Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature

Cytological diagnosis of patients with embryonal rhabdomyosarcoma of the cervix: case report and literature review

Cervical embryonal rhabdomyosarcoma(ERMS) is a rare malignancy. To date, no cases of ERMS diagnosed by cervical cytology have been reported. In this study, we report a case of cervical ERMS identified by a liquid-based cytology test and cell blocks in a 46-year-old postmenopausal woman. We describe the cytological features of ERMS, with the aim of helping cytopathologists recognize this rare cervical tumor.

Cancer of the vagina: 2021 update

Diagnosis of a primary vaginal cancer is rare, as most vaginal tumors are metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This is associated with persistence of high‐risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, as with cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.

A review of the different histologic subtypes of primary vaginal cancer in terms of staging and role of imaging, as well as treatment options and prognoses.

Childhood Rhabdomyosarcoma of the Female Genital Tract: Association with Pathogenic DICER1 Variation, Clinicopathological Features, and Outcomes

STUDY OBJECTIVE

Rhabdomyosarcomas (RMSs) of the female genital tract (FGT) have been recently shown to be associated with germline pathogenic variation in DICER1, which can underlie a tumor predisposition disorder. We sought to determine the incidence of a pathogenic variation in DICER1 in a cohort of RMSs of the FGT, as well as to evaluate the clinicopathological features and outcomes of the patients. DESIGN, SETTING, PARTICIPANTS, INTERVENTIONS, AND MAIN OUTCOME MEASURES: We retrospectively reviewed medical records of the patients diagnosed with RMS of the FGT between 1990 and 2019. Molecular genetic sequencing of the tumor to detect an RNase IIIb domain hot spot mutation in DICER1 samples was performed in 7 patients. Individuals with a missense mutation in the tumor were also screened for a loss of function germline mutation in DICER1.

RESULTS

Of 210 cases of pediatric RMS, 11 arose from the FGT. Molecular genetic sequencing of the tumor samples revealed a somatic missense mutation in the RNase IIIb domain of DICER1 in a total of 3 patients, 2 patients with embryonal RMS of the cervix/uterus, and 1 patient with ovarian embryonal RMS. As a result of genetic testing for the loss of function germline mutation in DICER1, a heterozygous pathogenic variant was also found in 2 of these patients.

CONCLUSION

Despite the limited number of patients, our findings suggest that it is important to be aware of the possible association between RMS of FGT and pathogenic germline DICER1 variants because the detection of this mutation in a patient or relatives can provide the opportunity for surveillance of related conditions that might improve long-term outcomes and survival.

Diagnosis and treatment of pleomorphic rhabdomyosarcoma of the uterus: a rare case report and review of the literature

Pleomorphic rhabdomyosarcomas of the uterus (PRMSu) is a rare malignant tumor of the female genital tract. Accurate diagnosis and effective treatment of PRMSu are important. We report an 81-year-old woman who was diagnosed with PRMSu. She had an extremely unusual presentation of secondary dyspnea because of an extremely large uterus (26.0 cm). Pelvic magnetic resonance imaging showed rare severe enlargement and intrauterine filling with tumor tissue, and she was initially diagnosed with uterine leiomyosarcoma. The patient underwent hysterectomy, as well as bilateral salpingo-oophorectomy and omentectomy, and was finally confirmed as having PRMSu by histopathology combined with immunohistochemistry. We performed a systematic review of the literature between 1982 and 2020 and focused on different treatment strategies and prognosis of PRMSu. A retrospective review of 28 cases was conducted and survival analysis was estimated by using the Kaplan–Meier method. We found that the accuracy of diagnosis of PRMSu completely depends on histopathology and immunohistochemistry because of no special clinical symptoms, no sensitive tumor markers, and no special imaging findings. Although there is no standardized approach for treating this rare disease, the treatment strategy of a surgical operation combined with adjuvant chemotherapy appears to be the best choice.

Uterine cavity embryonal rhabdomyosarcoma

Rhabdomyosarcoma (RMS) is a rare solid tumor in childhood and adolescence. The higher incidence is predominant during the first two decades of life. According to the Intergroup RMS Study Group, the embryonal RMS (ERMS), botryoidal variant, constitutes a histological subtype characterized as a “grape-like” lesion of 2.0 cm to 9.5 cm. The treatment involves chemotherapy, surgery, and/or radiotherapy. We present the case of a 14-year-old female patient diagnosed with ERMS, botryoidal variant, which originated in the uterine cervix with vaginal externalization. The initial therapeutic approach comprised an initial prolapsed mass excision followed by Wertheim–Meigs surgery due to the tumor extension. No consensual protocol to ERMS treatment is found in the medical literature; however, a combined approach seems to offer a better result. The postoperative time period was uneventful and the patient followed an adjuvant therapy with vincristine, d-actinomycin, and cyclophosphamide. A comprehensive evaluation of the therapeutic options preserving the reproductive function—unfortunately not always possible—is part of a multi-disciplined care team concerning the pediatric patients.

Recurrent Cervical Sarcoma Botryoides in a 3-Year-Old Female: Approach in a Limited Resource Setting

BACKGROUND Sarcoma botryoides, known as embryonal rhabdomyosarcoma (ERMS), is a malignant tumor which arises from embryonic muscle cells. The incidence of ERMS in the uterine cervix rarely occurs at a very young age. With sufficient resources, management of this disease is not difficult. However, in limited resources settings, such as in Indonesia, the situation is more challenging. This case report aims to highlight the difficulties encountered in diagnosing and treating patients with sarcoma botryoides. CASE REPORT A 3-year-old female patient came the outpatient clinic of our hospital with a protruding mass from her vagina resembling a bunch of grapes which easily bled. She underwent surgery to remove the mass. After the procedure, she did not return to the hospital for the recommended adjuvant chemotherapy treatment due to limited funds. Three months later, she came to the outpatient clinic with the same complaint, despite smaller size. Due to limited resources, we only evaluated the metastasis using chest x-ray and did not perform intra-operative biopsy. In the second surgery, a wide excision with 1-2 cm margin was performed, followed by adjuvant chemotherapy for 6 series. We achieved a satisfactory outcome in this case, and 18 months after the surgery, the patient was still in remission. CONCLUSIONS Sarcoma botryoides is a rare malignancy. The effective treatment for sarcoma botryoides is wide excision with safe margin of 1-2 cm, followed by 6-12 cycles of vincristine, actinomycin D, and cyclophosphamide (VAC) regiment as an adjuvant chemotherapy. A family's understanding of the treatment plan is important to achieve desired outcomes. Even with limited resources, this malignancy can still be properly treated.

Cancer of the vagina

Diagnosis of a primary vaginal cancer is rare because most of these lesions will be metastatic from another primary site. Although cancer of the vagina is more common in postmenopausal women, an increase in young women being diagnosed with primary vaginal cancer has been reported, especially in countries with a high HIV prevalence. This will be associated with persistence of high-risk HPV infection. The emphasis should be on primary prevention with prophylactic HPV vaccination. Once there is a suspicion of a primary vaginal cancer, this should be confirmed histologically with biopsy. Staging has been done clinically, similar to cervical cancer; however, there is a role for imaging in assisting with staging as this is often a difficult assessment. Treatment should be individualized and depends on stage as well as histologic subtype. It is prudent to refer cases to centers of excellence with experience in dealing with this rare gynecological cancer.

[A rare cases of rhabdomyosarcoma of the uterine cervix: about a case and review of the literature]

Le rhabdomyosarcome du col utérin fait partie des types histologiques rares des cancers du col, qu'on observe généralement chez la jeune fille ou la femme en période d'activité générale. La stratégie thérapeutique se base sur l'association des trois modalités thérapeutiques (chimiothérapie-radiothérapie-chirurgie) vu l'agressivité de la maladie. Nous rapporterons ainsi un cas de rhabdomyosarcome du col utérin chez une fille de 20 ans. Il s'agit d'une patiente âgée de 20 ans, rapportant comme antécédents pathologique particulier la notion d'infection génitale à répétition. Le premier signe rapporté était des métrorragies abondantes avec à l'examen la présence d'une masse cervicale en grappe de raisin. La biopsie était en faveur d'un rhabdomyosarcome du col. Le bilan d'extension montrait une masse localement avancée sans métastase. La patiente a reçu 5 cures de VAC avec une régression du processus tumoral de 90%. Patiente fut opérée et a bénéficié d'une hystérectomie sans conservation des annexes. Puis elle a bénéficié d'une radiothérapie postopératoire sur le pelvis. Le recul était de 13 mois, la patiente est toujours en rémission complète. Le RMS du col utérin est une tumeur rare qui survit essentiellement chez la jeune fille. L'extension est surtout locorégionale. Le traitement consiste en un geste chirurgical allant d'un éventuel traitement conservateur jusqu'au traitement radical associé à une chimiothérapie péri-opératoire. La place de la radiothérapie demeure imprécise.

Abnormal vaginal bleeding in women with gynaecological malignancies

Abnormal vaginal bleeding is a common gynaecological symptom, and most causes are benign. International Federation of Gynaecology and Obstetrics proposed a PALM-COEIN classification in 2011 to decrease heterogeneity in studies. The gynaecological malignancies that present with abnormal bleeding vary according to the age of the patient and the origin (upper versus lower genital tract). It is important that a thorough history and examination is performed to make this distinction. The common malignancies presenting symptoms and treatment are discussed in this article according to the age of the patient. There is a considerable overlap between the reproductive age and menopause. This article focuses on children, adolescents and women in the reproductive age group.

Literature Review of Benign Müllerian Papilloma Contrasted With Vaginal Rhabdomyosarcoma

STUDY OBJECTIVES

Benign müllerian papillomas of the genital tract are rare and, hence, can be mistaken for vaginal rhabdomyosarcoma on initial clinical review. This review of the literature will consolidate the previous cases of müllerian papilloma reported and looks for clues to differentiate the 2 entities.

DESIGN AND SETTING

We provide a case report and literature review, with patients from a pediatric adolescent gynecology clinic in a tertiary center.

METHODS

We conducted a search of English-language publications from 1951 (the first case report) until January 2014 by using the search words "Müllerian papilloma" and "prepubertal bleeding." References from previous published reports were also obtained for completeness.

MAIN OUTCOME

Literature review of benign müllerian papilloma.

RESULTS

Since 1951, 56 cases of müllerian papilloma were reported, including 4 cases at our institution. Comorbid conditions were found in 31.5% of cases (with 3 cases associated with mesenchymal tumors). The average length of time from onset of symptoms (primarily vaginal bleeding) to diagnosis was 6.7 months (range, 1 day to 3 years), with only 1 case diagnosed incidentally. Median age of presentation was 5 years (range, 1 day to 52 years). Most cases were localized and resected with ease. Histology reveals complex papillary lesions without cytologic atypia.

CONCLUSION

Benign müllerian papilloma is distinguished from the more significant diagnosis of vaginal rhabdomyosarcoma by initial length of vaginal bleeding at presentation, lack of vaginal wall extension, ease of resection, and histopathology. This is compared with vaginal rhabdomyosarcoma which commonly exhibits both localized and distant spread.

Wrong place at the wrong time: A case of cervical embryonal rhabdomyosarcoma in pregnancy

•

First case of NACT in cervical embryonal RMS

•

Second case occurring in pregnancy

•

Histological review outlining diagnostic difficulties

Embryonal rhabdomyosarcoma (botryoid type) of the uterine corpus and cervix in adult women: report of a case series and review of the literature

In its classical form, embryonal rhabdomyosarcoma (ERMS, botryoid type) is a vaginal neoplasm occurring in infants and young girls and is often not considered in the differential diagnosis of uterine corpus and cervical spindle cell tumors in adult women. Clinicopathologic and immunohistochemical features of 25 cases of ERMS in women 20 years of age or older were analyzed. Patient age ranged from 20 to 89 years (mean, 44.4 y; median, 46 y), with 8 patients aged 20 to 39 years, 14 patients aged 40 to 59 years, and 3 patients older than 60 years of age. Tumors originated in the cervix in 20 cases and in the uterine corpus in 5. They were characterized by an edematous hypocellular spindle cell proliferation, typically with cellular condensation beneath epithelial surfaces (cambium layer), in which tightly packed hypercellular foci were scattered. Neoplastic cells had hyperchromatic nuclei and minimal cytoplasm, usually with delicate cytoplasmic processes. Occasionally, elongated or globular cells with eosinophilic cytoplasm (rhabdomyoblasts) were evident, but cytoplasmic cross-striations were only rarely identified. Apoptotic bodies and mitotic figures were usually identified in the hypercellular foci. Hemorrhage was common, often making recognition of the hypercellular foci difficult. Desmin and myogenin were coexpressed in 22 of 23 (95.6%) tumors evaluated. Proliferative activity, as assessed by Ki-67 expression, was notably elevated in all tumors evaluated, typically concentrated in the hypercellular foci. Estrogen and progesterone receptors were expressed focally in only 3 of 12 (25%) and 1 of 8 (12.5%) tumors evaluated, respectively. Follow-up was available in 7 cases. Five patients were alive without evidence of disease with follow-up of 3 to 8 years, and 1 patient was alive with disease at 5 months. One patient died at 5 months with pulmonary nodules, but it was not determined whether this was due to metastatic ERMS or the patient's known ductal breast carcinoma. ERMS has a broader clinical profile than classically expected and should be considered in the differential diagnosis of a uterine corpus or cervical spindle cell tumor, regardless of patient age. Recognition can be rendered difficult by the hypocellular background, which can suggest a benign polyp or low-grade tumor, and hemorrhage, which can obscure the characteristic hypercellular foci. Identification of hypercellular foci in which mitotic activity and apoptotic bodies are found, desmin and myogenin are coexpressed, proliferative activity is notably elevated, and hormone receptor expression is usually absent is very useful for establishing the diagnosis.

18-Year-Old Woman with an Embryonal Rhabdomyosarcoma of the Uterus in Statu Nascendi

Background: We report a case of an 18-year-old woman with an embryonal rhabdomyosarcoma in statu nascendi. Case: A fist-sized embryonal rhabdomyosarcoma of the uterus filling the vaginal vault was diagnosed in an adolescent with virgo intacta suffering from therapy resistant vaginal discharge, bleeding and bulging mass for six months. Further imaging revealed one suspicious pelvine lymph node. Excision of the tumour including the intracervical stalk was performed and followed by systemic multiagent chemotherapy. PET-CT scan presented a complete response after the third cycle. Histological complete response was shown by laparoscopic dissection of regional pelvic lymph nodes and curettage. Conclusion: Uterine Rhabdomyosarcoma should be considered as differential diagnosis of therapy resistant vaginal flour and bleeding in young women. Fertility-sparing therapy is possible in selected exceptional cases.

Embryonal rhabdomyosarcoma of the uterine cervix in a 47-year-old woman

Embryonal rhabdomyosarcoma (RMS) of the female genital tract usually occurs in the vagina during childhood. The uterine cervix as a primary site is rare, but is more frequent until the second decade of life. It usually has a good prognosis and the treatment is based on multidrug chemotherapy, radiotherapy and surgery. RMS accounts for <5% of all adult soft tissue sarcomas. Previous reports that included all primary sites showed a poorer five-year disease specific survival for adults with RMS when compared to the pediatric population. This difference has been attributed to a higher proportion of adverse prognostic clinical and pathological factors, and to inadequate treatment given to adults with RMS. A total of 115 patients with cervical embryonal RMS have previously been described; however, only 10 cases were reported in women older than 40 years. We present a 47-year-old woman treated with radical hysterectomy followed by adjuvant chemotherapy and review the current literature.

Embryonal rhabdomyosarcoma: adjuvant and ex vivo assay-directed chemotherapy

The aim of this retrospective study was to evaluate differences in treatment of embryonal rhabdomyosarcoma (RMS) of the uterus in 2 premenopausal women. We discuss adjuvant chemotherapy and use of ChemoFx Assay (Precision Therapeutics, Pittsburgh, PA) to guide choice of active chemotherapeutic agents. Two premenopausal patients were identified with a pathologic diagnosis of embryonal RMS of the uterus. Both met inclusion criteria for the study. A 21-year-old woman underwent a staging abdominal hysterectomy for a variant of embryonal RMS. Vincristine, actinomycin D, and cyclophosphamide were given adjunctively for a complete response. A 20-year-old woman underwent a diagnostic dilation and curettage revealing embryonal RMS. Initial treatment included an abdominal hysterectomy and nodal sampling. Presentation to a subsequent gynecologic oncologist 7 months later revealed recurrence. Carboplatin, doxorubicin, and paclitaxel provided a partial response. After a second surgical resection, ChemoFx Assay identified ifosfamide and mitomycin C as active agents and resulted in a complete response. Recommended treatment includes surgery and chemotherapy with possible radiation therapy if deemed necessary. The benefit of adding neoadjuvant or adjuvant chemotherapy and radiation therapy allows for a conservative surgical approach and improved survival. Choosing active chemotherapy agents can be aided by ChemoFx Assay. The chemotherapy most commonly used for treatment of embryonal RMS is a combination of vincristine, actinomycin D, and cyclophosphamide.

Robotic radical hysterectomy and pelvic lymphadenectomy for uterine rhabdomyosarcoma

Mullerian rhabdomyosarcoma (RMS) is a rare malignancy most commonly diagnosed in childhood and adolescence. RMS of the female genital tract is often difficult to diagnose. Treatment includes chemotherapy with adjuvant surgery and/or radiation therapy reserved for persistent disease. We report a case of an 18-year-old African-American female who presented with severe menometrorrhagia, and was diagnosed with embryonal rhabdomyosarcoma of the uterus. After vincristine, dactinomycin, and cyclophosphamide failed to eradicate the central tumor, she underwent a robotic radical hysterectomy and pelvic lymphadenectomy. Mullerian rhabdomyosarcoma was once managed with multimodality therapy that often included ultraradical surgery including total pelvic exenteration. Surgical procedures that were exclusively performed via large abdominal incisions can now be completed with minimally invasive techniques. Robotic surgery can be safely and successfully applied to radical hysterectomy and lymphadenectomy for uterine rhabdomyosarcoma.

Clinicopathologic features of rhabdomyosarcoma of gynecologic origin in adults

Rhabdomyosarcoma (RMS) is the most common soft tissue tumor found in children. Up to 20% of RMS tumors in children originate in the genital tract making this the second most common site. RMS of gynecologic origin in adults is much less common. The purpose of this study was to describe the clinical and pathologic features of RMS of the adult female genital tract. We reviewed the histologic slides of women 16 years of age and older and included them in our study if they contained the classic histologic features of RMS as described by the 2002 World Health Organization classification of tumors. Rhabdomyoblastic components present in other established malignancies were not studied. We identified 15 patients, with a median age of 48 years (range, 16 to 69). Eleven (73%) of the tumors were of embryonal histology (cervix, 8; uterus, 2; and ovary, 1). Of the remaining 4 tumors, 2 were of alveolar (vulva) and 2 of pleomorphic (uterus, 1; fallopian tube, 1) histologic subtype. The majority (79%) of these patients presented with locoregional disease and had surgery as their primary intervention (73%). The median progression-free survival (PFS) and disease-specific survival was 9 months [95% confidence interval (CI), 1-24] and 21 months (95% CI, 14-28), respectively. The 5-year disease-specific survival was only 29%. There was a significant difference in PFS between cases of embryonal compared to cases with nonembryonal histology (19 vs. 3 mo, respectively) (P=0.04). Adult RMS of gynecologic origin presents with locoregional disease and most are morphologically similar to pediatric RMS; however, adult RMS behaves more aggressively, with worse overall survival. It is unclear whether these divergent outcomes are the result of differences in clinical management or because these tumors are biologically distinct.

Embryonal rhabdomyosarcoma (sarcoma botryoides) of the cervix presenting as a cervical polyp treated with fertility-sparing surgery and adjuvant chemotherapy

BACKGROUND

Embryonal rhabdomyosarcoma (sarcoma botryoides) of the female genital tract is rare in the cervix. It tends to occur in children and young women, and appears to have a better prognosis than sarcoma botryoides of the vagina and uterus.

CASE

We report a case of embryonal rhabdomyosarcoma (sarcoma botryoides) presenting as a cervical polyp in a 19-year-old female. The tumor was composed of rhabdomyoblasts of varying differentiation dispersed within a loose, myxoid stroma, and formed a distinct 'cambium' layer beneath the epithelium. The patient was successfully treated with fertility-sparing surgery and adjuvant chemotherapy.

CONCLUSIONS

Awareness of this uncommon lesion in this site and its clinical implications is important to avoid misdiagnosis. Therapy has recently inclined towards conservative treatment.

Alveolar rhabdomyosarcoma of the cervix

BACKGROUND

Alveolar rhabdomyosarcoma (RMS) has a high risk for local and distal failure. Multimodal management of a patient with alveolar RMS of the cervix uteri is outlined.

CASE

A 39-year-old woman suffered from alveolar RMS of the cervix without involvement of uterus and parametrium. She was treated with total hysterectomy and left salpingo-oophorectomy. Systemic chemotherapy and pelvic irradiation were also offered. She remains in clinical remission 3 years after presentation.

CONCLUSION

Postoperative chemotherapy and irradiation could be effective treatments for alveolar rhabdomyosarcoma of the cervix in adult patients.

Embryonal rhabdomyosarcoma of the uterine cervix: case report and review of the literature

OBJECTIVES

Sarcoma botryoides rarely arises in the uterine cervix. It usually presents in the adolescent age group. The peak incidence is in the second decade. A combined modality approach to treating rhabdomyosarcoma (RMS) has markedly improved survival. We present two cases of cervical RMS. One of them had a very aggressive clinical course.

CASE

Two cases of RMS in young women who presented with rapidly progressive cervical tumor are reported. They were treated with two-stage surgical procedure and chemotherapy.

CONCLUSIONS

A combined modality approach to treating RMS using multidrug chemotherapy, radiotherapy, and surgery has markedly improved survival. One of our cases has been free of disease for more than 5 years.

Protruding giant cervical polyp in a young adolescent with a previous rhabdomyosarcoma

Giant cervical polyps are rare entities, with only 8 reported cases in the international literature (MEDLINE 1966-2002). Of these cases, only one has been described in the pediatric population. There has been no report of a giant cervical polyp occurring in the older, although early, adolescent period. The discovery of a giant cervical polyp in a young adolescent is a gynecological oddity. The immense size of giant cervical polyps, together with their menacing appearance and unusual presentation, can simulate a malignant neoplasm. Care must be taken in their diagnosis and management so that the patient's fertility is not compromised. We report on a young adolescent girl with a previous history of a rhabdomyosarcoma (RMS), who presented with a giant cervical polyp protruding from the vaginal introitus. The literature on this entity is reviewed.

[Sarcoma botryoïde of the uterine cervix: report of a case]

Botryoïde sarcoma of the uterine cervix is a very rare tumor of the young woman or during genial activity. Less than 100 cases have been reported in the literature. The treatment ranged from radical surgery to conservative surgery followed by chemotherapy. We report a case of cervical botryoide rhabdomyosarcoma occurred in a 33 year-old woman treated primary by chemotherapy followed by surgery and adjuvant chemotherapy. The patient died by extensive metastatic retroperitoneal nodes and lung.

[Botryoide sarcoma of the uterine cervix. Apropos of 1 case]

Sarcoma botryoide (SB), a variant of rhabdomyosarcoma, is a rare tumor who are rarely localized in the uterine cervix. Only 99 cases have been described to date. The authors reported this case with review of the literature in order to insist on diagnosis progress and a new combined modality approach using: radiotherapy, surgery and chemotherapy which have improved prognosis in the localized disease especially.

p53 protein detection by the western blotting technique in normal and neoplastic specimens of human endometrium

The aim of the study was to investigate p53 protein expression by the Western blotting technique (estimated by integrated optical density - IOD) in normal (n = 13) and neoplastic (n = 40) human endometrial tissues as well as in a case of uterine carcinosarcoma and in a specimen of the botryoid sarcoma of the uterine cervix. p53 protein levels were correlated with patients' age as well as with conventionally used clinicopathological features of the endometrial neoplasm. A statistically significant difference was noted in p53 levels in the nuclear, but not in the cytoplasmatic, fraction between the normal endometria and endometrial cancer tissues (P < 0.0001). In the neoplastic endometria, nuclear p53 protein expression was higher than in cytoplasmatic fraction, and the difference was significant (P < 0.05). Higher nuclear p53 protein levels correlated with advanced histological grading of endometrioid endometrial carcinomas, but no relationship was noted between p53 protein expression and patients' age, clinical stage, histological type or depth of myometrial invasion. A case of uterine carcinosarcoma and a specimen of a botryoid sarcoma of the uterine cervix expressed nuclear p53 oncoprotein (57 IOD and 89 IOD, respectively). In conclusion, we found a statistically higher nuclear p53 levels in malignant as compared to normal human endometrial specimens by the Western blotting technique. Although there were no significant differences between p53 expression and clinicopathological features of the neoplasm (except poor histological grading), further studies are necessary to evaluate the influence of p53 nuclear/cytoplasmatic levels on the clinical outcome of Polish patients suffering from endometrial cancer.

Conservative treatment followed by chemotherapy with doxorubicin and ifosfamide for cervical sarcoma botryoides in young females

Sarcoma botryoides of the cervix is an extremely rare tumour and seems to be associated with a better prognosis than its vaginal counterpart. Recent studies have suggested that it is possible to limit surgery to local excision in stage I cases. We report three cases of young subjects treated successfully with polypectomy or diathermy loop excision followed by adjuvant chemotherapy. One patient had a local recurrence which was treated with further local excision. All subjects remain alive without evidence of recurrence and with normal menstrual function 36, 38 and 38 months following initial diagnosis. A conservative surgical approach to early cervical sarcoma botryoides is possible. The efficacy of adjuvant chemotherapy and the regimen of choice still need to be investigated.