1
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Castle JT, Levy BE, Allison DB, Rodeberg DA, Rellinger EJ. Pediatric Rhabdomyosarcomas of the Genitourinary Tract. Cancers (Basel) 2023; 15:2864. [PMID: 37345202 PMCID: PMC10216134 DOI: 10.3390/cancers15102864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2023] [Revised: 05/19/2023] [Accepted: 05/20/2023] [Indexed: 06/23/2023] Open
Abstract
Rhabdomyosarcoma (RMS) is the most common soft tissue sarcoma in the pediatric and adolescent population, with 350 new cases diagnosed each year. While they can develop anywhere in the body, the genitourinary tract is the second most common primary location for an RMS to develop. Overall survival has improved through the increased use of protocols and multidisciplinary approaches. However, the guidelines for management continue to change as systemic and radiation therapeutics advance. Given the relative rarity of this disease compared to other non-solid childhood malignancies, healthcare providers not directly managing RMS may not be familiar with their presentation and updated management. This review aims to provide foundational knowledge of the management of RMSs with an emphasis on specific management paradigms for those arising from the genitourinary tract. The genitourinary tract is the second most common location for an RMS to develop but varies greatly in symptomology and survival depending on the organ of origin. As the clinical understanding of these tumors advances, treatment paradigms have evolved. Herein, we describe the breadth of presentations for genitourinary RMSs with diagnostic and treatment management considerations, incorporating the most recently available guidelines and societal consensus recommendations.
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Affiliation(s)
- Jennifer T. Castle
- Department of Surgery, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA;
| | - Brittany E. Levy
- Department of Surgery, University of Kentucky, Lexington, KY 40536, USA;
| | - Derek B. Allison
- Department of Pathology and Laboratory Medicine, Department of Urology, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA;
| | - David A. Rodeberg
- Department of Surgery, Department of Pediatric Surgery, University of Kentucky, Lexington, KY 40536, USA;
| | - Eric J. Rellinger
- Department of Surgery, Department of Pediatric Surgery, Markey Cancer Center, University of Kentucky, Lexington, KY 40536, USA
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2
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Sarcoma Botryoides: Optimal Therapeutic Management and Prognosis of an Unfavorable Malignant Neoplasm of Female Children. Diagnostics (Basel) 2023; 13:diagnostics13050924. [PMID: 36900067 PMCID: PMC10000398 DOI: 10.3390/diagnostics13050924] [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: 12/22/2022] [Revised: 02/05/2023] [Accepted: 02/14/2023] [Indexed: 03/05/2023] Open
Abstract
Embryonal rhabdomyosarcoma (ERMS) is a rare malignancy and occurs primarily in the first two decades of life. Botryoid rhabdomyosarcoma is an aggressive subtype of ERMS that often manifests in the genital tract of female infants and children. Due to its rarity, the optimal treatment approach has been a matter of debate. We conducted a search in the PubMed database and supplemented it with a manual search to retrieve additional papers eligible for inclusion. We retrieved 13 case reports and case series, from which we summarized that the current trend is to approach each patient with a personalized treatment plan. This consists of a combination of local debulking surgery and adjuvant or neoadjuvant chemotherapy (NACT). Effort is made in every approach to avoid radiation for the sake of preserving fertility. Radical surgeries and radiation still have a role to play in extensive disease and in cases of relapse. Despite the rarity and aggressiveness of this tumor, disease-free survival and overall prognosis is excellent, especially when it is diagnosed early, compared with other subtypes of rhabdomyosarcoma (RMS). We conclude that the practice of a multidisciplinary approach is appropriate, with favorable outcomes; however, larger-scale studies need to be organized to have a definite consensus on optimal management.
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3
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Han LM, Weiel JJ, Longacre TA, Folkins AK. DICER1-associated Tumors in the Female Genital Tract: Molecular Basis, Clinicopathologic Features, and Differential Diagnosis. Adv Anat Pathol 2022; 29:297-308. [PMID: 35778792 DOI: 10.1097/pap.0000000000000351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
DICER1 syndrome is a tumor predisposition syndrome in which patients are at an increased risk of developing a wide variety of benign and malignant neoplasms with a hallmark constellation of pediatric pleuropulmonary blastoma, cystic nephroma, and thyroid lesions. DICER1 encodes an RNA endoribonuclease that is crucial to the processing of microRNA and may play a role in the maturation of Müllerian tissue. Within the gynecologic tract, germline mutations in DICER1 are associated with an array of rare tumors, including Sertoli-Leydig cell tumor, embryonal rhabdomyosarcoma of the cervix, gynandroblastoma, and juvenile granulosa cell tumor, which typically present in childhood, adolescence, or early adulthood. In addition, somatic DICER1 mutations have been described in rare gynecologic tumors such as adenosarcoma, Sertoli cell tumor, ovarian fibrosarcoma, cervical primitive neuroectodermal tumor, carcinosarcoma, and germ cell tumors. In light of the significant association with multiple neoplasms, genetic counseling should be considered for patients who present with a personal or family history of these rare DICER1-associated gynecologic tumors. This review highlights the most current understanding of DICER1 genetic alterations and describes the clinical, histopathologic, and immunohistochemical features and differential diagnoses for gynecologic tumors associated with DICER1 mutation.
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Affiliation(s)
- Lucy M Han
- Department of Pathology, Stanford University, Stanford, CA
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4
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Embryonal Rhabdomyosarcoma of the Uterine Cervix: A Clinicopathologic Study of 94 Cases Emphasizing Issues in Differential Diagnosis Staging, and Prognostic Factors. Am J Surg Pathol 2022; 46:1477-1489. [PMID: 35941719 DOI: 10.1097/pas.0000000000001933] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Embryonal rhabdomyosarcoma of the uterine cervix (cERMS) is rare and frequently associated with DICER1 mutations. We report 94 tumors that arose in patients aged 7 to 59 (median=23) years and presented with vaginal bleeding (52), protruding vaginal mass (17), cervical polyp (8), or expelled tumor fragments per vagina (5). Nine had DICER1 syndrome, 8 of whom had other syndromic manifestations including ovarian Sertoli-Leydig cell tumor (7), multinodular goiter (3), pleuropulmonary blastoma (2), pineoblastoma (1), and osteosarcoma (1). Syndromic patients were younger than nonsyndromic patients (16 vs. 24 y). Tumor size ranged from 2 to 24 (median=4.5) cm. Ninety-two tumors were polypoid, most being grape-like (77 of 92). They were characterized by aggregates of primitive cells, almost always exhibiting a cambium layer, within a variably myxoedematous stroma and were hypocellular (63), moderately cellular (22), or hypercellular (9). Entrapped glands, typically scant, were present in 84 tumors. Primitive hyperchromatic ovoid to spindled cells with minimal cytoplasm predominated but differentiated rhabdomyoblasts with abundant eosinophilic cytoplasm (having cross-striations in 30) were seen in 83 tumors; they were often sparse but predominated in three. Nine tumors showed areas of intersecting fascicles and 4 zones with densely cellular (solid) growth. Cartilage was present in 38. Anaplasia was seen in 15 tumors, as was necrosis. Mitotic activity ranged from 1 to 58/10 high-power fields (median=8). The varied microscopic features resulted in a spectrum of differential diagnostic considerations, mainly typical and cellular forms of fibroepithelial polyps, Mullerian adenosarcoma, and other sarcomas. Follow-up was available for 79 patients ranging from 6 to 492 (median=90) months. Treatment information was available in 62 and included polypectomy in 6 patients (2 also received chemotherapy), limited resection in 26 (14 also received chemotherapy), hysterectomy in 29 (15 with adjuvant chemotherapy), and biopsies only in 1 (with chemotherapy). Staging was possible in 56 tumors; according to the "uterine sarcoma" system (tumor size and extent) they were: stage I (10/56; could not be further subclassified as size not available), IA (22/56), IB (18/56), IIA (2/56), IIB 3/56), IIIC (1/56). According to the "adenosarcoma" system (depth of invasion and extent) they were: stage IA (26/56), IB (14/56), IC (10/56), IIA (2/56), IIB (3/56), IIIC (1/56). Eight patients had local recurrence following incomplete excision (10%). Eleven of 79 patients had extrauterine recurrences (14%) and 9 died of disease (11%). Older age was associated with extrauterine recurrence (median 44 vs. 22; P=0.002) and decreased disease-specific survival (median 44 vs. 22; P=0.02). For patients with tumors initially confined to the cervix, the adenosarcoma staging system was superior to the uterine sarcoma staging system for predicting survival (P=0.02). Three patients with DICER1 syndrome who underwent fertility-preserving surgery developed a second primary cERMS 7, 7, and 12 years after their primary tumor. All 9 patients with DICER1 syndrome had tumors confined to the cervix and none died of disease. This study highlights the intriguing clinical aspects of cERMS including its long-known tendency to occur in the young but also more recently appreciated association with DICER1 syndrome. Establishing the diagnosis may still be difficult because of the hazard of sampling a neoplasm which in areas may appear remarkably bland and also because of its potential confusion with other neoplasms. This study indicates that this tumor has a good prognosis at this site and in selected cases a conservative surgical approach is a realistic consideration.
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5
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A Rare Case of Embryonal Rhabdomyosarcoma of the Uterine Cervix. Case Rep Pathol 2022; 2022:8459566. [PMID: 35464884 PMCID: PMC9020987 DOI: 10.1155/2022/8459566] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/26/2022] [Accepted: 03/29/2022] [Indexed: 11/17/2022] Open
Abstract
Embryonal rhabdomyosarcoma (RMS) of the uterine cervix is an exceedingly rare mesenchymal tumor that accounts for less than 1% of all cervical cancers. This highly malignant tumor primarily affects adolescents and young adults. Due to the paucity of publications on this clinical entity, there are no clearly established treatment protocols. However, a multimodal approach to treatment that involves surgical intervention combined with adjuvant chemoradiotherapy appears to improve patient outcomes. Herein, we report a case of embryonal rhabdomyosarcoma of the uterine cervix in a 24-year-old female, who presented with an exophytic cervical mass and vaginal bleeding. Histopathology and immunohistochemistry confirmed embryonal rhabdomyosarcoma of the uterine cervix with extension into the lower uterine segment. This patient was successfully managed with a combination of neoadjuvant chemoradiotherapy, a total abdominal hysterectomy with bilateral salpingo-oophorectomy, and adjuvant chemoradiotherapy.
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6
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Ahmed AA, Habeebu S, Farooqi MS, Gamis AS, Gonzalez E, Flatt T, Sherman A, Surrey L, Arnold MA, Conces M, Koo S, Dioufa N, Barr FG, Tsokos MG. MYOD1 as a prognostic indicator in rhabdomyosarcoma. Pediatr Blood Cancer 2021; 68:e29085. [PMID: 33913590 PMCID: PMC9907363 DOI: 10.1002/pbc.29085] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 03/22/2021] [Accepted: 04/09/2021] [Indexed: 01/01/2023]
Abstract
BACKGROUND/OBJECTIVES Rhabdomyosarcoma (RMS) is characterized by the expression of the myogenic regulatory protein MYOD1. Histologic types include alveolar, embryonal (ERMS), and spindle cell sclerosing RMS (SRMS). SRMS harbors MYOD1 mutations in a subset of adult cases in association with poor prognosis. DESIGN/METHODS To study the level of MYOD1 protein expression and its clinical significance, we have analyzed variable numbers of pediatric (<18 years of age) and adult (age range ≥18 to 35 years) ERMS and SRMS cases for presence or absence of MYOD1 immunoreactivity in correlation with clinical outcome and MYOD1 L122R mutations. RESULTS Lack of MYOD1 immunoreactivity, identified in 23.8% of nonalveolar RMS (non-ARMS) cases, was more prevalent in SRMS (44%) than ERMS (17.2%) and was significantly associated with low overall survival and unfavorable tumor sites (p < .05). Lack of MYOD1 immunoreactivity was not associated with MYOD1 L122R mutations, which were identified in 3/37 (8%) cases including only two of 31 (6.5%) pediatric cases, one of 11 or 9% pediatric SRMS, and one case of infant ERMS. CONCLUSION These studies highlight the prognostic role of MYOD1 in non-ARMS. Lack of MYOD1 immunoreactivity is associated with poor prognosis in ERMS and SRMS. MYOD1 gene mutations are generally infrequent in pediatric RMS. Although mutations are predominant in SRMS, they may exceptionally occur in infantile ERMS.
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Affiliation(s)
- Atif A. Ahmed
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Sultan Habeebu
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Midhat S. Farooqi
- Department of Pathology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Alan S. Gamis
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Elizabeth Gonzalez
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Terrie Flatt
- Department of Pediatric Hematology Oncology, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Ashley Sherman
- Department of Health Services and Outcomes Research, Children’s Mercy Hospital/University of Missouri, Kansas City, Missouri, USA
| | - Lea Surrey
- Department of Pathology, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael A. Arnold
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Miriam Conces
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Selene Koo
- Department of Pathology and Laboratory Medicine, Nationwide Children’s Hospital, Columbus, Ohio, USA,Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Nikolina Dioufa
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
| | - Frederic G. Barr
- Laboratory of Pathology, National Cancer Institute, Bethesda, Maryland, USA
| | - Maria G. Tsokos
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
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7
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Bell SG, Konney TO, Appiah-Kubi A, Tawiah A, Amo-Antwi K, Annan JJK, Lawrence ER, Lieberman R, Johnston C. Two rare presentations of embryonal rhabdomyosarcoma of the cervix in teenagers at a low-resource teaching hospital in Ghana: A case series. Gynecol Oncol Rep 2021; 36:100750. [PMID: 33850996 PMCID: PMC8022137 DOI: 10.1016/j.gore.2021.100750] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 03/01/2021] [Accepted: 03/14/2021] [Indexed: 11/05/2022] Open
Abstract
We report on two cases of embryonal rhabdomyosarcoma of the cervix in Ghana. Only 20% of rhabdomyosarcoma diagnoses in children occur in the genitourinary tract. Embryonal rhabdomyosarcoma of the cervix is rare, with no standardized treatment. The teenaged patients underwent fertility-sparing surgery followed by chemotherapy. This treatment regimen is accessible in low-income countries.
We report two cases of embryonal rhabdomyosarcoma (ERMS) of the cervix in teenagers presenting to Komfo Anokye Teaching Hospital in Kumasi, Ghana within one month of each other. Between October and November 2019, two patients presented with ERMS of the cervix. They both underwent fertility-sparing surgery followed by chemotherapy with vincristine, actinomycin-D, and cyclophosphamide. Preoperative workup for the two patients was minimal due to limited availability and high cost of imaging in a low-resource setting. Both patients were discussed at a multidisciplinary tumor board meeting to guide best management practices. Both patients had local surgical resection with histological confirmation of ERMS and negative margins, followed by six cycles of vincristine, actinomycin-D, and cyclophosphamide. Neither of the patients had perioperative complications or received radiation therapy. At the time of publication, both patients are currently alive and without evidence of recurrence. Fertility-sparing surgery followed by chemotherapy for patients with ERMS of the cervix is accessible in low-income countries.
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Affiliation(s)
- Sarah G Bell
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | | | - Adu Appiah-Kubi
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | - Augustine Tawiah
- Komfo Anokye Teaching Hospital, Okomfo Anokye Road, Kumasi, Ghana
| | | | | | - Emma R Lawrence
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Richard Lieberman
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
| | - Carolyn Johnston
- University of Michigan, Department of Obstetrics and Gynecology, 1500 E. Medical Center Dr., Ann Arbor, MI 48109, USA
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8
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Caroleo AM, De Ioris MA, Boccuto L, Alessi I, Del Baldo G, Cacchione A, Agolini E, Rinelli M, Serra A, Carai A, Mastronuzzi A. DICER1 Syndrome and Cancer Predisposition: From a Rare Pediatric Tumor to Lifetime Risk. Front Oncol 2021; 10:614541. [PMID: 33552988 PMCID: PMC7859642 DOI: 10.3389/fonc.2020.614541] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 11/24/2020] [Indexed: 12/24/2022] Open
Abstract
DICER1 syndrome is a rare genetic condition predisposing to hereditary cancer and caused by variants in the DICER1 gene. The risk to present a neoplasm before the age of 10 years is 5.3 and 31.5% before the age of 60. DICER1 variants have been associated with a syndrome involving familial pleuropulmonary blastoma (PPB), a rare malignant tumor of the lung, which occurs primarily in children under the age of 6 years and represents the most common life-threatening manifestation of DICER1 syndrome. Type I, II, III, and Ir (type I regressed) PPB are reported with a 5-year overall survival ranging from 53 to 100% (for type Ir). DICER1 gene should be screened in all patients with PPB and considered in other tumors mainly in thyroid neoplasms (multinodular goiter, thyroid cancer, adenomas), ovarian tumors (Sertoli-Leydig cell tumor, sarcoma, and gynandroblastoma), and cystic nephroma. A prompt identification of this syndrome is necessary to plan a correct follow-up and screening during lifetime.
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Affiliation(s)
- Anna Maria Caroleo
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Maria Antonietta De Ioris
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Luigi Boccuto
- JC Self Research Institute, Greenwood Genetic Center, Greenwood, SC, United States.,School of Nursing, College of Behavioral, Social and Health Sciences, Clemson University, Clemson, SC, United States
| | - Iside Alessi
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Giada Del Baldo
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Antonella Cacchione
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Emanuele Agolini
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Martina Rinelli
- Laboratory of Medical Genetics, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Annalisa Serra
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
| | - Andrea Carai
- Department of Neuroscience, Bambino Gesù Children Hospital (IRCCS), Rome, Italy
| | - Angela Mastronuzzi
- Department of Onco - Hematology and Cell and Gene Therapy, Bambino Gesù Pediatric Hospital (IRCCS), Roma, Italy
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9
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Almusalam L, Alghtani N, Alkushi A, Arabi H. Uterine cervix rhabdomyosarcoma: an uncommon entity in an adult patient. BMJ Case Rep 2020; 13:e238596. [PMID: 33257391 PMCID: PMC7705496 DOI: 10.1136/bcr-2020-238596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/10/2020] [Indexed: 11/03/2022] Open
Abstract
Embryonal rhabdomyosarcoma (ERMS) is a malignant neoplasm mostly affecting the genitourinary system of children and is rarely seen in adults. ERMS in uterine cervix is rare and can be misdiagnosed in adult as adenosarcoma or carcinosarcoma. The use of immunohistochemical staining is highly recommended to make sure that the correct diagnosis is reached. To the best of our knowledge, only seven cases of cervical ERMS in women above the age of 50 have been reported in English literature. Herein, we report a rare case of cervical ERMS in a 50-year-old woman that was initially misdiagnosed as an adenosarcoma.
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Affiliation(s)
- Latifa Almusalam
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Nuorh Alghtani
- Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Abdulmohsen Alkushi
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
- King Saud bin Abdulaziz University for Health Sciences, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
| | - Haitham Arabi
- Department of Pathology & Laboratory Medicine, King Abdulaziz Medical City, Riyadh, Saudi Arabia
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10
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Buruiana FE, Gupta B, Singh K. Rhabdomyosarcoma of the cervix in teenagers - Is fertility preservation a feasible option? Gynecol Oncol Rep 2020; 34:100677. [PMID: 33304979 PMCID: PMC7708689 DOI: 10.1016/j.gore.2020.100677] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 11/12/2020] [Accepted: 11/17/2020] [Indexed: 11/30/2022] Open
Abstract
Embryonal rhabdomyosarcoma (RMS) of the cervix. Subtypes of embryonal RMS. Disease of adolescence. Fertility preservation. Lack of standard treatment.
Embryonal rhabdomyosarcoma (RMS) of the cervix is a rare entity, encountered mainly in the first two decades of life. The literature consists mainly of case reports and few small case series, and no standard treatment guidelines are available. As this is a disease of adolescence, fertility preservation in well selected cases is of paramount importance. We report 3 cases of cervical RMS, in adolescents highlighting the clinical presentation, diagnosis and management.
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Affiliation(s)
- F E Buruiana
- ST7 O&G, Clinical Fellow Gynaecological Oncology, PanBirmingham Cancer Centre, Birmingham City Hospital NHS Trust, UK
| | - B Gupta
- Commomnwealth Fellow Gynaecological Oncology, PanBirmingham Cancer Centre, Birmingham City Hospital NHS Trust, UK
| | - K Singh
- Consultant Gynaecological Oncology, PanBirmingham Cancer Centre, Birmingham City Hospital NHS Trust, UK
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11
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Ghirardi V, Bizzarri N, Guida F, Vascone C, Costantini B, Scambia G, Fagotti A. Role of surgery in gynaecological sarcomas. Oncotarget 2019; 10:2561-2575. [PMID: 31069017 PMCID: PMC6493462 DOI: 10.18632/oncotarget.26803] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 01/19/2019] [Indexed: 12/13/2022] Open
Abstract
Gynaecological sarcomas account for 3-4% of all gynaecological malignancies and have a poorer prognosis compared to gynaecological carcinomas. Pivotal treatment for early-stage uterine sarcoma is represented by total hysterectomy. Whereas oophorectomy provides survival advantage in endometrial stromal sarcoma is still controversial. When the disease is confined to the uterus, systematic pelvic and para-aortic lymphadenectomy is not recommended. Removal of enlarged lymph-nodes is indicated in case of disseminated or recurrent disease, where debulking surgery is considered the standard of care. Fertility sparing surgery for uterine leiomyosarcoma is not supported by strong evidence, whilst available data on fertility sparing treatment for endometrial stromal sarcoma are more promising. For ovarian sarcomas, in the absence of specific data, it is reasonable to adapt recommendations existing for uterine sarcomas, also regarding the role of lymphadenectomy in both early and advanced stage disease. Specific recommendations on cervical sarcomas' surgery are lacking. Existing data on surgical approach vary from radical hysterectomy to fertility-preserving surgery in the form of trachelectomy or wide local excision, however no definite conclusions can be drafted on the recommended surgical approach. For vulval sarcomas, complete surgical excision with at least 2 cm of free margin is considered to be the primary treatment which is associated with good prognosis. The aim of this review is to provide highest quality evidence to guide gynaecologic oncologists throughout surgical management of gynaecological sarcomas.
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Affiliation(s)
- Valentina Ghirardi
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Nicolò Bizzarri
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Francesco Guida
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Carmine Vascone
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Barbara Costantini
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Giovanni Scambia
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
| | - Anna Fagotti
- Division of Gynecologic Oncology, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome 00168, Italy.,Catholic University of Sacred Heart, Rome 00168, Italy
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12
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13
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Ovarian conservation in management of pediatric gynecology malignancies. Curr Opin Obstet Gynecol 2018; 30:316-325. [DOI: 10.1097/gco.0000000000000484] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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14
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Moke DJ, Thomas SM, Hiemenz MC, Nael A, Wang K, Shillingford N, Biegel JA, Mascarenhas L. Three synchronous malignancies in a patient with DICER1 syndrome. Eur J Cancer 2018; 93:140-143. [PMID: 29395683 DOI: 10.1016/j.ejca.2017.12.021] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2017] [Accepted: 12/21/2017] [Indexed: 01/11/2023]
Affiliation(s)
- Diana J Moke
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Stefanie M Thomas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
| | - Matthew C Hiemenz
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Ali Nael
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Kasper Wang
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Division of Pediatric Surgery, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Nick Shillingford
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Jaclyn A Biegel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA; Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA, USA
| | - Leo Mascarenhas
- Division of Hematology, Oncology, and Blood and Marrow Transplantation, Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, USA; Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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15
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Pinto A, Kahn RM, Rosenberg AE, Slomovitz B, Quick CM, Whisman MK, Huang M. Uterine rhabdomyosarcoma in adults. Hum Pathol 2018; 74:122-128. [PMID: 29320751 DOI: 10.1016/j.humpath.2018.01.007] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 12/18/2017] [Accepted: 01/02/2018] [Indexed: 11/30/2022]
Abstract
Rhabdomyosarcoma (RMS) is an aggressive mesenchymal tumor most commonly diagnosed in the pediatric population, and when occurring in adults, tends to develop in the deep soft tissue of the limbs. Primary uterine RMS comprises an even more restricted subset, with little known or reported when compared to most other gynecologic sarcomas. Our goal with this study was to retrospectively evaluate cases from two academic institutions and describe the main histopathologic findings of this rare gynecologic malignancy. A total of 8 cases were identified, consisting of 4 pleomorphic rhabdomyosarcomas (PRMS), 2 alveolar rhabdomyosarcomas (ARMS), and 2 embryonal rhabdomyosarcomas (ERMS). They occurred in patients ranging from 22 to 70 years old, and the most common presenting symptom was vaginal bleeding. Most patients presented with advanced stage at diagnosis, including metastatic disease to lymph nodes and to distant sites. The masses were mostly (6/8) centered in the myometrium, while two cases arose in the cervix (2/8). Histologic characteristics of the tumors were dependent on the RMS subtype, although all cases demonstrated a similar immunohistochemical profile regardless of their subclassification. RMS of the uterus has a very poor prognosis, and data regarding treatment of this rare malignancy is limited, and usually extrapolated from non-uterine sites.
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Affiliation(s)
- Andre Pinto
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136.
| | - Ryan M Kahn
- Department of Obstetrics and Gynecology, New York-Presbyterian Hospital / Weill Cornell, New York, NY 10021
| | - Andrew E Rosenberg
- Department of Pathology, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Brian Slomovitz
- Department of Gynecology Oncology, University of Miami Miller School of Medicine, Miami, FL 33136
| | - Charles Matthew Quick
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Michella K Whisman
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR 72205
| | - Marilyn Huang
- Department of Gynecology Oncology, University of Miami Miller School of Medicine, Miami, FL 33136
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16
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Is fertility-preservation safe for adult non-metastatic gynecologic rhabdomyosarcoma patients? Systematic review and pooled survival analysis of 137 patients. Arch Gynecol Obstet 2017; 297:559-572. [DOI: 10.1007/s00404-017-4591-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 11/10/2017] [Indexed: 11/26/2022]
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17
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Yuan G, Yao H, Li X, Li H, Wu L. Stage 1 embryonal rhabdomyosarcoma of the female genital tract: a retrospective clinical study of nine cases. World J Surg Oncol 2017; 15:42. [PMID: 28173865 PMCID: PMC5297139 DOI: 10.1186/s12957-017-1110-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 02/01/2017] [Indexed: 12/15/2022] Open
Abstract
Background The aim of the study is to investigate the clinical features, treatments, and prognosis of stage 1 embryonal rhabdomyosarcoma of the female genital tract. Methods A retrospective analysis was performed on nine cases of stage 1 embryonal rhabdomyosarcoma of the female genital tract. Clinical characteristics, treatments, recurrence, and prognosis were analyzed. Results Of the nine patients with embryonal rhabdomyosarcoma, three originated from the vagina and six from the cervix. For the eight patients who initially received surgery, the median survival time was 88 months. As for the six patients that received adjuvant chemotherapy, five of them who received six or more cycles of treatment achieved tumor-free survival and the survival time ranged from 9 to 228 months. The remaining patient, who declined further treatment after two cycles of chemotherapy, relapsed 11 months following the surgery and died 3 months later. Out of the nine patients, only one was initially treated with chemotherapy, and achieved complete remission, but relapsed 21 months later. After a combination of surgery and chemotherapy, this patient remained tumor-free for total of 117 months. Conclusions Patients with early stage embryonal rhabdomyosarcoma of the female genital tract have good prognosis, and the combination of surgery and chemotherapy can lead to better outcomes.
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Affiliation(s)
- Guangwen Yuan
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Hongwen Yao
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Xiaoguang Li
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Hongjun Li
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China
| | - Lingying Wu
- Department of Gynecologic Oncology, Cancer Hospital of Peking Union Medical College and Chinese Academy of Medical Science, No 17 Panjiayuan South Street, Chaoyang District, Beijing, China.
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18
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[Rhabdomyosarcoma of adult genital tract: A short review]. ACTA ACUST UNITED AC 2016; 45:821-826. [PMID: 27212613 DOI: 10.1016/j.jgyn.2016.03.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 03/22/2016] [Accepted: 03/22/2016] [Indexed: 11/24/2022]
Abstract
Rhabdomyosarcoma, most common soft tissue tumor in children, represent 8% of solid tumors in children. Conversely, in adults, this histology is very rare and no consensual recommendation is supported. If gynecological localization is one of the most frequent in children, it is a minority in adults. The management of this type of tumor is based on treatment multimodality combining surgery, chemotherapy, radiotherapy and brachytherapy. This pathological separate entity differs from other sarcomas by its greater sensitivity to chemotherapy and radiotherapy. The aim of this study is to conduct a general review of diagnostic and treatment of genital tract rhabdomyosarcoma in adults, and to report pathological characteristics of this type of tumor.
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19
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Jarzembowski JA. Pediatric renal and genitourinary tract tumors and the contributions of Dr. Louis "Pepper" Dehner therewith. Semin Diagn Pathol 2016; 33:419-426. [PMID: 27720562 DOI: 10.1053/j.semdp.2016.08.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Dr. Louis "Pepper" Dehner is an internationally renowned surgical pathologist, especially in the subspecialty of pediatric pathology. Although his clinical and academic expertise are broad, with over 400 published articles, some of his most intriguing contributions have been in the area of pediatric renal and genitourinary pathology. This review focuses on the entities in these following organ systems where he has focused his efforts: malignant rhabdoid tumor, renal medullary carcinoma, Ewing sarcoma/peripheral neuroectodermal tumor, and the DICER1-related lesions cystic nephroma, embryonal rhabdomyosarcoma of the uterine cervix, and Sertoli-Leydig cell tumor.
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Affiliation(s)
- Jason A Jarzembowski
- Department of Pathology, Medical College of Wisconsin, Children׳s Hospital of Wisconsin, 9000 W. Wisconsin Ave, MS #701, Milwaukee, Wisconsin 53226.
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20
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21
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Fertility-sparing surgery for the management of young women with embryonal rhabdomyosarcoma of the cervix: A case series. Gynecol Oncol Rep 2016; 18:4-7. [PMID: 27642626 PMCID: PMC5018073 DOI: 10.1016/j.gore.2016.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Revised: 08/23/2016] [Accepted: 08/25/2016] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE To report three cases of embryonal rhabdomyosarcoma (ERMS) of the cervix in young women successfully treated with fertility-sparing surgery and chemotherapy. METHODS Between January 2014 and December 2015, three cases of ERMS of the cervix were confirmed in young women at a single tertiary cancer center. All cases were managed by a pediatric oncologist and a gynecologic oncologist with a combination of surgery and chemotherapy. Fertility-sparing surgeries (cervical conization or robotic-assisted radical trachelectomy) were offered to patients depending on the tumor size. RESULTS All patients were nulliparous and aged 14, 20 and 21 years and all presented with abnormal uterine bleeding. The first patient was managed with radical trachelectomy followed by adjuvant chemotherapy. The second patient underwent primary hysteroscopic resection of the tumor followed by completion cervical conization and adjuvant chemotherapy. The third patient received neoadjuvant chemotherapy followed by loop electrosurgical excision procedure (LEEP) with positive residual margins. She then underwent completion radical trachelectomy. None of the patients experienced perioperative complications. None of the women received radiation. All patients are alive with no evidence of disease. CONCLUSION Fertility-sparing surgery and chemotherapy in well-selected patients with ERMS of the cervix result in low complication rates and excellent oncologic outcomes. This treatment option may be considered in young patients who wish to preserve fertility by avoiding hysterectomy. A collaborative effort between pediatric oncologists and gynecologic oncologists is imperative to facilitate innovative approaches to these rare tumors in young adults.
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22
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Abstract
Patients with germline DICER1 mutations are at increased risk of developing a wide range of tumors, most of which are relatively rare in the general population. In the gynecologic tract, these include ovarian sex cord-stromal tumors, particularly Sertoli-Leydig cell tumor, and embryonal rhabdomyosarcoma of the cervix. In some cases, these are the sentinel neoplasms. DICER1-associated tumors may have distinctive morphologic appearances that may prompt the pathologist to consider an underlying tumor predisposition syndrome and therefore consideration of genetic evaluation in the patient and her family.
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MESH Headings
- DEAD-box RNA Helicases/genetics
- Diagnosis, Differential
- Female
- Genetic Predisposition to Disease
- Genital Neoplasms, Female/diagnosis
- Genital Neoplasms, Female/genetics
- Genital Neoplasms, Female/pathology
- Germ-Line Mutation
- Humans
- Neoplastic Syndromes, Hereditary/diagnosis
- Neoplastic Syndromes, Hereditary/genetics
- Neoplastic Syndromes, Hereditary/pathology
- Ovarian Neoplasms/diagnosis
- Ovarian Neoplasms/genetics
- Ovarian Neoplasms/pathology
- Prognosis
- Rhabdomyosarcoma, Embryonal/diagnosis
- Rhabdomyosarcoma, Embryonal/genetics
- Rhabdomyosarcoma, Embryonal/pathology
- Ribonuclease III/genetics
- Sertoli-Leydig Cell Tumor/diagnosis
- Sertoli-Leydig Cell Tumor/genetics
- Sertoli-Leydig Cell Tumor/pathology
- Sex Cord-Gonadal Stromal Tumors/diagnosis
- Sex Cord-Gonadal Stromal Tumors/genetics
- Sex Cord-Gonadal Stromal Tumors/pathology
- Uterine Cervical Neoplasms/diagnosis
- Uterine Cervical Neoplasms/genetics
- Uterine Cervical Neoplasms/pathology
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Affiliation(s)
- Colin J R Stewart
- Department of Histopathology, King Edward Memorial Hospital, School for Women's and Infants' Health, University of Western Australia, Subiaco, Perth, Western Australia 6008, Australia.
| | - Adrian Charles
- Department of Anatomical Pathology, Sidra Medical and Research Center, PO Box 26999, Doha, Qatar
| | - William D Foulkes
- Department of Human Genetics, McGill University, Montreal, Quebec, Canada; Department of Oncology, McGill University, Montreal, Quebec, Canada; Department of Medical Genetics, Jewish General Hospital, McGill University Health Centre, Montreal, Quebec, Canada; Cancer Genetics Laboratory, Lady Davis Institute, Montreal, Quebec H3T 1E2, Canada
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23
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Razakanaivo M, Nguyen NP, Thariat J, Molinie V, Vlastos AT, Verschraegen C, Vinh-Hung V. Overview of embryonal rhabdomyosarcoma of cervix in women over 40-year-old. World J Obstet Gynecol 2016; 5:110-117. [DOI: 10.5317/wjog.v5.i1.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/16/2015] [Accepted: 12/14/2015] [Indexed: 02/05/2023] Open
Abstract
The literature on cervical embryonal rhabdomyosarcoma (RMS) is reviewed here to identify management guidelines for middle-aged women diagnosed with this rare type of gynecologic cancer. Specifically, the PubMed, Web of Science and Google Scholar databases, were searched to find published case series on cervical embryonal RMS reporting on four or more patients, of whom at least one was > 40-year-old. The χ2 test was used to assess heterogeneity. Five articles published between 1986 and 2013 were identified, reporting on a total of 47 patients, of whom 22 (46.8%) were older and 25 (53.2%) younger than 40-year-old. Although the two age groups did not differ significantly by stage of disease or radiotherapy treatment, the older age group received less chemotherapy (55% vs 90%, P = 0.008) and had more hysterectomy (86% vs 43%, P = 0.009). Follow-up data was missing for 18/47 (38.3%) patients. Among the 29 patients with follow-up data, survival was shorter in the older group, with 8/12 (67%) alive and 3 with disease at a median follow-up of 2.6 years, as compared with the younger group that had 15/17 (88%) alive and none with disease at a median follow-up of 3.5 years. The longest survivals among the older women were observed in those who received radiotherapy, including one case with a resected lung metastasis. A prospective multi-institutional collaboration and better follow-up are needed to determine the optimal management of cervical embryonal RMS. Long-term survival appears feasible if management is accompanied by chemotherapy and radiotherapy.
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Jayi S, Bouguern H, Fdili FZ, Chaara H, Chbani L, Hafidi I, Kamaoui I, Arifi S, Mellas N, Bouhafa T, Hassouni K, Tizniti S, Laamarti A, Melhouf MA. Embryonal rhabdomyosarcoma of the cervix presenting as a cervical polyp in a 16-year-old adolescent: a case report. J Med Case Rep 2014; 8:241. [PMID: 24986146 PMCID: PMC4092352 DOI: 10.1186/1752-1947-8-241] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2013] [Accepted: 04/07/2014] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Embryonal rhabdomyosarcoma of the female genital tract is rare in the cervix. It has been mainly discussed in the context of individual case studies. It tends to occur in children and young women. Treatment ranges from radical surgery to conservative surgery, followed by chemotherapy. CASE PRESENTATION A 16-year-old Moroccan adolescent girl presented to our center with a protruding mass from her vaginal introitus, as a polyp of 6cm. An examination revealed a polyp within her vagina, thought to be arising from her cervix and a polypectomy was performed. Microscopic findings are consistent with an embryonal rhabdomyosarcoma (botryoide type). A computed tomography of her thorax, abdomen and pelvis were performed and residual disease was found as a mass located at her cervix, which measured approximately 4.5cm in its widest dimensions, without evidence of metastatic disease. Due to the fact that she is young, after discussions in a multidisciplinary meeting, she was subsequently treated with four cycles of multi-agent chemotherapy. Two cycles of chemotherapy and radiotherapy were administered due to the lack of response, but she presented vaginal bleeding with persistence of the same mass in computed tomography. Hence a total interadnexal hysterectomy was made. A histologic examination found residual embryonal rhabdomyosarcoma (botryoide type) located in all her cervix and she is currently under chemotherapy. CONCLUSIONS The presence of a cervical polyp in an adolescent is a gynecologic oddity and must necessarily be examined histologically because it might be a rhabdomyosarcoma. This is extremely important because diagnosis at an early stage of the disease is a highly favorable prognostic factor that allows "fertility-sparing surgery" for these young patients.
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Affiliation(s)
- Sofia Jayi
- Department of Gynecology and Obstetrics, University Hospital of Fez, Fez, Morocco.
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Cate F, Bridge JA, Crispens MA, Keedy VL, Troutman A, Coffin CM, Fadare O. Composite uterine neoplasm with embryonal rhabdomyosarcoma and primitive neuroectodermal tumor components: rhabdomyosarcoma with divergent differentiation, variant of primitive neuroectodermal tumor, or unique entity? Hum Pathol 2013; 44:656-63. [DOI: 10.1016/j.humpath.2012.09.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2012] [Revised: 07/07/2012] [Accepted: 09/05/2012] [Indexed: 10/27/2022]
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