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1.
Eur J Gynaecol Oncol ; 35(5): 584-8, 2014.
Artigo em Inglês | MEDLINE | ID: mdl-25423710

RESUMO

Malignant mixed mesodermal tumors (MMMTs) are highly aggressive and usually diagnosed at advanced stages. MMMT originates from either the ovary or the uterus. Because this disease is relatively rare, an optimal treatment modality has not yet been established. The authors report four cases of ovarian MMMT (one heterologous MMMT and three homologous MMMTs) during 1990-2011. The patients underwent operation immediately after histopathologically confirmation and were treated with platinum-based combination chemotherapy. The extent of operation, the outcomes of radiation therapy, and the proper chemotherapeutic regimen are still controversial. The authors report herein four cases of ovarian MMMTs alone with a brief literature review.


Assuntos
Tumor Mesodérmico Misto/terapia , Neoplasias Ovarianas/terapia , Idoso , Terapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/patologia , Neoplasias Ovarianas/patologia
2.
Minerva Endocrinol ; 39(3): 155-65, 2014 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-25003226

RESUMO

Endometriosis is one of the most commonly encountered benign problems in gynecology. Even though endometriosis appears to predispose to ovarian cancer the progression from atypical epithelial proliferation (atypical endometriosis and metaplasia), to the formation of well-defined borderline tumors and finally to endometrioid ovarian cancer will take several years. To elaborate on the concept of endometriosis as a precursor of some types of ovarian cancer, we present an overview of the pathophysiological and genetic characteristics, common in those two conditions. Furthermore, we present the genetic mutations found in ovarian cancers and we outline the common genetic alterations of endometriosis and ovarian cancer, focusing on the PI3K/Akt/mTOR-signaling pathway.


Assuntos
Endometriose/patologia , Neoplasias Ovarianas/patologia , Lesões Pré-Cancerosas/patologia , Carcinoma/patologia , Carcinoma Endometrioide/patologia , Transformação Celular Neoplásica/genética , Progressão da Doença , Suscetibilidade a Doenças , Endometriose/fisiopatologia , Feminino , Instabilidade Genômica , Humanos , Tumor Mesodérmico Misto/patologia , Mutação , Proteínas de Neoplasias/fisiologia , Oncogenes , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/fisiopatologia , Lesões Pré-Cancerosas/fisiopatologia , Proteínas Quinases/fisiologia , Transdução de Sinais/genética , Transdução de Sinais/fisiologia , Microambiente Tumoral
3.
Curr Probl Diagn Radiol ; 42(5): 191-208, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-24070713

RESUMO

A clear understanding of the normal anatomy and pattern of disease spread is important in evaluating many retroperitoneal disorders. Primary retroperitoneal tumors are uncommon, accounting for 0.1%-0.2% of all malignancies in the body; 80%-90% of all primary retroperitoneal tumors are malignant. The primary retroperitoneal neoplasms can be divided into solid or cystic masses. The solid neoplasms can be classified according to their tissue of origin into 3 main categories: mesodermal tumors, neurogenic tumors, and extragonadal germ cell tumors. Computed tomography and magnetic resonance imaging play a vital role in the localization, characterization, evaluation of the extent of local invasion, assessment of metastases, and determination of treatment response for these tumors. The diagnosis of a primary retroperitoneal malignancy is often challenging owing to overlap of imaging findings. A definitive diagnosis can be established only at histopathologic analysis. However, knowledge of the important tumor characteristics, growth pattern, and vascularity can assist in narrowing the differential diagnosis.


Assuntos
Imagem por Ressonância Magnética , Tumor Mesodérmico Misto/patologia , Neoplasias Embrionárias de Células Germinativas/patologia , Neoplasias Retroperitoneais/patologia , Tomografia Computadorizada por Raios X , Feminino , Humanos , Masculino , Tumor Mesodérmico Misto/diagnóstico por imagem , Invasividade Neoplásica , Neoplasias Embrionárias de Células Germinativas/diagnóstico por imagem , Neoplasias Retroperitoneais/diagnóstico por imagem , Espaço Retroperitoneal/patologia , Carga Tumoral
4.
Eur J Gynaecol Oncol ; 32(5): 542-6, 2011.
Artigo em Inglês | MEDLINE | ID: mdl-22053671

RESUMO

A 47-year-old woman was diagnosed with extragenital mullerian adenosarcoma with sarcomatous overgrowth. One month after her initial surgery, the patient developed pelvic recurrence, which was completely excised by surgery. However, one month later, the patient developed further recurrences in her pelvis and upper abdomen. A clinical complete response was achieved with three cycles of liposomal doxorubicin and is currently clinically free of disease. So far, including the present case, 23 cases of extragenital mulleian adenosarcoma have been reported in the English literature. Because of the rarity of the reported cases, there are no treatment guidelines based on a good level of evidence. In the current report, through a literature review, we provide information on the activity of pegylated liposomal doxorubicin for extragenital mullerian adenosarcoma with sarcomatous overgrowth.


Assuntos
Neoplasias Abdominais/tratamento farmacológico , Adenossarcoma/tratamento farmacológico , Doxorrubicina/análogos & derivados , Tumor Mesodérmico Misto/tratamento farmacológico , Neoplasias Pélvicas/tratamento farmacológico , Polietilenoglicóis/uso terapêutico , Neoplasias Abdominais/patologia , Adenossarcoma/patologia , Doxorrubicina/uso terapêutico , Feminino , Humanos , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/patologia , Neoplasias Pélvicas/patologia , Sarcoma/patologia
5.
Ther Umsch ; 68(10): 559-64, 2011 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-21968895

RESUMO

Malignant mesodermal tumors of the uterus are an inhomogenous group of uterine malignancies with different pathogenesis, clinical presentation and prognosis. These rare tumors represent approximately 1 % of all uterine malignancies. The aggressive carcinosarcomas or mixed muellerian tumors are defined by mixed malignant epithelial and malignant mesodermal histopathology and are of the same precursor cell origin like endometrial cancer. Thus, carcinosarcomas were reclassified by the FIGO as an aggressive type of endometrial cancer and treated like type II endometrial cancer. Adenosarcomas are also mixed tumors with benign epithelial proliferation and malignant mesodermal cell growth, have a good prognosis and represent less than 5 % of all mesodermal uterine malignancies. Besides carcinosarcomas, the pure mesodermal leiomyosarcomas are the most common mesodermal malignancies. Patients with leiomyosarcamos are usually perimenopausal, and although more than half of the patients present with symptoms, diagnosis occurs incidentally in most cases in final histopathologic workup of an excised putative myoma or uterus. Adequate anamnesis, gynecologic examination and careful imaging by transvaginal ultrasound in the preoperative setting might hint to correct differential diagnosis in many cases. Overall the prognosis of uterine leiomyomas is poor. Malignancies of the endometrial stroma are very rare and divided in two subgroups, the mostly estrogen receptor positive endometrial stromal sarcoma, which occur preferably in premenopausal women and show a favorable prognosis, and the very aggressive undifferentiated endometrial sarcomas. The more rare undifferentiated endometrial sarcomas occur in postmenopausal women and most patients die in the first two years after diagnosis. Risk stratification of preoperative differential diagnosis requires improvements and the correct histopathologic workup of mesodermal uterine malignancies is still a challenge for pathologists.


Assuntos
Neoplasias Uterinas/cirurgia , Adenossarcoma/diagnóstico , Adenossarcoma/patologia , Adenossarcoma/cirurgia , Carcinossarcoma/diagnóstico , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Tumores do Estroma Endometrial/diagnóstico , Tumores do Estroma Endometrial/patologia , Tumores do Estroma Endometrial/cirurgia , Endossonografia , Feminino , Humanos , Histerectomia , Laparoscopia , Leiomioma/diagnóstico , Leiomioma/patologia , Leiomioma/cirurgia , Leiomiossarcoma/diagnóstico , Leiomiossarcoma/patologia , Leiomiossarcoma/cirurgia , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/diagnóstico , Tumor Mesodérmico Misto/patologia , Tumor Mesodérmico Misto/cirurgia , Tumor Mulleriano Misto/diagnóstico , Tumor Mulleriano Misto/patologia , Tumor Mulleriano Misto/cirurgia , Estadiamento de Neoplasias , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/secundário , Prognóstico , Ultrassonografia Doppler em Cores , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/patologia
6.
Acta Med Croatica ; 65 Suppl 1: 229-34, 2011 Sep.
Artigo em Servo-Croata (Latino) | MEDLINE | ID: mdl-23126058

RESUMO

Malignant mixed mesodermal tumor (MMMT) of the ovary is a rare aggressive tumor that consists of an epithelial (carcinoma) and a stromal (sarcoma) component. MMMT accounts for less than 2% of ovarian cancers and has a very poor prognosis. We present a case and difficulties of diagnosing an ovarian MMMT in a postmenopausal woman with a history of invasive breast carcinoma treated postoperatively with radiotherapy and tamoxifen. A 52-year-old patient presented with unilateral ovarian tumor and moderately elevated CA125 (107 U/mL) and underwent laparotomy. Fine needle aspiration of the ovary and ascites for cytologic analysis, and tumor biopsy for histopathology were performed intraoperatively. Intraoperative cytologic sample showed necrotic background with rare single malignant cells with pale, abundant cytoplasm and conspicuous nucleoli suggesting clear cell carcinoma. Ascites sample showed inflammatory and reactive background with suspected papillary formations mimicking adenocarcinoma. Postoperatively, cytochemical PAS staining and immunocytologic staining with epithelial antigen (EA), cytokeratin (CK)7 and vimentin showed EA and PAS positivity for ovarian tumor, and EA and CK7 for ascites, suggesting a clear cell carcinoma. Histology revealed ovarian clear cell carcinoma. Three months later, the patient underwent hemicolectomy because of tumors on the right large bowel serosa with intraoperative morphological finding of metastatic malignant tumor without other specific features. Postoperative morphological analysis and immunohistochemical staining of the tumor revealed two malignant components, epithelial and stromal one. Repeat histologic analysis of the ovarian tumor confirmed ovarian MMMT (with a clear cell carcinoma component). Other studies of breast cancer emphasize that patients with invasive breast cancer and mutations of BRCA1 and BRCA2 genes are at an increased risk of primary ovarian cancer. Our study confirmed it and suggested considering a second primary malignant tumor of ovarian origin in patients with a history of breast carcinoma, postoperatively treated with radiotherapy and tamoxifen. Although rare, second primary ovarian tumors may present as MMMT.


Assuntos
Neoplasias da Mama/patologia , Tumor Mesodérmico Misto/diagnóstico , Segunda Neoplasia Primária/patologia , Neoplasias Ovarianas/diagnóstico , Neoplasias do Colo/secundário , Feminino , Humanos , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/patologia , Tumor Mesodérmico Misto/secundário , Neoplasias Ovarianas/patologia
7.
Int J Gynecol Pathol ; 29(3): 234-8, 2010 May.
Artigo em Inglês | MEDLINE | ID: mdl-20407321

RESUMO

Malignant mixed mesodermal tumors (MMMTs) of the ovary are rare, highly aggressive neoplasms that arise most commonly in postmenopausal women. Histologically, they consist of a mixed population of malignant epithelial and mesenchymal elements. Neuroectodermal differentiation in ovarian MMMTs is exceedingly uncommon, with only a few case reports in the literature. We present a case of an ovarian MMMT with neuroectodermal differentiation in a 78-year-old female patient. Histologically, the tumor was composed of epithelial, mesenchymal, and neuroectodermal elements. The neuroectodermal component was predominantly that of a medulloepithelioma, with scattered areas displaying features of an anaplastic astrocytoma, including rare ganglion cell differentiation. The neuroectodermal component showed immunoreactivity for glial fibrillary acidic protein, synaptophysin, and S100 protein. Ultrastructurally, the neuroectodermal component was populated by cells with irregular nuclei, finely dispersed chromatin, rudimentary cell junctions, and a delicate basement membrane, all of which have been described in medulloepitheliomas. DNA ploidy analysis was also performed on the various components of the tumor and compared with 3 additional cases of MMMT without neuroectodermal differentiation and 2 ovarian immature teratomas. Our findings suggest that the neuroectodermal component may arise from a separate clone or at least evolves at an earlier stage of tumor development.


Assuntos
Tumor Mesodérmico Misto/patologia , Tumores Neuroectodérmicos/patologia , Neoplasias Ovarianas/patologia , Idoso , Diferenciação Celular/fisiologia , DNA de Neoplasias/genética , Feminino , Humanos , Imuno-Histoquímica , Microscopia Eletrônica de Transmissão , Tumor Mesodérmico Misto/genética , Tumor Mesodérmico Misto/terapia , Tumor Mesodérmico Misto/ultraestrutura , Tumores Neuroectodérmicos/genética , Tumores Neuroectodérmicos/terapia , Tumores Neuroectodérmicos/ultraestrutura , Neoplasias Ovarianas/genética , Neoplasias Ovarianas/terapia , Neoplasias Ovarianas/ultraestrutura , Ploidias
8.
Gynecol Oncol ; 105(2): 399-403, 2007 May.
Artigo em Inglês | MEDLINE | ID: mdl-17292457

RESUMO

PURPOSE: To evaluate the efficacy and toxicity of cisplatin and ifosfamide in the treatment of patients with malignant mixed mesodermal tumor (MMMT) of the ovary. METHODS: Ten patients with histologically confirmed primary MMMT of the ovary diagnosed between 1993 and 2001 were enrolled in the study. Treatment consisted of cisplatin 75 mg/m2 on day 1, followed by ifosfamide 2.0 g/m2 over 24 h on days 1, 2 and 3. Mesna, 400 mg/m2, was given IV immediately prior to and 4 and 8 h after the start of each ifosfamide infusion. Chemotherapy was repeated on a 28-day cycle if blood counts permitted. Standard response criteria were used. Nine patients were evaluable for response. RESULTS: Eight of the nine patients responded to therapy, with 7 complete responses (78%) and 1 partial response. Seven of the eight responders (87.5%) eventually recurred. The median progression-free survival was 10 months (range 0-94.4 months). The median overall survival was 17.1 months (range 8-125.5 months). One patient remained free of disease 94.4 months after diagnosis, and one patient remained alive with recurrence 125.5 months following diagnosis. There were 13 grade 3 toxicities and 4 grade 4 toxicities. Four patients had grade 4 and three had grade 3 neutropenia, all of which required dose reductions. CONCLUSION: The combination of cisplatin and ifosfamide/mesna demonstrated activity against MMMT of the ovary. Response durations were short, however, and the regimen was associated with significant toxicity. Novel agents with activity against MMMT of the ovary and acceptable toxicity are needed.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Tumor Mesodérmico Misto/tratamento farmacológico , Neoplasias Ovarianas/tratamento farmacológico , Idoso , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Terapia Combinada , Feminino , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Mesna/administração & dosagem , Mesna/efeitos adversos , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/patologia , Tumor Mesodérmico Misto/cirurgia , Estadiamento de Neoplasias , Neoplasias Ovarianas/patologia , Neoplasias Ovarianas/cirurgia , Projetos Piloto
9.
Int J Gynecol Cancer ; 16(1): 106-9, 2006.
Artigo em Inglês | MEDLINE | ID: mdl-16445619

RESUMO

Primary malignant mesodermal ovarian sarcomas are rare tumors and have a poor prognosis. The disease is usually diagnosed at a late stage and 5-year survivals are uncommon. Most patients are treated with debulking surgery followed by adjuvant chemotherapy. We report ten patients treated at a single institution. All patients underwent surgery and 90% received adjuvant chemotherapy. The median survival was 20 months, and only one patient survived beyond 5 years. Newer treatment strategies are urgently needed in the management of this disease.


Assuntos
Causas de Morte , Tumor Mesodérmico Misto/mortalidade , Tumor Mesodérmico Misto/patologia , Neoplasias Ovarianas/mortalidade , Neoplasias Ovarianas/patologia , Adulto , Idoso , Quimioterapia Adjuvante , Estudos de Coortes , Terapia Combinada , Feminino , Humanos , Imuno-Histoquímica , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/terapia , Estadiamento de Neoplasias , Neoplasias Ovarianas/terapia , Ovariectomia/métodos , Prognóstico , Medição de Risco , Análise de Sobrevida , Fatores de Tempo
10.
Gynecol Oncol ; 97(2): 624-37, 2005 May.
Artigo em Inglês | MEDLINE | ID: mdl-15863170

RESUMO

OBJECTIVE: To conduct a systematic review of the literature regarding the systemic treatment of advanced uterine sarcoma and provide an evidence-based summary of the available literature. METHODS: MEDLINE, EMBASE, and the Cochrane Library databases were searched. "Uterine sarcoma," "leiomyosarcoma," "mixed mesodermal tumor," "chemotherapy," and "systemic therapy" were combined with the search terms for study designs. RESULTS: Three randomized controlled trials and 24 prospective phase II trials were included in the systematic review. In a randomized trial of doxorubicin versus doxorubicin plus cyclophosphamide for advanced or recurrent uterine sarcoma, doxorubicin produced an overall response rate (RR) of 19% and median survival of 11.6 months, which was similar to the response with combination chemotherapy (RR 19%, median survival 10.9 months). A randomized trial comparing ifosfamide plus cisplatin versus ifosfamide alone in mixed mesodermal tumors showed a significant improvement in RR and progression-free survival with the combination compared with ifosfamide alone, however, the combination was associated with increased toxicity including death. A randomized trial comparing doxorubicin to doxorubicin with dacarbazine in women with advanced or recurrent uterine sarcoma demonstrated a significantly higher RR with the combination (P < 0.05), but no significant difference in survival. CONCLUSIONS: Offering palliative chemotherapy to patients with advanced, unresectable uterine sarcoma who are symptomatic from this disease is a reasonable decision. Doxorubicin is an option for women with advanced uterine sarcoma. The combination of cisplatinum and ifosfamide is also an option for women with metastatic mixed mesodermal tumors; however, this combination is associated with significant toxicity when compared to ifosfamide alone.


Assuntos
Tumor Mesodérmico Misto/tratamento farmacológico , Sarcoma do Estroma Endometrial/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Ensaios Clínicos Fase II como Assunto , Feminino , Humanos , Leiomiossarcoma/tratamento farmacológico , Ensaios Clínicos Controlados Aleatórios como Assunto
11.
J Natl Cancer Inst ; 97(5): 375-84, 2005 Mar 02.
Artigo em Inglês | MEDLINE | ID: mdl-15741574

RESUMO

BACKGROUND: Tamoxifen treatment of breast cancer is associated with an increased risk of endometrial cancer, but tamoxifen-related risks of endometrial cancer are unclear in premenopausal women, in long-term users of tamoxifen, and in women for whom several years have passed since ending treatment. We conducted a case-control study in Britain to investigate these risks. METHODS: We compared treatment information on 813 case patients who had endometrial cancer after their diagnosis for breast cancer and 1067 control patients who had breast cancer but not subsequent endometrial cancer. We assessed risk by conditional logistic regression analysis. All statistical tests were two-sided. RESULTS: Overall, tamoxifen treatment, compared with no treatment, was associated with an increased risk of endometrial cancer (odds ratio [OR] = 2.4; 95% confidence interval [CI] = 1.8 to 3.0). Risk increased statistically significantly (P(trend)<.001) with duration of treatment (for > or =5 years of treatment compared with no treatment, OR = 3.6, 95% CI = 2.6 to 4.8). As an indication of background levels of treatment, 16% of control patients received 5 years or more of treatment. Risk of endometrial cancer adjusted for treatment duration did not diminish in follow-up to at least 5 years after the last treatment ended. Risk of endometrial cancer was not associated with the daily dose of tamoxifen and was comparable in pre- and postmenopausal women. Ever treatment with tamoxifen was associated with a much greater risk of Mullerian and mesodermal mixed endometrial tumors (OR = 13.5, 95% CI = 4.1 to 44.5) than of adenocarcinoma (OR = 2.1, 95% CI = 1.6 to 2.7) or clear cell and papillary serous tumors (OR = 3.1, 95% CI = 0.8 to 17.9). CONCLUSIONS: There is an increasing risk of endometrial cancer associated with longer tamoxifen treatment, extending well beyond 5 years. The increased risk of endometrial cancer associated with tamoxifen treatment should be considered clinically for both premenopausal and postmenopausal women during treatment and for at least 5 years after the last treatment.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/prevenção & controle , Neoplasias do Endométrio/induzido quimicamente , Moduladores de Receptor Estrogênico/efeitos adversos , Tamoxifeno/efeitos adversos , Idoso , Antineoplásicos Hormonais/administração & dosagem , Estudos de Casos e Controles , Inglaterra , Moduladores de Receptor Estrogênico/administração & dosagem , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/induzido quimicamente , Tumor Mulleriano Misto/induzido quimicamente , Razão de Chances , Medição de Risco , Fatores de Risco , Moduladores Seletivos de Receptor Estrogênico/efeitos adversos , Tamoxifeno/administração & dosagem , Fatores de Tempo
12.
Am J Surg Pathol ; 29(3): 420-3, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15725814

RESUMO

Biphasic neoplasms with a benign to atypical epithelial component and a usually low-grade malignant stromal component have been reported in various sites, probably being best known for their occurrence in the uterine corpus (mullerian adenosarcoma). We report a tumor of this type that occurred in the testis of a 76-year-old man and, to our knowledge, is the first mesodermal adenosarcoma reported at this site. The patient had scrotal swelling for many years with a pronounced increase in the swelling over the past 2 years. A large complex solid-cystic testicular tumor was evident on ultrasound, and examination of a radical orchiectomy specimen showed a 6.5-cm mass. On microscopic examination, the neoplasm had a phyllodes-like appearance with bland cuboidal to flattened epithelium covering polypoid fronds, and lining glands and cysts. The stroma varied from cellular, particularly where it condensed around the glands and cysts, to hypocellular and hyalinized. It was immunoreactive for muscle specific actin, CD10, and to a lesser degree, desmin. This case expands the known sites where mesodermal adenosarcoma may occur. The histogenesis is speculative, but possible options are discussed.


Assuntos
Adenossarcoma/patologia , Tumor Mesodérmico Misto/patologia , Neoplasias Testiculares/patologia , Actinas/metabolismo , Adenossarcoma/metabolismo , Adenossarcoma/cirurgia , Idoso , Biomarcadores Tumorais/metabolismo , Desmina/metabolismo , Humanos , Masculino , Tumor Mesodérmico Misto/metabolismo , Tumor Mesodérmico Misto/cirurgia , Neprilisina/metabolismo , Orquiectomia , Neoplasias Testiculares/metabolismo , Neoplasias Testiculares/cirurgia , Resultado do Tratamento
13.
Gynecol Oncol ; 96(3): 630-4, 2005 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-15721404

RESUMO

OBJECTIVES: To determine progression-free survival (PFS) and overall survival (OS) in women with completely resected stage I or II carcinosarcoma of the uterus treated with adjuvant ifosfamide and cisplatin, and to assess the toxicity of this regimen. METHODS: Eligible patients had histologically confirmed carcinosarcoma (mixed mesodermal tumor) and no postoperative radiotherapy following complete resection for clinical stage I or II disease. They were to have adequate renal, hepatic, and hematologic functions and performance status of 2 or less. Study entry was to be within 8 weeks of hysterectomy. Patients with previous chemotherapy, or other noncutaneous malignancies, were ineligible. Ifosfamide was administered 1.5 g/m2 intravenously (IV) over 1 h and cisplatin was given 20 mg/m(2) over 15 min followed by mesna 120 mg/m2 IV bolus, then 1.5 g/m2/24 h as a continuous infusion. Initial doses (daily x 5 every 21 days x 3 cycles) were reduced by 20% (to 4 days) for myelotoxicity. RESULTS: Nine of seventy-six patients enrolled were deemed ineligible and another two who did not receive protocol treatment were inevaluable. Of the 65 evaluable patients, median age was 65 years; 50 patients (77%) were stage I and 15 (23%) were stage II. PFS and OS, respectively, were 69% and 82% at 24 months, and 54% and 52% at 84 months. Overall 5-year survival was 62%. Leukopenia was the most commonly reported, but manageable, toxicity. CONCLUSION: Adjuvant ifosfamide and cisplatin after primary surgery for stage I or II carcinosarcoma of the uterus is tolerable. In the absence of concurrent controls, the impact on PFS and OS is unclear. Pelvic relapse remains problematic.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Carcinossarcoma/tratamento farmacológico , Tumor Mesodérmico Misto/tratamento farmacológico , Neoplasias Uterinas/tratamento farmacológico , Adulto , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos , Carcinossarcoma/patologia , Carcinossarcoma/cirurgia , Quimioterapia Adjuvante , Cisplatino/administração & dosagem , Cisplatino/efeitos adversos , Feminino , Humanos , Ifosfamida/administração & dosagem , Ifosfamida/efeitos adversos , Infusões Intravenosas , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/patologia , Tumor Mesodérmico Misto/cirurgia , Recidiva Local de Neoplasia/patologia , Estadiamento de Neoplasias , Neoplasias Uterinas/patologia , Neoplasias Uterinas/cirurgia
15.
Ginekol Pol ; 75(10): 793-6, 2004 Oct.
Artigo em Polonês | MEDLINE | ID: mdl-15587911

RESUMO

A rare case of uterine's mixed mesodermal malignant tumor in young woman was described. Clinical symptoms, risk groups, treatment, and prognosis were presented. It was noticed that every year younger women are attacked by this kind of tumor.


Assuntos
Tumor Mesodérmico Misto , Neoplasias Uterinas , Adulto , Evolução Fatal , Feminino , Humanos , Tumor Mesodérmico Misto/complicações , Tumor Mesodérmico Misto/diagnóstico , Tumor Mesodérmico Misto/terapia , Fatores de Tempo , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/diagnóstico , Neoplasias Uterinas/terapia
16.
Gynecol Oncol ; 95(1): 264-6, 2004 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-15385144

RESUMO

BACKGROUND: The risk of tamoxifen related endometrial neoplasm has been confirmed by multiple studies. Especially rare endometrial tumors seem to develop more frequently under tamoxifen therapy. A recent analysis showed a substantially higher risk for malignant mixed mesodermal tumor (MMMT; designated in the WHO classification of female genital tract neoplasms as carcinosarcoma) in association with tamoxifen intake. CASE: We are reporting a case of a 40-year-old multiparous premenopausal woman who received tamoxifen 20 mg daily for 2 years after the surgical treatment of breast cancer and subsequent adjuvant chemotherapy. Two years after initiation of tamoxifen treatment, the patient developed an MMMT of the uterus. More than 64 months after radical hysterectomy, salpingo-oophorectomy, and pelvic lymphadenectomy, she remains recurrence-free for MMMT. Unfortunately, she developed a local recurrence of her breast cancer in 2003. After surgical treatment, she is currently being treated with anastrozole. CONCLUSION: We are reporting a rare case of a premenopausal patient who developed a MMMT within short time of tamoxifen exposure for stage I breast cancer.


Assuntos
Antineoplásicos Hormonais/efeitos adversos , Neoplasias da Mama/tratamento farmacológico , Tumor Mesodérmico Misto/induzido quimicamente , Segunda Neoplasia Primária/induzido quimicamente , Tamoxifeno/efeitos adversos , Neoplasias Uterinas/induzido quimicamente , Adulto , Antineoplásicos Hormonais/uso terapêutico , Feminino , Humanos , Tamoxifeno/uso terapêutico
17.
Pathol Oncol Res ; 10(2): 117-20, 2004.
Artigo em Inglês | MEDLINE | ID: mdl-15188029

RESUMO

The mixed mesodermal tumor is a very uncommon malignancy. The aggressiveness of this lesion is illustrated by extremely poor prospects for afflicted patients: postoperative survival is usually shorter than 24 months. According to the literature, malignant mixed tumor of the ovary is rather rare and its occurrence with other malignancy is exceptional. We report here a case of a 62-years old woman with serous cystadenocarcinoma in the right ovary and a heterologous malignant mixed mesodermal tumor in the left one. Both tumors expressed cytokeratins, while only the mesodermal tumor expressed S-100 and focal NSE.


Assuntos
Cistadenocarcinoma Seroso/patologia , Tumor Mesodérmico Misto/patologia , Segunda Neoplasia Primária/patologia , Neoplasias Ovarianas/patologia , Biomarcadores Tumorais/metabolismo , Cistadenocarcinoma Seroso/metabolismo , Feminino , Humanos , Queratinas/metabolismo , Pessoa de Meia-Idade , Tumor Mesodérmico Misto/metabolismo , Segunda Neoplasia Primária/metabolismo , Neoplasias Ovarianas/metabolismo , Fosfopiruvato Hidratase/metabolismo , Proteínas S100/metabolismo
18.
Eur J Surg Oncol ; 30(5): 573-7, 2004 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-15135489

RESUMO

BACKGROUND: Malignant mixed mesodermal tumours (MMMT) of the female genital tract are rare and heterogeneous malignancies that impart grim prognosis. These tumours are characterized by an admixture of malignant epithelial and stromal elements comprising carcinomatous and sarcomatous neoplastic cells. Thus far, almost 350 cases of MMMT have been recorded in the international medical literature. Due to its rarity, there is no agreement on the best treatment strategy in women with metastasized MMMT. METHODS: Six women (mean age 59 years) with metastasized MMMT defined to the peritoneal cavity have been treated by cytoreductive surgery plus hyperthermic peritoneal perfusion plus postoperative adjuvant chemotherapy. All patients have been pre-treated by surgery for primary tumour and one by systemic chemotherapy. As cytostatics for hyperthermic peritoneal perfusion, we have used Mitomycin in a dosage of 18 mg/m2 plus Melphalan in a dosage of 25 mg/m2. As adjuvant treatment CDDP 40 mg/m2/dl, Mitomycin 7 mg/md2/dl and Ifosfamid 100 mg/kg 24 h/dl was applicated via intraaortic catheter three times with a treatment free interval of 3 weeks. RESULTS: A complete cytoreduction without remnant tumour formations in the peritoneal cavity could be carried out in all six patients. The postoperative course was uneventful in all cases except for one where a spontaneous small bowel perforation and prolonged gall secretion had to be treated by re-operation. One patient died 4 months later by pneumonia without evidence of disease. Four patients are without evidence of disease after 2, 4, 14 and 19 months, whereas one patient developed liver metastases after 9 months still treated by systemic chemotherapy. CONCLUSION: Complete cytoreduction plus hyperthermic peritoneal perfusion plus adjuvant chemotherapy seems to be an effective treatment for recurrent or metastasized MMMT. Further studies have to define the value of this new treatment strategy for this rare tumour entity.


Assuntos
Quimioterapia do Câncer por Perfusão Regional , Hipertermia Induzida , Tumor Misto Maligno/secundário , Tumor Misto Maligno/terapia , Tumor Mesodérmico Misto/secundário , Tumor Mesodérmico Misto/terapia , Neoplasias Peritoneais/patologia , Neoplasias Peritoneais/terapia , Adulto , Idoso , Antibióticos Antineoplásicos/administração & dosagem , Antineoplásicos Alquilantes/administração & dosagem , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia Adjuvante , Terapia Combinada , Feminino , Alemanha , Humanos , Ifosfamida/administração & dosagem , Laparotomia , Fígado/patologia , Pessoa de Meia-Idade , Mitomicina/administração & dosagem , Recidiva Local de Neoplasia/terapia , Estadiamento de Neoplasias , Cavidade Peritoneal/patologia , Resultado do Tratamento , Saúde da Mulher
19.
Rev Med Chir Soc Med Nat Iasi ; 107(3): 650-3, 2003.
Artigo em Romano | MEDLINE | ID: mdl-14756080

RESUMO

To correlate the cytopathological and the histopathological findings in uterine mixed mesodermal malignant tumor (MMMT) we have examined the cervical smear, endometrial curettage and hysterectomy specimen of a patient diagnosed with uterine tumor. The smear was stained by Papanicolaou staining and the tissue processed by routine technique and stained H&E. The original cytological diagnosis was adenosquamous carcinoma. The histopathological diagnosis was MMMT of heterologous type. A review of the smear revealed features which may orientate the diagnosis: multinucleate cells, isolated cells with cyanophilic cytoplasm, hyperchromatic nuclei and prominent nucleoli, elongated cyanophilic cells of sarcomatous origin. We conclude that the cytopathological diagnosis of the MMMT in cervical smears is very difficult. This may be sustained by the evidence of more cell types and cellular features orientating to a sarcomatous origin. The most important differential diagnosis is adenosquamous carcinoma.


Assuntos
Tumor Mesodérmico Misto/patologia , Neoplasias Uterinas/patologia , Adenocarcinoma/patologia , Idoso , Carcinoma de Células Escamosas/patologia , Curetagem , Diagnóstico Diferencial , Feminino , Humanos , Histerectomia , Tumor Mesodérmico Misto/cirurgia , Teste de Papanicolaou , Neoplasias Uterinas/cirurgia , Esfregaço Vaginal
20.
J Reprod Med ; 47(11): 946-8, 2002 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-12497688

RESUMO

BACKGROUND: Malignant mixed mesodermal tumors (MMMTs) are uncommon, highly aggressive tumors of the uterus composed of both carcinomatous and sarcomatous elements, both likely to be derived from the same original stem cell. There is a strong association between endometrial adenocarcinoma and polycystic ovary disease. However, only two cases of MMMT occurring in women with polycystic ovaries have been reported. CASE: A 36-year-old woman with polycystic ovary disease developed an MMMT of the endometrium. CONCLUSION: Some cases of MMMT may be estrogen related.


Assuntos
Tumor Mesodérmico Misto/diagnóstico , Síndrome do Ovário Policístico/diagnóstico , Neoplasias Uterinas/diagnóstico , Adulto , Anemia/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Tumor Mesodérmico Misto/complicações , Tumor Mesodérmico Misto/patologia , Tumor Mesodérmico Misto/radioterapia , Tumor Mesodérmico Misto/cirurgia , Síndrome do Ovário Policístico/complicações , Síndrome do Ovário Policístico/patologia , Síndrome do Ovário Policístico/radioterapia , Síndrome do Ovário Policístico/cirurgia , Hemorragia Uterina/etiologia , Neoplasias Uterinas/complicações , Neoplasias Uterinas/patologia , Neoplasias Uterinas/radioterapia , Neoplasias Uterinas/cirurgia
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