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Results for “Mixed Tumor, Mesodermal”

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PubMed1993

Dedifferentiated extrauterine adenosarcoma responsive to chemotherapy.

Extrauterine adenosarcoma, a low-grade mixed mesodermal tumor, is an uncommon neoplasm. Little information is available regarding the efficacy of treatment of tumors not amenable to surgical resection. Our patient's pelvic adenosarcoma progressed despite multiple attempts at surgical excision over an 8-year period. Hormonal therapy with medroxyprogesterone acetate and tamoxifen did not alter the frequency of recurrence. However, aggressive cisplatin-ifosfamide-based combination chemotherapy produced a dramatic response in the metastatic tumor in the liver. Cisplatinum, doxorubicin, and ifosfamide may thus be active against this tumor. Regional arterial infusion, when feasible, may enhance response.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1993

Uterine leiomyosarcoma and endometrial stromal sarcoma: lymph node metastases and sites of recurrence.

This study was undertaken to examine the incidence and conditions under which lymph node metastases are present and patterns of recurrence in women with uterine leiomyosarcoma (LMS) and endometrial stromal sarcoma (ESS), excluding malignant mixed mesodermal tumors. From 1981 through 1991, 21 women with LMS and 10 women with ESS were treated. Retroperitoneal lymph node dissections were performed in 15 women with LMS and 7 women with ESS. In the women with LMS, 4/15 (26.7%) had lymph node metastases; in each there was disseminated intra-abdominal disease. In the 7 women with ESS, there were no lymph node metastases present. Ten women (47%) with LMS developed recurrences, and 3 (14%) had persistent disease. In the 10 women with ESS, 3 (30%) had recurrences, and 1 (10%) had persistent disease. In total, recurrences involved the lung in 84% of cases. Of the 13 women with recurrences, 7 had undergone lymph node sampling, and all were negative; 4 additional women had no evidence of adenopathy on abdominal-pelvic CT scan. Lymph node metastases were found only with extrauterine disease, and in all of these cases there was rapid progression of the sarcoma. Women without extrauterine disease did not have lymph node metastases detected; however, there was still a high rate (40%) of distant failure. Knowledge of lymph node status had minimal impact on the clinical management of women with uterine LMS and ESS.

Adult↗

PubMed1999

Laparoscopic lymphadenectomy for gynecologic malignancies.

OBJECTIVE: The purpose of our study was to detail our 5-year experience with laparoscopic lymphadenectomy for gynecologic malignancies. METHODS: From 11/5/92 to 3/9/98, we performed laparoscopic lymphadenectomies on 94 patients with various gynecologic malignancies. Pelvic, paraaortic, and combinations of both pelvic and paraaortic lymphadenectomies were performed depending on the primary site of disease and indication for lymph node dissection. Data were prospectively collected on all patients. RESULTS: From 11/5/92 to 3/9/98 we performed 94 laparoscopic lymphadenectomies for gynecologic malignancies. The distribution included 64 patients with cervical cancer, 14 with ovarian cancer, 12 with endometrial cancer, 2 with fallopian tube cancer, 1 with a uterine malignant mixed mesodermal tumor, and 1 with a metastatic neuroendocrine tumor. Fifty-five patients had only pelvic lymph node dissections, 9 patients had paraaortic dissections only, and 30 had both pelvic and paraaortic dissections performed. Among 30 patients having laparoscopic lymphadenectomy only, the mean hospital stay was 3.6 days. Included in this group were 19 patients who received postoperative neoadjuvant chemotherapy for cervical cancer as inpatients prior to ambulatory radiation therapy. The mean length of stay for this group was 4.6 days versus 1.7 days for the 11 patients who did not receive postoperative chemotherapy (P = 0.0025). The mean number of pelvic nodes was 11.9 (range 0-57), with a mean of 4. 5 between 11/5/92 and 12/31/95 and a mean of 19.1 from 1/1/96 to 3/9/98. The mean number of paraaortic nodes obtained was 3.7 (range 0-14), with a mean of 3.4 from 11/5/92 to 12/31/95 and a mean of 4.1 from 1/1/96 to 3/9/98. A total of 3 patients required conversions to laparotomy. One was for a vascular injury to the vena cava, 1 for a large tumor extending to both sidewalls, and the third for removal of densely matted lymph nodes. CONCLUSIONS: Laparoscopic lymphadenectomy is a technically feasible procedure for patients with gynecologic malignancies requiring lymph node dissections, with an acceptable safety profile and nodal yield. The number of nodes obtained increased in direct proportion to operator experience. In addition, patients may benefit from a decrease in hospital stay compared to conventional lymphadenectomy via laparotomy.

Adult↗

PubMed2001

Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study.

OBJECTIVE: The goal of this study was to estimate the clinical activity of paclitaxel in patients with persistent or recurrent carcinosarcoma of the uterus who have failed other treatments. METHODS: The Gynecologic Oncology Group (GOG) conducted a phase II study of paclitaxel 170 mg/m(2) (135 mg/m(2) in those with prior irradiation) intravenously every 3 weeks in patients with histologic confirmation of carcinoma and measurable disease who had failed appropriate local therapy. RESULTS: A total of 53 patients were entered into the study between September 1994 and January 1997; 44 patients were evaluable for response. The median age of the patients treated was 65 years (range: 38-79). Twenty-six patients had heterologous mixed mesodermal tumors (MMTs) and 18 patients had homologous tumors. A median of three courses were administered (range: 1-18). Fifteen patients had previous radiation therapy and 33 patients had failed prior chemotherapy. Eight patients (18.2%) had a response to paclitaxel: four patients had a complete response and four had a partial response. Neutropenia was the most common toxic effect. CONCLUSIONS: Paclitaxel had moderate activity in patients with carcinosarcoma of the uterus. The GOG is currently studying the combination of paclitaxel and ifosfamide versus ifosfamide alone for patients with advanced or recurrent carcinosarcoma of the uterus.

Adult↗

PubMed1995

Uterine adenofibroma presenting as a cystic adnexal mass.

Uterine adenofibroma is a form of mixed mesodermal tumor in which both the epithelial and stromal components are benign. Almost all previously reported cases have been confined to the endometrium or endocervical mucosa. Our patient presented with a cystic adnexal mass and had a hysterectomy.

Adenofibroma↗

PubMed1990

Early phase II Gynecologic Oncology Group experience with ifosfamide/mesna in gynecologic malignancies.

Starting in July 1985, the Gynecologic Oncology Group conducted a series of phase II trials with ifosfamide/mesna in advanced or recurrent gynecologic malignancies. Previously untreated patients received 1.5 g/m2 i.v. ifosfamide daily for 5 days. Mesna was given i.v. q4h x 3 following ifosfamide; each dose was 20% of the daily ifosfamide dose. All patients with ovarian and 87% of those with cervical cancer had previously undergone platinum-based therapy. Because of the toxicity encountered in previously treated patients with ovarian carcinoma, the dose of ifosfamide was reduced to 1.2 g/m2 daily in all patients who had received prior chemo- or radiotherapy. In epithelial ovarian carcinoma, responses were observed in 8 (20.0%) of 41 evaluable patients, with 3 (7.0%) complete responses. Response duration was 2.1-20.3+ months, with a median of 6.9+ months. In squamous-cell carcinoma of the cervix, 3 (11.1%) of 27 evaluable patients showed partial responses of 1.8, 2.2, and 3.1 months' duration. Of 26 untreated patients with mixed mesodermal tumors of the uterus, 5 (19.2%) achieved complete and 3 (11.5%) showed partial responses, for an overall response rate of 30.7%. Response duration was 1.4(+)-8.6 months, with a median of 3.8 months. Toxicity included two deaths due to renal insufficiency and a third related to neurologic impairment. Hematologic toxicity was manageable. Ifosfamide/mesna has activity in a wide range of gynecologic malignancies.

Antineoplastic Agents↗

PubMed1996

Sarcoma of the uterus. A clinical study of 42 patients.

Records of 42 patients with a diagnosis of uterine sarcoma treated between 1974 and 1995 at the Department of Oncology and Radiotherapy, Medical University of Gdańsk have been reviewed. There were 15 cases of leiomyosarcoma, 14 cases of carcinosarcoma (malignant mixed mesodermal tumor) and 13 cases of endometrial stromal sarcoma. There were 24 FIGO stage I patients, 3 stage II patients, 7 stage III patients and 8 stage IV patients. Thirty seven patients had previously been operated on, of whom 33 had undergone total abdominal hysterectomy and bilateral salpingoophorectomy. Adjuvant postoperative treatment was administered in 19 patients and included radiotherapy in 16 patients, chemotherapy in two and chemotherapy and irradiation in one. Out of 31 radically operated patients, 19 (61%) had recurrences, within 2-42 months of primary treatment (median 10 months); nine patients had distant metasases, six patients had local recurrence and four had both local and distant failure. Treatment failure occurred in seven out of 14 patients who received adjuvant radiotherapy and in 12 out of 17 treated without irradiation. Median survival time in both groups was 26 months. The survival for the whole series ranged from 2 months to 19+ years (median 26 months) and was not related to tumor type. Two and five year actuarial survival rates were 54% and 30%, respectively.

Adult↗

PubMed1985

Uterine sarcoma: analysis of prognostic variables in 71 cases.

The histories of 94 patients with a diagnosis of uterine sarcoma, treated from 1962 to 1982, at the Medical College of Virginia Hospital were reviewed. Histologic features were studied by one of the authors (V.S.), and cases that did not meet strict pathologic criteria were rejected. The 71 patients with uterine sarcoma accepted for this study had a survival rate of 22.5% from 1 to 11 years. Survival rates were similar for leiomyosarcoma, mixed mesodermal tumor, and endometrial stromal sarcoma. Clinical staging had some predictive value, since 45 patients with Stage I disease had a 27% survival rate, and 26 patients with Stages II, III, and IV disease had only a 12% survival rate (p less than 0.05). The type of treatment had no demonstrable effect on final outcome but did influence the recurrence patterns. Chemotherapy (used in 25 patients) was neither of benefit when used as adjuvant therapy nor effective in prolonging survival in patients with recurrence (mean survival, 5.4 months).

Adult↗

PubMed1995

p53 in endometrial cancer and its putative precursors: evidence for diverse pathways of tumorigenesis.

To elucidate the role of p53 abnormalities in endometrial tumorigenesis, a diverse group of endometrial neoplasms and their putative precursors, atypical endometrial hyperplasia, and endometrial intraepithelial carcinoma (EIC) were studied using a conventional immunohistochemical technique. Immunostaining for p53 protein was detected in 24 (86%) of 28 serous carcinomas compared with nine (20%) of 45 endometrioid carcinomas (P < .001). Immunoreactivity was also detected in two (100%) of two clear cell carcinomas, five (83%) of six mixed endometrioid/serous carcinomas, and seven (70%) of 10 malignant mixed mesodermal tumors. Benign endometrial tissue and 12 examples of atypical endometrial hyperplasia were nonreactive. In 27 (79%) of 34 tumors containing EIC, both the tumor and EIC were immunoreactive for p53, whereas in 7 (21%) both were negative. Immunostaining for p53 highlighted small foci of EIC and showed the extent and distribution of the lesions. The strong association and similar p53 immunostaining pattern of EIC and serous carcinoma support the hypothesis that serous carcinomas develop from endometrial surface epithelium that demonstrates abnormal p53 protein expression in conjunction with transformation to EIC. Mutation of p53 seems unrelated to the development of endometrioid carcinoma from atypical endometrial hyperplasia but may be related to dedifferentiation in some of these neoplasms.

Carcinoma in Situ↗

PubMed1984

Autopsy findings in patients with uterine sarcoma.

Autopsy findings were reviewed in 22 patients treated for uterine sarcoma at the University of Michigan Hospitals. Included are 11 mixed mesodermal tumors, 6 endometrial stromal sarcomas, and 5 leiomyosarcomas. Only one patient died with disease limited to the pelvis. Forty-five percent of the patients died with disease limited to the pelvis and abdomen. The most common site of the disease above the diaphragm was the lung. Lymph nodes were involved in 59% of our patients. There were no obvious differences in the patterns of spread between the tumor types.

Combined Modality Therapy↗

PubMed1986

Uterine sarcomas: prognostic factors and treatment modalities--study on 209 patients.

From 1975 through 1984, 209 patients with uterine sarcoma were studied in 13 French Oncology Centers. The repartition by histologic type was the following: 31 patients (PTS) with carcinosarcoma, 81 PTS with leiomyosarcoma, 27 PTS with endometrial sarcoma, and 70 PTS with mullerian mixed mesodermal tumors. The prognostic factors were analyzed using a proportional hazards regression model. The analysis of prognostic factors showed that the strongest predictor of survival was menopausal status. Increasing tumor extension and increasing WHO performance status were also prognostic factors. No significant difference for prognosis was found for histologic type, operability, and age. Two-year survival rates were quite similar for all kinds of treatment, being 58.0% for tumor extension T1 and T2 and 35.0% for tumor extension T3 and T4. Two-year recurrence and metastasis rates were lower with addition of radiotherapy or chemotherapy without any benefit on survival rates. Cooperative clinical trials including all histologic types should be undertaken to improve survival. The knowledge of the prognostic factors can help to refine treatment comparisons.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed1989

Fallopian tube carcinoma: a clinicopathological study of 17 cases.

From 1969 through 1986, 17 patients with primary adenocarcinoma of the fallopian tube were treated at the Loma Linda University Medical Center. Stages I, II, and III of the disease were present in 6, 5, and 6 patients, respectively. The mean age of the patients was 59.9 years. Vaginal bleeding or discharge (57%), followed by abdominal pain or discomfort (29%), was the most common symptom in our patients. A palpable pelvic mass was detected in two-thirds of the patients. One case of carcinosarcoma, one case of mixed mesodermal tumor, and one case of endometrioid carcinoma are included. No patient in this series had a correct preoperative diagnosis. Therapy consisted of surgical resection, usually followed by various combinations of adjuvant radiation therapy and/or chemotherapy. The overall 5-year survival rate was 31%. Five patients (29%) are alive without evidence of disease. This study supports the need for collaboration among large centers to define the optimal adjuvant therapy of this disease. In the absence of the desired treatment protocols, such lesions should be approached in a manner similar to that used for ovarian cancers.

Adenocarcinoma↗

PubMed1990

Adenofibroma of the uterus: multiple recurrences following wide local excision.

The uterine adenofibroma is a form of mixed mesodermal tumor in which both epithelial and stromal components are benign. A case is presented in which a patient with this lesion was treated with excision of the tumor rather than hysterectomy. Two years later, she developed a recurrence of the lesion, which was again treated with wide local excision. A hysterectomy was done 9 months later, and a polypoid lesion was noted in the fundus of the uterus which on histologic examination was thought to be potentially either an adenofibroma precursor or a maturation of the previous cellular adenofibroma. Since uterine adenofibroma usually occurs in older patients, the standard treatment has been hysterectomy. Because of this patient's age, she was initially treated with a more conservative approach. However, despite the fact that the uterine adenofibroma is a benign lesion, it has an obvious potential to recur when treated conservatively.

Adenofibroma↗

PubMed1990

Chromosome rearrangements in two uterine sarcomas.

Cytogenetic analysis of short-term cultures from two uterine sarcomas revealed clonal chromosome abnormalities in both cases. A locally recurrent mixed mesodermal tumor had the karyotype 61,XX,+2,+3,+del(5)(q11),+6,+7,+del(7)(q32),+8,+8,+8,+10, -11,-11,+der(11)t(1;11)(q12;p15),+der(11)t(1;11)(q12;p15),+der(11)t(1;11)(q12;p15),+del(12)(q14q21),+13,+15,del(17)(q23),+20. The other tumor, a lung metastasis from a uterine leiomyosarcoma, had several karyotypically abnormal clones. Two of them consisted of highly aberrant cells with modal chromosome numbers of 82 and 153, respectively, but because of insufficient quality the complex anomalies could not be identified. Various chromosomal changes that included translocations, deletions, insertions, and numerical rearrangements (always with extra chromosome 7 material) were identified in pseudo- or near-diploid cells, resulting in nine additional cytogenetically abnormal clones.

Aged↗

PubMed2004

Endometrial pathologies associated with postmenopausal tamoxifen treatment.

OBJECTIVE: To evaluate various endometrial pathologies described in association with postmenopausal tamoxifen treatment, as well as the clinical aspects of these endometrial pathologies. METHODS: A search was made in PUB MED for all studies published in English, up to the end of 2003, reporting on endometrial pathologies in association with postmenopausal tamoxifen treatment. Overall 106 studies were available, and all are included in this review. The types of studies included were mostly randomized clinical trials, non-randomized cohort studies, prospective and retrospective case controlled studies. RESULTS: Endometrial polyps represent the most common endometrial pathology associated with postmenopausal tamoxifen exposure. A high rate of malignancy was reported in these polyps. Endometrial hyperplasia, endometrial polyps, endometrial cancer and malignant mixed mesodermal tumors and sarcoma are more commonly diagnosed in postmenopausal breast cancer tamoxifen-treated patients as compared to non-treated patients. Long-term tamoxifen users are more likely to succumb to endometrial cancer and endometrial sarcomas than non-users, due to the unfavorable histology of the endometrial malignancy, and an advanced stage of diagnosis. CONCLUSIONS: The clinician should be alerted to these pathologies, which, in some cases, may potentially increase the mortality of these patients. Consequently, it is suggested that their supervision is of importance, especially if the patients experience any gynecological symptoms, including pelvic pain or pressure.

Antineoplastic Agents, Hormonal↗

PubMed2005

Laparoscopic lymphadenectomy for gynecologic malignancies using ultrasonically activated shears: analysis of first 100 cases.

OBJECTIVE: To evaluate the feasibility, safety and utility of the ultrasonic shears for laparoscopic pelvic and para-aortic lymph node retrieval in the treatment of gynecologic cancers. METHODS: Data on laparoscopic lymphadenectomy performed for gynecologic malignancies using ultrasonic shears over a 5-year period were collected and analyzed prospectively. RESULTS: Laparoscopic lymphadenectomy using ultrasonic shears was performed on 100 patients with a median age of 58 (17-87) years. The types of malignancies included cervical (n = 29), endometrial (n = 48), ovarian (n = 15), fallopian tube (n = 2), malignant mixed mesodermal tumor (n = 2), vaginal (n = 2) and synchronous ovarian and endometrial cancers (n = 2). Sites of lymphadenectomy included pelvic (n = 49), para-aortic (n = 30) or both pelvic and para-aortic (n = 21). The median nodal yield was 22 (0-87). 66/100 were complete lymphadenectomies with a median nodal yield of 28 (2-71). The median length of hospital stay was 2 (1-13) days and the average blood loss was 148 (0-500) ml. Overall complication rate was 13%. There were 3 intra-operative complications, which were all managed laparoscopically. There were no unplanned conversions to laparotomy. There were 10 post-operative complications including port-site metastasis in a patient with positive nodes (n = 1), trocar-site hernia requiring a second laparoscopy (n = 1), deep leg vein thrombosis (n = 1), and a small bowel obstruction (n = 1). CONCLUSIONS: This is the largest series to date demonstrating the safety and efficacy of ultrasonic shears in laparoscopic lymphadenectomy for gynecologic malignancies. In addition to the potential for lowering the risk for tissue damage, ultrasonic shears offer multifunctionality which allows for a simpler technique with the use of fewer instruments.

Adolescent↗

PubMed2001

Ovarian carcinoma recurring as carcinosarcoma.

Malignant mixed mesodermal tumor is a rare tumor of the ovary and its histogenesis is controversial. We report the case of an ovarian tumor that seemed to be a pure carcinoma and recurred as a carcinosarcoma, and suggest a possible histogenesis for this kind of tumor. The patient was a 62-year-old Japanese woman. The primary tumor was confined to the right ovary and was a histologically poorly differentiated endometrioid adenocarcinoma with focal squamous differentiation. The tumor recurred as peritoneal dissemination 9 months later showing a histological appearance of carcinosarcoma of heterologous type. The recurrent tumor also contained intermingled foci of similar histology as the primary tumor. The carcinomatous component of the recurrent tumor showed more obvious differentiation to adenocarcinoma with increased expression of epithelial markers compared to the primary tumor. Epithelial membrane antigen was positive also in a few cells of the sarcomatous component, which implies that this tumor had features of metaplastic carcinoma. The DNA ploidy pattern of the primary ovarian tumor was diploid, while an additional aneuploid subpopulation appeared in the recurrent tumor. These findings suggest the possible histogenesis of carcinosarcoma of the ovary as progression and clonal evolution of endometrioid adenocarcinoma.

Carcinoma, Endometrioid↗

PubMed1996

Sonographic characteristics of adenofibroma of the endometrium following tamoxifen therapy for breast cancer: two case reports.

Adenofibroma of the endometrium is thought to be a rare benign variant of the mixed mesodermal tumor, and its preoperative diagnosis is difficult. We describe the sonographic characteristics of two cases of adenofibroma of the endometrium. In both cases the patient was receiving prolonged tamoxifen therapy following surgery for breast cancer. Sonographically, this rare disease is observed as an intracavitary mass containing multiple small cysts with low-resistance intratumor blood flow. The unique sonographic findings make the preoperative diagnosis possible.

Adenofibroma↗