS For the 22 patients included, we give age at time of diagnosis, body mass index, pre and post surgical histology, details of surgical treatment, adjuvant treatment and evolution of the pathology. Mean age at time of diagnosis was 69.6. Sixty-eight percent of patients had overweight or obesity. Revealing symptoms were in 91% of cases post-menopausal meno- or metrorrhagias. Preoperatively, histology had an important number of false negative and, 57% of diagnoses were ignored in our study. All patients had first intention surgery, only 54% were yet at an early stage. Sixteen had association radiotherapy, eight of chemotherapy, two declined any adjuvant treatment. Ten patients died with a mean survival of 12.9 months, eight had a good evolution still at 35 months, two had recent pelvic relapse, two were lost to follow-up. CONCLUSION Uterine carcinosarcomas are rare, aggressive, yet not very well known tumors. First line treatment will be surgery with peritoneal cytology, hysterectomy, bilateral adnexectomy, pelvic and sometimes lumbo-aortic lymphadenectomy, omentectomy, peritoneal biopsies. Adjuvant chemotherapy has shown its interest in this type of tumor. Radiotherapy is still debated.
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Affiliation(s)
- G Giraudet
- Clinique de gynécologie médico-chirurgicale, hôpital Jeanne-de-Flandre, CHRU de Lille, France.
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Abstract
There are only a few reports of uterine cancers in women with Down syndrome, whose tumor profile is marked by a reduced risk for solid neoplasms. There are no reports of a uterine carcinosarcoma arising in a woman with Down syndrome. in our case, a delayed diagnosis of uterine carcinosarcoma was confirmed in a 38-year-old, nulliparous, single, obese woman with Down syndrome, who presented with irregular vaginal bleeding. Although uterine cancers are underrepresented in women with Down syndrome, uterine malignancy should be considered in the differential diagnosis of abnormal vaginal bleeding. A timely and complete gynecological examination will preclude a delay in diagnosis.
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Bansal S, Lewin SN, Burke WM, Deutsch I, Sun X, Herzog TJ, Wright JD. Sarcoma of the cervix: natural history and outcomes. Gynecol Oncol 2010; 118:134-8. [PMID: 20541244 DOI: 10.1016/j.ygyno.2010.04.021] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Revised: 04/17/2010] [Accepted: 04/29/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Cervical sarcomas are rare neoplasms thought to follow an aggressive course. We examined the natural history of cervical sarcomas and compared their outcomes to that of squamous cell and adenocarcinomas of the cervix. In addition, we examined the prognostic significance of various demographic, clinical, and treatment related factors. METHODS The Surveillance, Epidemiology, and End Results (SEER) database was used to identify all women with primary cervical sarcomas diagnosed between 1988 and 2005. The clinical characteristics and outcomes of women with cervical sarcomas were compared to patients with squamous cell and adenocarcinomas of the cervix. Survival was examined using multivariable Cox proportional hazards models and the Kaplan-Meier method. RESULTS A total of 33,074 women with invasive cervical neoplasms were identified including 323 (1%) patients with cervical sarcomas. Among women with cervical sarcomas, carcinosarcoma was the most common and accounted for 40% (128) of the cases while adenosarcomas and leiomyosarcomas each accounted for 21% (67). Compared to women with squamous cell and adenocarcinomas, patients with cervical sarcomas tended to be younger, diagnosed in the later years of the study, have larger tumors, and have more advanced stage disease (p<0.05 for all). After adjusting for other known prognostic factors, patients with cervical sarcomas were 60% more likely to die from their tumors (cancer-specific survival HR=1.60; 95% CI, 1.30-1.96), (overall survival HR=1.60; 95% CI, 1.36-1.89) than patients with squamous cell carcinomas. A separate multivariable analysis limited to women with cervical sarcomas revealed no difference in survival for any of the sarcoma subtypes. CONCLUSION Primary cervical sarcomas are aggressive neoplasms. The prognosis for women with cervical sarcomas is inferior to that of squamous cell and adenocarcinomas matched by stage.
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Affiliation(s)
- Sharmilee Bansal
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, Columbia University College of Physicians and Surgeons, 161 Fort Washington Avenue, New York, NY 10032, USA
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Ratner ES, Tuck D, Richter C, Nallur S, Patel RM, Schultz V, Hui P, Schwartz PE, Rutherford TJ, Weidhaas JB. MicroRNA signatures differentiate uterine cancer tumor subtypes. Gynecol Oncol 2010; 118:251-7. [PMID: 20542546 DOI: 10.1016/j.ygyno.2010.05.010] [Citation(s) in RCA: 72] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2009] [Revised: 04/09/2010] [Accepted: 05/11/2010] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Endometrial cancer (EC) is the most common gynecologic malignancy. Type I EC has a favorable prognosis, while type II ECs account for half of all treatment failures. Little knowledge of the biological differences is available to predict EC outcomes besides their pathological distinctions. MicroRNAs (miRNA) are a family of non-translated RNAs important in regulating oncogenic pathways. Mis-expression patterns of miRNAs in EC, as well as differences in miRNA expression patterns between the subtypes of EC, has not been previously evaluated. Our purpose was to identify miRNA profiles of EC subtypes, and to identify miRNAs associated with these subtypes to ultimately understand the different biological behavior between these subtypes. METHODS Ninety-five fresh/frozen and paraffin-embedded samples of endometrial type I and II cancer, carcinosarcomas and benign endometrial samples were collected. MiRNA expression profiles were evaluated by microarray analysis. Statistical analysis was performed. RESULTS Distinct miRNA signatures in tumor versus normal samples and in endometrioid vs. uterine papillary serous carcinomas exist. Additionally, carcinosarcomas have a unique miRNA signature from either the type I or II epithelial tumors. CONCLUSIONS We hypothesize that further understanding the miRNAs that separate these subtypes of EC will lead to biological insights into the different behavior of these tumors.
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Affiliation(s)
- Elena S Ratner
- Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Yale University School of Medicine, New Haven, CT, USA
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Abstract
Carcinosarcoma of the ovary, also referred to as mixed mullerian tumor of the ovary, is a rare and aggressive tumor. This tumor type is unique in that it contains malignant epithelial and stromal elements. The average survival for a woman diagnosed with carcinosarcoma of the ovary is less than 2 years. Due to the rarity of this tumor, the optimal treatment for carcinosarcoma of the ovary has not been determined. We review the pathology, risk factors, and current treatment recommendations for carcinosarcoma of the ovary.
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Djordjevic B, Gien L, Covens A, Malpica A, Khalifa M. Polypoid or non-polypoid? A novel dichotomous approach to uterine carcinosarcoma. Gynecol Oncol 2009; 115:32-36. [DOI: 10.1016/j.ygyno.2009.06.018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2009] [Revised: 06/14/2009] [Accepted: 06/15/2009] [Indexed: 11/27/2022]
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Zagouri F, Dimopoulos AM, Fotiou S, Kouloulias V, Papadimitriou CA. Treatment of early uterine sarcomas: disentangling adjuvant modalities. World J Surg Oncol 2009; 7:38. [PMID: 19356236 PMCID: PMC2674046 DOI: 10.1186/1477-7819-7-38] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2008] [Accepted: 04/08/2009] [Indexed: 11/10/2022] Open
Abstract
Uterine sarcomas are a rare group of neoplasms with aggressive clinical course and poor prognosis. They are classified into four main histological subtypes in order of decreasing incidence: carcinosarcomas, leiomyosarcomas, endometrial stromal sarcomas and "other" sarcomas. The pathological subtype demands a tailored approach. Surgical resection is regarded as the mainstay of treatment. Total abdominal hysterectomy and bilateral salpingo-oophorectomy represents the standard treatment of uterine sarcomas. Pelvic and para-aortic lymph node dissection in carcinosarcomas is recommended, given their high incidence of lymph node metastases, and may have a role in endometrial stromal sarcomas. Adjuvant radiation therapy has historically been of little survival value, but it appears to improve local control and may delay recurrence. Regarding adjuvant chemotherapy, there is little evidence in the literature supporting its use except for carcinosarcomas. However, more trials are needed to address these issues, especially, their sequential application. Patients with uterine sarcomas should be referred to large academic centers for participation in clinical trials.
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Affiliation(s)
- Flora Zagouri
- Department of Clinical Therapeutics, Alexandra Hospital, University of Athens, School of Medicine, Athens, Greece.
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Hwang IC, Kuk MJ, Kim KK, Lee KB, Na SY, Lee KS, Suh HS. One Case of Malignant Mixed Müllerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy. Korean J Fam Med 2009. [DOI: 10.4082/kjfm.2009.30.9.723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Affiliation(s)
- In Cheol Hwang
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Myoung Jin Kuk
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kyoung Kon Kim
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Ki Bum Lee
- Department of Obstetrics and Gynecology, Gachon University Gil Hospital, Incheon, Korea
| | - Seo Young Na
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Kyoung Sik Lee
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
| | - Heuy Sun Suh
- Department of Family Medicine, Gachon University Gil Hospital, Incheon, Korea
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Reed N. The Management of Uterine Sarcomas. Clin Oncol (R Coll Radiol) 2008; 20:470-8. [DOI: 10.1016/j.clon.2008.04.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Revised: 03/23/2008] [Accepted: 04/05/2008] [Indexed: 01/09/2023]
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Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI. AJR Am J Roentgenol 2008; 191:278-83. [PMID: 18562759 DOI: 10.2214/ajr.07.3281] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of our study was to evaluate the sonographic, contrast-enhanced CT, and gadolinium-enhanced MRI findings of primary malignant mixed müllerian tumors (MMMTs) of the uterus. CONCLUSION Uterine MMMT most commonly presents as an intracavitary mass with coexistent dilatation of the endometrial canal. Tumors tend to appear hyperechoic on sonography, heterogeneously hypodense and ill defined on contrast-enhanced CT, and heterogeneously hyperintense on T2-weighted MR images with signal abnormalities indicating subacute hemorrhage on T1-weighted MR images. Myometrial invasion is common and has a predilection for the uterine fundus.
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