ABSTRACT
Malignant mixed mullerian tumors (MMMT) are uncommon neoplasms of the female genital tract that histologically consist of malignant epithelial components and stromal components. Most MMMTs are found in postmenopausal women. The clinical course is very poor due to frequent metastasis and recurrence. Among the carcinogenic epidemiologic predisposing factors, the relationship of previous pelvic irradiation to subsequent development of a malignant mixed mullerian tumor has been reported in recent years. We are reporting a case of MMMT of the uterus which occured in a woman who received radiation therapy for cervical cancer 11 years before the present date.
Subject(s)
Female , Humans , Causality , Neoplasm Metastasis , Recurrence , Uterine Cervical Neoplasms , UterusABSTRACT
OBJECTIVE: Uterine sarcoma is relatively rare tumor of mesodermal origin, and constitutes 2% to 6% of uterine malignancies. It is the most malignant group of gynecologic tumors and presents difficult problems in regard to diagnosis and management. The purpose of this study is to investigate the clinicopathologic findings and outcome of patients with uterine sarcoma. METHODS: From March 1990 to March 2004, 8 patients were evaluated with histologically proven uterine sarcoma at department of obstetrics and gynecology of Gyeongsang University Hospital for their clinical profiles and survival retrospectively. RESULTS: The age of patients with uterine sarcoma ranged 39 to 71, and the mean age was 58.4 years. The common presenting symptoms were abnormal uterine bleeding, abdominal pain and lower abdominal palpable mass. Using the FIGO classification: two patients had stage I, one patients had stage II, two patients had stage III, three patients had stage IV disease. Four patients were treated with surgery followed by postoperative adjuvant chemotherapy and/or radiotherapy, three patients were treated surgery alone, and one patient was treated with radiotherapy alone. Recurrences were revealed at two patients, and the sites were pelvis and brain. The mean duration of follow up was 25.1 months and the overall 2 years survival rate was 25%. The most common pathologic type of uterine sarcomas was leiomyosarcoma. MMMT (malignant mixed mullerian tumor) showed worse prognosis than LMS (leiomyosarcoma) or ESS (endometrial stromal sarcoma). CONCLUSION: Uterine sarcoma are aggressive tumors with a poor prognosis. Age and stage were significant prognostic factor. The primary treatment modality has been surgical resection. The role of adjuvant chemotherapy and radiotherapy have not get been clearly defined and further large scaled multicentric studies are needed.
Subject(s)
Humans , Abdominal Pain , Brain , Chemotherapy, Adjuvant , Classification , Diagnosis , Follow-Up Studies , Gynecology , Leiomyosarcoma , Mesoderm , Obstetrics , Pelvis , Prognosis , Radiotherapy , Recurrence , Retrospective Studies , Sarcoma , Survival Rate , Uterine HemorrhageABSTRACT
Malignant mixed Mullerian tumor(MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversial. The patients with advanced stage ovarian cancer could only benefit from an optimal surgical debulking. However, the optimal cytoreductive surgery may often be difficult to achieve due to the initial extent of the disease. Thus primary surgery for this subset of patients may be questionable. So, we tried neoadjuvant Taxol and/or cis-platinum combined chemotherapy as primary treatment. At the end of neoadjuvant chemotherapy, the patient showed markedly decrease of serum CA 125 level(from 210 U/ml to 59 U/ml) and optimal cytoreductive surgery was performed. After surgery, adjuvant chemotherapy was administered and the serum CA 125 level decreased to the normal range. This case shows our experience of neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy in patient with primarily unresectable ovarian malignant mixed Mullerian tumor(MMMT).
Subject(s)
Female , Humans , Chemotherapy, Adjuvant , Cisplatin , Drug Therapy , Ovarian Neoplasms , Ovary , Paclitaxel , Reference ValuesABSTRACT
Malignant mixed Mullerian tumor(MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversial. The patients with advanced stage ovarian cancer could only benefit from an optimal surgical debulking. However, the optimal cytoreductive surgery may often be difficult to achieve due to the initial extent of the disease. Thus primary surgery for this subset of patients may be questionable. So, we tried neoadjuvant Taxol and/or cis-platinum combined chemotherapy as primary treatment. At the end of neoadjuvant chemotherapy, the patient showed markedly decrease of serum CA 125 level(from 210 U/ml to 59 U/ml) and optimal cytoreductive surgery was performed. After surgery, adjuvant chemotherapy was administered and the serum CA 125 level decreased to the normal range. This case shows our experience of neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy in patient with primarily unresectable ovarian malignant mixed Mullerian tumor(MMMT).
Subject(s)
Female , Humans , Chemotherapy, Adjuvant , Cisplatin , Drug Therapy , Ovarian Neoplasms , Ovary , Paclitaxel , Reference ValuesABSTRACT
Malignant mixed m llerian tumor (MMMT) of the ovary is very rare neoplasm consisting of both a sarcomatous and carcinomatous component and represent is fewer than 1% of all ovarian malignancies. Characteristically, ovarian MMMTs follow an aggressive clinical course, and long-term survival is unusual. Almost all MMMTs are found in postmenopausal women, often with low parity and usually in an advanced stage. Stage has been recognized as the single most important prognostic factors. However, a major improvement in prognosis for this rare malignancy has not yet been achieved. The authors have experienced one case of primary malignant mixed m llerian tumor of the ovary and report our experience with a brief review of literature.
Subject(s)
Female , Humans , Ovary , Parity , PrognosisABSTRACT
Carcinosarcoma of the female genital tract, also called malignant mixed mullerian tumor (MMMT), is a rare and relatively aggressive tumor with various homologous and heterologous components. There have been various studies to find prognostic factors and to investigate the histogenesis, including tissue culture, electron microscopy, and immunohistochemical studies. We investigated carcinomatous, sarcomatous, and transitional areas of 6 cases of carcinosarcoma of the uterus and ovary by using epithelial and mesenchymal markers. Immunohistochemical profiles of the transitional areas were significantly different from those of carcinomatous and sarcomatous areas. Immunoreactivities for cytokeratin and epithelial membrane antigen (50% and 22.2%) were weaker than those of carcinomatous areas (95.2% and 100%), but stronger than those of sarcomatous areas (11.1% and 5.6%)(p<0.01). In transitional areas, vimentin, smooth muscle actin and S-100 protein were more strongly expressed than in carcinomatous areas, but more weakly expressed than in sarcomatous areas (p<0.01, p<0.01, and p=0.018, respectively). Myoglobin was entirely negative in carcinomatous areas and immunoreactive in minor portions of transitional and sarcomatous areas (22.2% and 16.7%, respectively). These results suggest that the transitional areas are between the carcinomatous and sarcomatous nature in differentiation, further supporting that the carcinosarcomas of the female genital tract may arise, through metaplastic change, from a type of carcinoma.
Subject(s)
Female , Humans , Actins , Carcinosarcoma , Immunohistochemistry , Keratins , Metaplasia , Microscopy, Electron , Mucin-1 , Muscle, Smooth , Myoglobin , Ovary , S100 Proteins , Uterus , VimentinABSTRACT
Malignant mixed mullerian tumor (MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversal. The authors have experienced one case of primary malignant mixed mullerian tumor of the ovary and reprot our experiences with a brief review of literature.