The Role of F-18 Fluorodeoxyglucose Positron Emission Tomography in Patients with Malignant Mixed Mullerian Tumors of the Uterus / 핵의학분자영상

PURPOSE: Malignant Mixed Mullerian Tumor (MMMT) of the uterine corpus is one of the very uncommon and the most lethal tumors in the uterus. The aim of this study was to evaluate the role of FDG PET in detecting distant metastasis and residual and/or recurrent disease. METHODS: Ten patients who underwent FDG PET for detecting distant metastasis and recurrence were included. Focal FDG accumulation was regarded as abnormal. We also reviewed serum CA 125 levels, anatomical images, and histopathological examination. RESULTS: Three patients of 10 FDG PET showed abnormal FDG uptake. One had high serum CA 125 levels and high fractions of carcinomatous element on histopathologic examination. FDG PET showed metastatic lesions in unexpected locations, which could not be detected by anatomical images. Another had normal serum CA 125 levels with high sarcomatous element and CT could only detect a few lesions. The other had high serum CA 125 levels and also had high carcinomatous element. Seven patients who had no abnormal uptake on FDG PET had no clinical evidence of recurrence during the follow up period (51.7+/-12.2 months). The mean disease free intervals of these 7 patients were 36.4+/-6.0 months. Two patients with abnormal findings had never become disease-free condition during the follow up period (6.0+/-4.2 months. CONCLUSION: FDG PET could be a useful modality for unexpected distant metastasis and follow up tool in patients with MMMT.

Malignant Mixed Mullerian tumors of the ovary: The result of Platinum-based combination chemotherapy following the cytoreductive surgery / 부인종양

OBJECTIVE: The purpose of this study was to review the therapeutic results and the clinical outcome of the patients treated with optimal cytoreductive surgery and platinum-based chemotherapy for malignant mixed mullerian tumors (MMMTs) of the ovary. The evaluate the role of such treatments in ovarian MMMTs. METHODS: A retrospective analysis was performed with medical records that nine patients underwent complete surgical staging from February 1993 to January 2004 at Asan Medical Center, Korea. Seven patients received IP (ifosfamide/cisplatin) chemotherapy as a first-line chemotherapy and the other patients received other platinum-based combination chemotherapy. Demographic data, pathologic findings, treatment and survival time were studied. RESULTS: Nine patients diagnosed with MMMTs of the ovary after optimal cytoreductive surgery. The International Federation of Gynecology and Obstetrics stages for the 9 women were none stage I, 1 stage II, 6 stage III, 2 stage IV. The median survival time of all patients was 41 months (1-76 months). The overall survival rate was 55.5% at 1 year and 40% at 2 years. CONCLUSION: Malignant mixed mullerian tumors of the ovary grow very rapidly and are usually in advanced stages when diagnosed. But our results of clinical experience for platinum-based combination chemotherapy after optimal cytoreductive surgery could be a standard treatment for ovarian MMMTs.

Malignant Mixed Mullerian Tumor Arising from Adenomyosis of Uterus

Malignant mixed mullerian tumor (MMMT) is an unusual tumor composed of malignant epithelial and nonepithelial components in the same lesion and is subdivided into homologous and heterologous types. Epidemiologically, these tumors are associated with prior pelvic irradiation, functioning ovarian lesions, exogenous estrogen therapy and rarely endometriosis. We experienced a case of uterine MMMT which arose from adenomyosis in a 47-year-old woman who had no specific past medical history. The posterior uterine corpus showed a 3.5x3.0x2.0 cm sized, relatively well defined tumor mass within the background of the adenomyosis. The tumor was composed of well differentiated endometrial adenocarcinoma and sarcomatous stroma with foci of rhabdomyosarcomatous differentiation confirmed by immunohistochemical and electron microscopic studies. Through the immunohistochemical study, both the epithelial and nonepithelial components were positive for cytokeratin and it suggested that the sarcomatous area originated from metaplasia of the adenocarcinoma component. From the overall findings, it is regarded as an uterine heterologous MMMT which arose from adenomyosis.