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Ngo C, Cotteret S, Deneche I, Kfoury M, Chehab R, Tran-Dien A, Vibert J, Leary A, Gouy S, Maulard A, Morice P, Scoazec JY, Pautier P, Genestie C. Uterine adenosarcoma: Clinical significance of histological classification and SNP array analysis. Hum Pathol 2024; 148:14-22. [PMID: 38688412 DOI: 10.1016/j.humpath.2024.04.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Revised: 04/24/2024] [Accepted: 04/25/2024] [Indexed: 05/02/2024]
Abstract
Mullerian adenosarcoma is a rare malignant biphasic tumor. The mesenchymal component may be low or high grade, with or without sarcomatous overgrowth (SO). Little is known about the molecular heterogeneity of these tumors. In this study, we aim to reclassify a large retrospective monocentric cohort of uterine adenosarcomas according to tumor grade and SO, to evaluate the clinical significance of pathological classification and to correlate with copy-number variations inferred from single nucleotide polymorphism array. Of the 67 uterine adenosarcomas, 18 (26.9%) were low grade without SO, 7 (10.4%) low grade with SO, 8 (11.9%) high grade without SO and 34 (50.7%) high grade with SO. SO, necrosis and RMS were more frequent in high grade than low grade adenosarcomas (p < 0.001). Low-rank test showed that recurrence-free survival was significantly shortened in high grade than low grade adenosarcomas (p = 0.035) and SO was associated with shortened overall and recurrence-free survival (p = 0.038 and p = 0.009, respectively). High-grade tumors displayed complex genomic profiles with multiple segmental losses including TP53, ATM and PTEN genes. The median genomic index was significantly higher in high grade than low grade tumors (27 [3-60] vs 5,3 [0-16], p < 0.0001) and was significantly higher in presence of SO in low grade tumors (12,8 [10-16] vs 2,6 [0-10], p = 0.0006). We propose to report sarcomatous overgrowth with the tumor grade for prognostication in adenosarcoma and representative sampling is crucial for evaluation of these histological criteria.
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Affiliation(s)
- Carine Ngo
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France.
| | - Sophie Cotteret
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France
| | - Imène Deneche
- Department of Statistics, Gustave Roussy, Villejuif, France
| | - Maria Kfoury
- Department of Gynaecological Oncology, Gustave Roussy, Villejuif, France
| | - Randa Chehab
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France
| | | | - Julien Vibert
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France
| | - Alexandra Leary
- Department of Gynaecological Oncology, Gustave Roussy, Villejuif, France
| | - Sébastien Gouy
- Department of Gynaecological Oncology Surgery, Gustave Roussy, Villejuif, France
| | - Amandine Maulard
- Department of Gynaecological Oncology Surgery, Gustave Roussy, Villejuif, France
| | - Philippe Morice
- Department of Gynaecological Oncology Surgery, Gustave Roussy, Villejuif, France; Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Jean-Yves Scoazec
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France; Université Paris Saclay, Faculté de Médecine, Le Kremlin-Bicêtre, France
| | - Patricia Pautier
- Department of Gynaecological Oncology, Gustave Roussy, Villejuif, France
| | - Catherine Genestie
- Department of Pathology and Laboratory Medicine, Gustave Roussy, Villejuif, France
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Chen JW, Huang YJ, Wang LL, Liu JJ, Shi MM, Li N. Mullerian adenosarcoma of the uterus with MASO: a case report of cervical adenosarcoma in a young female that never had sexual behavior. BMC Womens Health 2024; 24:308. [PMID: 38783282 PMCID: PMC11112954 DOI: 10.1186/s12905-024-03140-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024] Open
Abstract
BACKGROUND Cervical mullerian adenosarcoma is a rare uterine sarcoma, especially in young women. Its pathological features are low-grade malignant tumors with bidirectional differentiation, and the degree of malignancy is similar to that of low-grade endometrial stromal sarcoma. This paper reports the case of a young asexual patient who has been closely followed up after tumor resection and has not had any recurrences. CASE PRESENTATION A 20-year-old, young asexual woman was diagnosed with cervical mullerian adenosarcoma with sarcomatous overgrowth (MASO). Cervical tumor resection was performed after admission, and the resection margin was negative. After the operation, she refused to undergo secondary surgery due to fertility requirements and did not receive adjuvant treatment. The patient was closely followed up after the operation and has not yet relapsed. CONCLUSION A young woman with cervical MASO did not receive adjuvant treatment after cervical tumor resection. For women with fertility requirements, close follow-ups should be conducted after the operation to guard against tumor recurrence and radical tumor resection should be performed as early as possible after the patient no longer requires their fertility.
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Affiliation(s)
- Jia-Wei Chen
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Ya-Jie Huang
- Department of Obstetrics and Gynecology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, 610051, China
| | - Ling-Lu Wang
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Jun-Jiang Liu
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Ming-Mei Shi
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China
| | - Na Li
- Department of Obstetrics and Gynecology, The Second Affiliated Hospital of Zunyi Medical University, The intersection of Xinlong Avenue and Xinpu Avenue, Honghuagang District, Zunyi, Guizhou Province, 563000, China.
- Department of Obstetrics and Gynecology, The Sixth People's Hospital of Chengdu, Chengdu, Sichuan, 610051, China.
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Mancari R, Yusuf Y, Macuks R, Achimas-Cadariu P, Piek JM, Sperduti I, Corrado G, Vizza E, Zapardiel I. Prognostic factors in uterine adenosarcoma: subanalysis of the SARCUT study. Front Oncol 2024; 14:1393707. [PMID: 38835369 PMCID: PMC11148341 DOI: 10.3389/fonc.2024.1393707] [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: 02/29/2024] [Accepted: 04/25/2024] [Indexed: 06/06/2024] Open
Abstract
Objective The purpose of the study was to analyse the role of prognostic factors on the risk of recurrence and overall survival of patients with uterine adenosarcoma. Methods A retrospective international multicentre study involving 46 centres collected 32 cases of uterine adenosarcoma, and these cases were included in the present subanalysis. Clinical and demographic features and tumour characteristics were gathered, as well as information on treatment and relapse. Disease-free and overall survival were analysed. Results The 5-year disease-free survival (DFS) was 85.3% and the 5-year overall survival (OS) rate was 89.5%. The risk factors significantly associated with overall survival were age (HR 1.09, 95% CI 1.03-1.15; p = 0.004) and FIGO stage II-III (HR 17.75, 95% CI 2.87-109.93; p = 0.002). Patients who experienced early relapse (within 12 months) had a tumour size >30 mm and advanced stage. The majority of recurred cases were treated with radiotherapy or surgery and obtained a good response rate. Conclusion The most significant prognostic factors in uterine adenosarcoma were age and FIGO stage and, indirectly, tumour size at diagnosis. The use of secondary surgery and/or radiotherapy could help in prolonging the disease-free status of the patients.
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Affiliation(s)
- Rosanna Mancari
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Yildirim Yusuf
- Gynecologic Oncology Department, Tepecik Training and Research Hospital, Izmir, Türkiye
| | - Ronalds Macuks
- Latvian Oncology Center of Riga Eastern Clinical University Hospital, Riga, Latvia
| | - Patriciu Achimas-Cadariu
- Gynecologic Oncology Department, Institute of Oncology Prof. Dr. I Chiricuta, Cluj-Napoca, Romania
- Gynecologic Oncology Department, University of Medicine and Pharmacy Iuliu Hatieganu, Cluj Napoca, Romania
| | - Jurgen Martinus Piek
- Gynecologic Oncology Department, Catharina Ziekenhuis Department of Gynecology, Eindhoven, Netherlands
| | - Isabella Sperduti
- Unit of Biostatistical, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Giacomo Corrado
- Gynecologic Oncology Unit, Department of Woman, Child and Public Health, Fondazione Policlinico Uni-versitario A. Gemelli IRCCS, Rome, Italy
| | - Enrico Vizza
- Gynecologic Oncology Unit, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Ignacio Zapardiel
- Gynecologic Oncology Unit, La Paz University Hospital, Madrid, Spain
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Yao X, Wang W, He Y. Clinicopathological analysis of 22 Müllerian adenosarcomas and the sequencing of DICER1 mutation. Diagn Pathol 2024; 19:56. [PMID: 38570882 PMCID: PMC10988924 DOI: 10.1186/s13000-024-01477-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Accepted: 03/04/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Müllerian adenosarcoma, a rare malignancy, presents diagnostic and therapeutic challenges. In this study, we conducted an analysis of the clinicopathological characteristics of 22 adenosarcomas, with a particular focus on screening for DICER1 hot mutations. METHODS The cohort consisted of patients with adenosarcoma who were registered at the West China Second Hospital between the years 2020 and June 2022. Sanger sequencing was employed to screen for somatic Hotspot mutations in the RNase IIIb domain of DICER1 in the 22 adenosarcomas. RESULTS Only one patient exhibited a DICER1 mutation that was not a DICER1 Hotspot mutation. Among the 22 patients, all underwent total hysterectomy with bilateral salpingo-oophorectomy, and 14 out of these 22 patients received adjuvant treatment. CONCLUSION In summary, our study of 22 Müllerian adenosarcomas focused on the clinicopathological features and the presence of DICER1 Hotspot mutations. Although our findings did not reveal any DICER1 mutations in the studied samples, this negative result provides valuable information for the field by narrowing down the genetic landscape of adenosarcomas and highlighting the need for further research into alternative molecular pathways driving this malignancy.
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Affiliation(s)
- Xiaohong Yao
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
| | - Wei Wang
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China
- Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, Chengdu, 610041, China
| | - Ying He
- Department of Pathology, West China Second University Hospital, Sichuan University, Chengdu, 610041, China.
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Karabajakian A, Genestie C, Meeus P, Guyon F, Llacer Moscardo C, Croce S, Taieb S, Duffaud F, Pautier P, Ray-Coquard I, Blay JY. [Uterin adenosarcoma: French Guidelines of the French Sarcoma Group and the Rare Gynecologic Tumor Group]. Bull Cancer 2023; 110:836-843. [PMID: 37202293 DOI: 10.1016/j.bulcan.2023.04.017] [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] [Received: 10/05/2022] [Revised: 04/10/2023] [Accepted: 04/24/2023] [Indexed: 05/20/2023]
Abstract
Uterine adenosarcoma is a very rare malignancy defined as a biphasic tumor composed of both benign epithelial component and a malignant sarcoma component. The stage of the disease is determined by the presence of myometrial invasion and the extent of extra-uterine disease. The most important histopronostic factors are the existence of a sarcomatous overgrowth defined by a sarcomatous contingent occupying more than 25 % of the volume of the tumor (directly correlated to the grade of the disease), the presence of a heterologous and/or a high-grade component. Stage I adenosarcomas without sarcomatous overgrowth have a good prognosis, with an overall 5-year survival of up to 80 %. In localized disease, complete surgical removal is recommended. The role of hormone therapy, chemotherapy and adjuvant radiotherapy is not established. If possible, relapses should be re-treated surgically, with the aim of achieving complete resection. In the advanced inoperable or metastatic setting, hormone therapy is an option for low-grade adenosarcomas with estrogen receptor (ER) and progesterone receptor (PR) overexpression. For high-grade tumors, the standard chemotherapies are doxorubicin-based combinations, although an integrated approach of surgery and medical treatment should also be considered in this setting.
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Affiliation(s)
- Andy Karabajakian
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Catherine Genestie
- Gustave-Roussy cancer campus, service de biopathologie, 94805 Villejuif, France
| | - Pierre Meeus
- Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France; Centre Léon-Bérard, département de chirurgie oncologique, 69008 Lyon, France
| | - Frédéric Guyon
- Institut Bergonié, département de chirurgie oncologique, 33076 Bordeaux, France
| | - Carmen Llacer Moscardo
- Institut du cancer de Montpellier (ICM), département de radiothérapie oncologique, 208, avenue des Apothicaires, parc euromédecine, 34298 Montpellier cedex 5, France
| | - Sabrina Croce
- Institut Bergonié, département de biopathologie, 33076 Bordeaux, France
| | - Sophie Taieb
- Centre Oscar Lambret, département de radiologie, 59000 Lille, France
| | - Florence Duffaud
- AP-HM, hôpitaux universitaires de Marseille Timone, département d'oncologie médicale, 13005 Marseille, France
| | - Patricia Pautier
- Gustave-Roussy Cancer Campus, département d'oncologie médicale, 94805 Villejuif, France.
| | - Isabelle Ray-Coquard
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
| | - Jean-Yves Blay
- Centre Léon-Bérard, département d'oncologie médicale, 69008 Lyon, France; Université Claude-Bernard Lyon 1, 69100 Villeurbanne, France
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Pérez-Fidalgo JA, Ortega E, Ponce J, Redondo A, Sevilla I, Valverde C, Isern Verdum J, de Alava E, Galera López M, Marquina G, Sebio A. Uterine sarcomas: clinical practice guidelines for diagnosis, treatment, and follow-up, by Spanish group for research on sarcomas (GEIS). Ther Adv Med Oncol 2023; 15:17588359231157645. [PMID: 37007636 PMCID: PMC10052607 DOI: 10.1177/17588359231157645] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 01/30/2023] [Indexed: 03/30/2023] Open
Abstract
Uterine sarcomas are very infrequent and heterogeneous entities. Due to its rarity, pathological diagnosis, surgical management, and systemic treatment are challenging. Treatment decision process in these tumors should be taken in a multidisciplinary tumor board. Available evidence is low and, in many cases, based on case series or clinical trials in which these tumors have been included with other soft tissue sarcoma. In these guidelines, we have tried to summarize the most relevant evidence in the diagnosis, staging, pathological disparities, surgical management, systemic treatment, and follow-up of uterine sarcomas.
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Affiliation(s)
| | - Eugenia Ortega
- Medical Oncology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jordi Ponce
- Gynecology Department, Hospital Universitario de Bellvitge. IDIBELL. Universidad de Barcelona, Barcelona, Spain
| | - Andres Redondo
- Medical Oncology Department, Hospital Universitario La Paz-IdiPAZ, Madrid, Spain
| | - Isabel Sevilla
- Clinical and Translational Research in Cancer/Instituto de Investigaciones Biomédicas de Málaga (IBIMA)/Hospitales Universitarios Regional and Virgen de la Victoria de Málaga, Málaga, Spain
| | - Claudia Valverde
- Medical Oncology Department, Vall d’Hebron University Hospital, Barcelona, Spain
| | - Josep Isern Verdum
- Radiotherapy Department, Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Enrique de Alava
- Institute of Biomedicine of Sevilla (IBiS), Virgen del Rocio University Hospital /CSIC/University of Sevilla/CIBERONC, Sevilla, Spain
- Department of Normal and Pathological Cytology and Histology, School of Medicine, University of Seville, Seville, Spain
| | - Mar Galera López
- Medical Oncology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Gloria Marquina
- Department of Medical Oncology, Hospital Clinico San Carlos, Madrid, IdISSC, Spain
- Department of Medicine, School of Medicine, Complutense University (UCM), Madrid, IdISSC, Spain
| | - Ana Sebio
- Medical Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona
- Universitat Autònoma de Barcelona, Barcelona, Spain
- Institut de Recerca Biomèdica Sant Pau (IIB Sant Pau), Barcelona, Spain
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Nucci MR, Webster F, Croce S, George S, Howitt BE, Ip PPC, Lee CH, Rabban JT, Soslow RA, van der Griend R, Lax SF, McCluggage WG. Data Set for Reporting of Uterine Malignant and Potentially Malignant Mesenchymal Tumors: Recommendations From the International Collaboration on Cancer Reporting (ICCR). Int J Gynecol Pathol 2022; 41:S44-S63. [PMID: 36305534 DOI: 10.1097/pgp.0000000000000911] [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: 11/07/2022]
Abstract
The International Collaboration on Cancer Reporting (ICCR) seeks to produce standardized, evidence-based protocols for the reporting of tumors with the aim of ensuring that all cancer reports generated worldwide will be of similar high quality and record the same elements. Herein, we describe the development of the data set for the reporting of uterine malignant and potentially malignant mesenchymal tumors by a panel of expert pathologists and a single clinician and provide the commentary and rationale for the inclusion of core and noncore elements. This data set, which incorporates the recent updates from the 5th edition of the World Health Organization Classification of Female Genital Tumors, addresses several subjects of debate including which mesenchymal tumors should be graded, how to document extent of invasion, mitotic counts, and the role of ancillary testing in tumor diagnosis and patient management. The inclusion of elements is evidence-based or based on consensus of the expert panel with clinical relevance being the guiding standard.
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Hu H, Wei Z, Zhao H, Yuan G. Epidemiology of adenosarcoma and the inverse probability of treatment weighting (IPTW) adjusted survival analysis of lymph node dissection in uterine adenosarcoma. Medicine (Baltimore) 2022; 101:e30607. [PMID: 36197202 PMCID: PMC9509147 DOI: 10.1097/md.0000000000030607] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
The objective for the study was to analysis the epidemiology of adenosarcoma, and independent prognostic factors and impact of lymph node dissection (LND) of uterine adenosarcoma. Cases of patients with primary adenosarcoma were obtained from the Surveillance, Epidemiology, and End Results (SEER) database from 2000 to 2016. Overall survival was analyzed by the Kaplan-Meier method and log-rank test. The differences in baseline covariates between the 2 groups were adjusted by inverse probability of treatment weighting method. The prognostic factors were identified by univariate and multivariate Cox regression analysis and hazard ratio and 95% confidence interval (CI) of covariates were also estimated. 1129 patients with pathological primary adenosarcoma between 2000 and 2016 were identified from the surveillance, epidemiology, and end results database. The only 4 patients were male. 1027 patients with primary uterine adenosarcoma, and 53.1% underwent LND and only 3.5% patients were with positive lymph node. Age, marital status, largest tumor size, tumor grade, T stage and chemotherapy were significantly correlated with survival. Race, tumor number, LND, and radiotherapy did not affect overall survival in patients. Inverse probability of treatment weighting-adjusted K-M curve showed that LND did not improve survival and lymph node metastasis (LNM) did not affect survival. The majority of primary adenosarcoma patients are female with high incidence of uterus and rare incidence of distant metastasis. Age, marital status, tumor size, T stage, grade, and chemotherapy are independent prognostic factors of uterine adenosarcoma. LNM was not a significant prognostic risk factor, and LND did not benefit survival.
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Affiliation(s)
- Hanjie Hu
- Key Laboratory of Gene Editing Screening and R&D of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Zhewen Wei
- Key Laboratory of Gene Editing Screening and R&D of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Hong Zhao
- Key Laboratory of Gene Editing Screening and R&D of Digestive System Tumor Drugs, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Guangwen Yuan
- Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- *Correspondence: Guangwen Yuan, Department of Gynecological Oncology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, No. 17 Nanli, Panjiayuan, Chaoyang District, Beijing 100021, China (e-mail: )
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9
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Hao Z, Yang S. The role of postoperative radiotherapy in patients with uterine sarcomas: A PSM-IPTW analysis based on SEER database. Front Surg 2022; 9:985654. [PMID: 36017510 PMCID: PMC9395938 DOI: 10.3389/fsurg.2022.985654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveThe optimal adjuvant therapy for uterine sarcomas remains poorly determined due to its rarity and histological diversity. The purpose of the study is to explore and characterize the association between utilization of radiotherapy and survival outcome in patients with surgically resected uterine sarcomas.MethodsWe collected data regarding uterine sarcomas which were confirmed after total hysterectomy between 2010 and 2018 period from the latest version of the Surveillance, Epidemiology, and End Results (SEER) database. Initially, 1-, 3- and 5-year survival rate were calculated to predict potential risk factors and possible role of adjuvant chemotherapy and radiotherapy. Propensity score matching (PSM) and inverse probability treatment weighting (IPTW) technique were employed to balance confounding factors in the utilization of additional therapy. Multivariate and exploratory subgroup analyses were respectively conducted to evaluate the impact of adjuvant therapy on overall survival (OS) and cause-specific survival (CSS).ResultsA total of 2897 patients were enrolled in the analysis. Survival benefit at 1-, 3-and 5-year after initial treatment was observed in the group of radiotherapy given, however, poorer prognosis in the group of chemotherapy administration. Accordingly, chemotherapy was enrolled as a confounding factor when stratifying and matching patients by receipt of radiotherapy. Prior to and after PSM-IPTW adjustment, radiotherapy both demonstrated beneficial effect on OS and CSS based on multivariate analysis. Further subgroup analysis indicated radiotherapy improved OS and CSS among a subset of patients in stage II-IV, particularly with uterine leiomyosarcoma, tumor grade IV, bigger tumor size than 100 mm and even with chemotherapy administration.ConclusionsAdjuvant radiotherapy in uterine sarcomas after hysterectomy might be underutilized, and proper use of adjuvant radiotherapy combined with chemotherapy after surgery in advanced-stage and high-risk patients might improve survival.
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Affiliation(s)
- Zhimin Hao
- Department of Gynecology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- School of Medicine, Ningbo University, Ningbo, China
- Correspondence: Zhimin Hao Sufen Yang
| | - Sufen Yang
- Department of Gynecology, The Affiliated Hospital of Medical School of Ningbo University, Ningbo, China
- Correspondence: Zhimin Hao Sufen Yang
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Mayr D, Horn LC, Hiller GGR, Höhn AK, Schmoeckel E. [Endometrial and other rare uterine sarcomas : Diagnostic aspects in the context of the 2020 WHO classification]. DER PATHOLOGE 2022; 43:183-195. [PMID: 35362728 DOI: 10.1007/s00292-022-01072-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/22/2022] [Indexed: 06/14/2023]
Abstract
Uterine sarcomas are a heterogeneous group of rare malignancies. Mostly (40-50%), they are leiomyosarcomas, followed by endometrial stromal sarcomas (ESS), low-grade (LG) and high-grade (HG), as well as undifferentiated sarcoma of the uterus (UUS) and adenosarcomas (AS). Other, non-organ-specific tumours such as NTRK-rearranged spindle cell neoplasia, perivascular epithelioid cell tumour (PEComa) and inflammatory myofibroblastic tumour (IMT) are extremely difficult to differentiate.In the most recent WHO classification, endometrial stromal tumours are subdivided as follows: benign, expansively growing endometrial stromal nodule (ESN) with sharp demarcation, the histologically similar-looking LG-ESS with infiltrative growth, the highly malignant HG-ESS and, as a diagnosis of exclusion, the highly aggressive UUS lacking specific lines of differentiation. LG-ESS can be differentiated from HG-ESS in most cases histomorphologically and immunohistochemically, but molecular investigations are necessary in individual cases. HG-ESS can be divided into 4 subtypes (YWHAE/NUTM2 fusion low-grade component, YWHAE/NUTM2 fusion high-grade component, ZC3H7B-BCOR fusion or BCOR-ITD) on the basis of molecular findings. Prognostically unfavourable factors in AS are severe sarcomatous overgrowth, deep myometrial invasion, high-grade histology and lymphatic vessel invasion. Tumours with NTRK fusion are immunohistochemically positive for S100 and TRK. PEComas express cathepsin K and HMB45, as well as TFE3 when translocation is present. Almost every IMT shows an alteration in the ALK gene In the case of overlapping morphology and simultaneous therapeutic and prognostic relevance, it is becoming increasingly important to verify or confirm the suspected histomorphological diagnosis by immunohistochemical and possibly molecular investigations.
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Affiliation(s)
- Doris Mayr
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland.
| | - Lars-Christian Horn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | | | - Anne Kathrin Höhn
- Institut für Pathologie, Universitätsklinikum Leipzig AöR, Leipzig, Deutschland
| | - Elisa Schmoeckel
- Pathologisches Institut, Ludwig-Maximilians-Universität München, Thalkirchner Straße 36, 80337, München, Deutschland
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Hu H, Song Q, Zhao H, Zheng B, Lu H. The first successful treatment and genetic sequencing of primary hepatic adenosarcoma with sarcomatous overgrowth: a case report. J Int Med Res 2022; 50:3000605221089546. [PMID: 35400213 PMCID: PMC9006382 DOI: 10.1177/03000605221089546] [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] [Indexed: 11/17/2022] Open
Abstract
Adenosarcoma is a rare type of tumor with a mixture of epithelial and stromal components and often occurs in the female reproductive system. Primary hepatic adenosarcoma (PHAS) is extremely rare, with only two cases reported so far. Both patients had poor outcomes. Here, we report the case of a 36-year-old man with pain under the xiphoid process who was diagnosed with a bile duct tumor. He was treated with adjuvant radiotherapy when surgery was performed on him. Pathologically, the tumor contained benign epithelial tissue, and the submucosa of the bile duct in the liver showed infiltrating growth of spindle cell components. The cells were dense, mildly heterotypic, and occasionally mitotic, and the patient was diagnosed with PHAS. Whole-exome sequencing results showed that a total of 12 mutations were shared by the two tissues. The patient received adjuvant radiotherapy and he was tumor-free until 31 months postoperatively. This case will provide some references of the disease to other researchers.
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Affiliation(s)
- Hanjie Hu
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Hepatobiliary Surgery, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Qianqian Song
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, State Key Laboratory of Molecular Oncology
| | - Hong Zhao
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Hepatobiliary Surgery, Beijing, China
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Bo Zheng
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Department of Pathology, Beijing, China
| | - Haizhen Lu
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
- National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Department of Pathology, Beijing, China
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12
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New Aspects of Sarcomas of Uterine Corpus-A Brief Narrative Review. Clin Pract 2021; 11:878-900. [PMID: 34842646 PMCID: PMC8628735 DOI: 10.3390/clinpract11040103] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 11/11/2021] [Accepted: 11/16/2021] [Indexed: 02/04/2023] Open
Abstract
Sarcomas of the uterine corpus are rare malignant neoplasms, which are further classified into mesenchymal tumors, and mixed (epithelial plus mesenchymal) tumors. The main issues concerning these neoplasms are the small number of clinical trials, insufficient data from evidence-based medicine, insignificant interest from the pharmaceutical industry, all of which close a vicious circle. The low frequency of these malignancies implies insufficient experience in the diagnosis, hence incomplete surgical and complex treatment. Additionally, the rarity of these sarcomas makes it very difficult to develop clinical practice guidelines. Preoperative diagnosis, neoadjuvant and adjuvant chemoradiation, target and hormone therapies still raise many controversies. Disagreements about the role and type of surgical treatment are also often observed in medical literature. There are still insufficient data about the role of pelvic lymph node dissection and fertility-sparing surgery. Pathologists’ experience is of paramount importance for an accurate diagnosis. Additionally, genetics examinations become part of diagnosis in some sarcomas of the uterine corpus. Some gene mutations observed in uterine sarcomas are associated with different outcomes. Therefore, a development of molecular classification of uterine sarcomas should be considered in the future. In this review, we focus on the epidemiology, pathogenesis, pathology, diagnosis and treatment of the following sarcomas of the uterine corpus: leiomyosarcoma, low- and high-grade endometrial stromal sarcomas, undifferentiated sarcoma and adenosarcoma. Uterine carcinosarcomas are excluded as they represent an epithelial tumor rather than a true sarcoma.
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Qu W, Liu Q, Jiao X, Zhang T, Wang B, Li N, Dong T, Cui B. Development and Validation of a Personalized Survival Prediction Model for Uterine Adenosarcoma: A Population-Based Deep Learning Study. Front Oncol 2021; 10:623818. [PMID: 33680946 PMCID: PMC7930479 DOI: 10.3389/fonc.2020.623818] [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: 10/30/2020] [Accepted: 12/30/2020] [Indexed: 01/16/2023] Open
Abstract
Background The aim was to develop a personalized survival prediction deep learning model for adenosarcoma patients using the surveillance, epidemiology and end results (SEER) database. Methods A total of 797 uterine adenosarcoma patients were enrolled in this study. Duplicated and useless variables were excluded, and 15 variables were selected for further analyses, including age, grade, positive lymph nodes or not, marital status, race, tumor extension, stage, and surgery or not. We created our deep survival learning (DSL) model to manipulate the data, which was randomly split into a training set (n = 519, 65%), validation set (n = 143, 18%) and testing set (n = 143, 18%). The Cox proportional hazard (CPH) model was also included comparatively. Finally, personalized survival curves were plotted for randomly selected patients. Results The c-index for the CPH model was 0.726, and the Brier score was 0.17. For our deep survival learning model, we achieved a c-index of 0.774 and a Brier score of 0.14 in the external testing set. In addition, the limitations of the traditional staging system were revealed, and a personalized survival prediction system based on our risk scoring grouping was developed. Conclusions Our study developed a deep neural network model for adenosarcoma. The performance of this model was superior to that of the traditional Cox proportional hazard model. In addition, a personalized survival prediction system was developed based on our deep survival learning model, which provided more accurate prognostic information for adenosarcoma patients.
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Affiliation(s)
- Wenjie Qu
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Qingqing Liu
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Xinlin Jiao
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Teng Zhang
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Bingyu Wang
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Ningfeng Li
- Cheeloo College of Medicine, Shandong University, Jinan, China
| | - Taotao Dong
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
| | - Baoxia Cui
- Department of Obstetrics and Gynecology, Qilu Hospital of Shandong University, Jinan, China
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14
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Rana IA, Hassan U, Bashir S, Hussain M, Shakeel M, Mushtaq S. Müllerian Adenosarcoma: A Single-Centre Experience of 59 Cases of This Rare Entity. Cureus 2021; 13:e13360. [PMID: 33747657 PMCID: PMC7969483 DOI: 10.7759/cureus.13360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background and objective Müllerian adenosarcomas (MA) are rare biphasic tumors with benign epithelial and sarcomatous stromal components. There is very limited cohort study data on MA in the South Asian countries and no such study has been attempted in Pakistan. Our aim was to evaluate the clinicopathological characteristics of MA and to review the published literature on the condition. Additionally, we also analyzed the impact of various prognostic factors on the overall survival (OS) of patients with MA. Materials and methods This was a retrospective observational study performed at the Shaukat Khanum Memorial Hospital and Research Centre, Lahore from 2003 to 2020. A total of 59 histologically confirmed cases of MA were included in the study and critically reviewed. Results The mean age of the patients was 54 ±16 years, and the most common tumor location was the uterine corpus (48, 81.4%), followed by the cervix (eight, 13.6%), ovary (two, 3.4%), and vagina (one, 1.7%). Sarcomatous overgrowth (SO) was seen in 22 (37.3%) patients, and high-grade cytology was observed in 18 (30.5%) patients. Furthermore, lymphovascular invasion (LVI) was present in six (10.2%) patients, and myometrial invasion was noted in 25 (42.4%) patients. The follow-up details of 29 patients were available, and death was recorded in 13 (44.8%) patients with a median OS of three years. Conclusion MA is a rare and diagnostically challenging entity due to its wide differential diagnosis. It is essential to take note of different morphological features such as SO, cytological features, LVI, and heterologous differentiation because of their significant prognostic impact.
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Affiliation(s)
- Iftikhar Ali Rana
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Usman Hassan
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Shaarif Bashir
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mudassar Hussain
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Mehroosh Shakeel
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
| | - Sajid Mushtaq
- Histopathology, Shaukat Khanum Memorial Cancer Hospital and Research Centre, Lahore, PAK
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Ali AMR, Tsai JW, Leung CH, Lin H, Ravi V, Conley AP, Lazar AJ, Wang WL, Nathenson MJ. The immune microenvironment of uterine adenosarcomas. Clin Sarcoma Res 2020; 10:5. [PMID: 32231779 PMCID: PMC7103067 DOI: 10.1186/s13569-020-0127-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 01/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Uterine adenosarcoma (UA) is an extremely rare sarcoma subtype. There has been limited evaluation of the immune microenvironment in these tumors. The objective of this study is to examine and describe the immune infiltrate and PD-1/PD-L1 expression in UA and to correlate these changes in the tumor micro-environment with the overall survival status or the disease-free survival status (DFSS), respectively. METHODS Patients (pts) treated at our center from 1982 to 2014 with UA were identified. Fifteen cases had tumor paraffin-embedded blocks available. Immunohistochemistry studies for CD3, CD8, FOXP3, CD163, PD-1 and PD-L1 (clone 22C3) were performed. Image analysis was used to assess the density (cells/mm2), except in PD-L1, where the percentage of membranous staining on tumor cells was noted. RESULTS Immune infiltrate analysis median (range) density in cells/mm2 varied broadly: CD3 178 (15-802); CD8 117 (11-661); FoxP3 4.8 (0.2-82); CD163 791 (264-1861); and PD1 5 (1-65). 3 cases had rare (1%) PD-L1 tumor membranous labeling. The reports yielded that ten pts were alive, and 5 were dead. Pts who were alive had significant higher CD3 and CD8 median densities in tumors than those who were dead (p = 0.040). There was no correlation between DFSS and CD3 or CD8 median densities. Patients who had no local recurrence had significantly higher CD3 and CD8 median densities in tumors than those who had local recurrence (p = 0.040). CONCLUSIONS In conclusion, this is the first report characterizing the presence of immune infiltrate and PD-1/PD-L1 expression in UA. CD3+ CD8+ T-cells density may be prognostic. The immune-responsiveness of UA needs to be further investigated in a larger study.
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Affiliation(s)
- Ali Mohammed Refaat Ali
- 1Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 Holcombe Blvd, Life Science Plaza (LSP11.5010), Houston, TX 77030 USA
| | - Jen-Wei Tsai
- 1Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 Holcombe Blvd, Life Science Plaza (LSP11.5010), Houston, TX 77030 USA
| | - Cheuk Hong Leung
- 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX 77030 USA
| | - Heather Lin
- 2Department of Biostatistics, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX 77030 USA
| | - Vinod Ravi
- 3Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX 77030 USA
| | - Anthony P Conley
- 3Department of Sarcoma Medical Oncology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd Unit 450, Houston, TX 77030 USA
| | - Alexander J Lazar
- 1Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 Holcombe Blvd, Life Science Plaza (LSP11.5010), Houston, TX 77030 USA
| | - Wei-Lien Wang
- 1Department of Translational Molecular Pathology, The University of Texas MD Anderson Cancer Center, 2130 Holcombe Blvd, Life Science Plaza (LSP11.5010), Houston, TX 77030 USA
| | - Michael J Nathenson
- 4Department of Medical Oncology, Center for Sarcoma and Bone Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Boston, MA 02215 USA
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Abstract
RATIONALE Uterine adenosarcoma (UA) with sarcomatous overgrowth (ASSO) is a rare and aggressive disease. Herein, wereported the case of a young patient with advanced uterine ASSO. PATIENTS CONCERNS A 29-year-old woman with the diagnoses of endometrial polyp and adenomyosis underwent hysteroscopic endometrial polypectomy for the giant endometrial polyp. Postoperative regular ultrasound scan indicated thickened endometriumand an ill-defined mass with continuous enlargement in the myometrium of the posterior wall of the uterus, which was considered as an adenomyoma. Two years after hysteroscopy, she was re-admitted due to lower abdominal distension and large pelvic mass. At that time, she had taken oral short-acting contraceptives for 2.5 years. DIAGNOSES Magnetic resonance imaging (MRI) of the pelvis revealed an irregular mass with the size of 12*56*107 mm in the right annex area, without distinct border with the rectum, moreover, an uneven intrauterine echo that has no obvious boundary with uterine wall. Right ovarian cancer and adenomyoma were initially considered. INTERVENTIONS The patient received transperitoneal retroperitoneal pelvic combined with total viscera resection, including uterus, bilateral appendages and rectum, omentectomy, appendectomy, lymphadenectomy, and ileostomy. Postoperative pathology confirmed ASSO in the uterine cavity and muscular layer, the whole cervical duct and the right adnexal. She underwent 2 systemic chemotherapy sessions after the surgery. The chemotherapy regimen was ifosfamide 2.5 g day 1 to 3, with liposomal doxorubicin 40 mg day 1. OUTCOMES The final diagnosis was uterine ASSO, International Federation of Gynecology and Obstetrics stage IVa. The patient has been following-up so far, with no progression. LESSONS Review of the case indicated that history of long-term oral short-acting contraceptives and giant endometrial polyps may be the high-risk factors for UA. For patients with high-risk factors, the follow-up ultrasound scan should be more frequently conducted. Moreover, 3D-ultrasound, MRI and outpatient hysteroscopy are recommended for routine screening. Placement of levonorgestrel-releasing intra-uterine system after hysteroscopy may be an effective intervention for patients with a high risk of giant polyps. Cluster of Differentiation 10, Estrogen receptor, Progesterone receptor, and nuclear antigen may be predictors for prognosis and selection of individualized treatment program.
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Ulrich UA, Denschlag D. Uterine Adenosarcoma. Oncol Res Treat 2018; 41:693-696. [DOI: 10.1159/000494067] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 09/26/2018] [Indexed: 01/03/2023]
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