Malignant Uterine Tumors Research Articles

Differential diagnosis of uterine smooth muscle tumors using diffusion-weighted imaging: correlations with the apparent diffusion coefficient and cell density.

The purpose of this study is to investigate the utility of the apparent diffusion coefficient (ADC) in differentiating benign and malignant uterine smooth muscle tumors classified by signal intensity (SI) on T2-weighted imaging (T2WI) and diffusion-weighted imaging (DWI), and to determine the correlation between ADC and tumor cell density. This retrospective study reviewed 168 lesions in 134 cases with pathologically confirmed uterine smooth muscle tumors, including 6 leiomyosarcomas and 3 smooth muscle tumors of uncertain malignant potential, and preoperative magnetic resonance imaging examinations performed between October 2009 and November 2012. T2WI and DWI were also performed for each subject. Tumors were then classified according to SI on T2WI and DWI relative to myometrial SI. The correlation between ADC and tumor cell density was also determined. In Group 1 (high on both T2WI/DWI), mean ADC was significantly lower for leiomyosarcoma (0.91 × 10(-3) mm(2)/s) than for leiomyoma (1.30 × 10(-3) mm(2)/s; p < 0.05) and mean cell density significantly higher for leiomyosarcoma (42.9%) than for leiomyoma (22.4%; p < 0.05). A strong negative correlation was seen between ADC and tumor cell density in Group 1 (Spearman, R = -0.72; p < 0.05). ADC may help to differentiate benign from malignant uterine smooth muscle tumors, particularly tumors with high SI on T2WI and DWI.

MR manifestations of uterine polypoid adenomyoma.

Polypoid adenomyoma (PA) is an uncommon benign tumor of the uterus appearing as a submucosal polypoid mass, or rarely as a subserosal polypoid mass. PA should be differentiated from atypical polypoid adenomyoma or malignant uterine tumors. The purpose of our case series is to evaluate magnetic resonance (MR) manifestations of PA for the differential diagnosis. Seven cases with surgically proven PA, five submucosal, and two subserosal, were evaluated. MR imaging findings including contrast enhancement in six cases (four cases with dynamic contrast-enhanced MR study), diffusion-weighted imaging (DWI) in five cases, and susceptibility weighted imaging (SWI) in two cases were retrospectively reviewed. All seven lesions exhibited isointensity compared with the myometrium and 4 of 7 lesions (57%) contained high signal intensity hemorrhagic areas on T1-weighted images. On T2-weighted images, signal intensity was variable and all seven lesions contained cysts. None of five lesions with DWI exhibited high signal intensity compared with the normal myometrium. All six lesions showed intense contrast enhancement similar to that of the myometrium on post-contrast T1-weighted images. Punctate low intensity areas reflecting blood contents were revealed in all two lesions with SWI. Submucosal or subserosal polypoid masses containing hemorrhagic areas, and cysts reflecting functional endometrium and dilatation of endometrial glands are suggestive for PA. Intense contrast enhancement similar to that of the myometrium may be another characteristic finding for PA.

Immunohistochemical detection of promyelocytic leukemia zinc finger and histone 1.5 in uterine leiomyosarcoma and leiomyoma.

The accurate distinction of leiomyoma from leiomyosarcoma is essential for patient management. However, the distinction can be difficult to make, particularly in tissue biopsy samples. Immunohistochemistry has been established as a useful technique to aid in the diagnosis of malignancies. The advantages of immunohistochemical studies are their ease of use and interpretation. This study is the first to evaluate the utility of the promyelocytic leukemia zinc finger (PLZF) protein and the histone 1.5 (H1.5) protein as potential diagnostic immunohistochemical markers for distinguishing leiomyosarcoma from leiomyoma. Tissue samples from 21 leiomyosarcomas and 26 leiomyomas were studied. The student t-test and the Fisher exact test were used to calculate the differences in staining between the 2 groups. Statistically significant differences were found in the staining indices of anti-PLZF and anti-H1.5 when comparing benign and malignant tumors (P < .0001 and P < .0001, respectively). The mean H1.5 staining score in leiomyosarcomas was 158.3, compared to 28.3 in leiomyomas. The mean PLZF score in leiomyosarcomas was 1.5 in contrast to 71.5 in leiomyomas. For H1.5 at a score ≥60, the sensitivity and specificity were 90.5% and 84.6%, respectively. For PLZF, a score ≤15 had a test sensitivity and specificity of 100% and 80.8%, respectively. This suggests that staining for H1.5 or PLZF can serve as a good screening test. Additionally, combining the 2 immunostains results in a sensitivity and specificity of 90.5% and 97.5%, respectively, in differentiating between leiomyoma and leiomyosarcoma. We describe immunostaining for PLZF and H1.5 in benign and malignant uterine smooth muscle tumors. Statistically significant differences in staining patterns were found, suggesting utility in distinguishing leiomyosarcomas from leiomyomas.

Hormone Level in Uterine Carcinoma Tissue Associated with Different Viral Infections

ABSTRACT Aim: Unpredictability of tumor biological behavior may be determined by the involvement of different infectious agents in carcinogenesis. Malignant tumor's independent synthesis of hormones contributes to autonomy of growth and absence of central regulation. The question of the influence of infectious agents on hormonal status of malignant uterine tumors still remains open. Methods: Levels of estrone (Е1), estradiol (Е2), testosterone (T), prolactin (PRL) and progesterone (Р4) were assessed in 41 tumor samples obtained during operative therapy of patients with endometrial cancer T1-2N0M0 in 10% homogenates with enzyme-linked immunosorbent assay (ELISA) with the use of standard test systems (XEMA). Mean age was 53.4±3.2 years, histological structure - endometrioid adenocarcinoma. IgG antibodies against herpes simplex virus (HSV), cytomegalovirus (CMV) and chlamydias were detected in tumor tissue with ELISA. The polymerase chain reaction method was used for the detection of CMV, HSV and chlamydia infection in ovarian tissue. Adenocarcinoma without IgG against infectious agents served as a control. Results: IgG against HSV antigens were found in 26.8% of the cases; IgG against CMV+HSV antigens+clamydias – in 17.1%; IgG against CMV antigens and IgG against CMV+HSV antigens – in 12.2%; 31.7% of the tissues did not have IgG against the infections. It was found that the infections alone or in combinations resulted in the increase of Е1 level by 1.3-1.7 times, Е2 by 1.6-1.9 times, PRL by 3 times while T concentration decreased by 1.4-3.4 times in comparison with adenocarcinomas without infectious agents. Р4 concentration in infected tumors did not differ significantly from the indices in uninfected ones remaining reduced in comparison with intact endometrium tissue. Conclusions: Infections in tumor tissue, alone or in combinations, cause additional potential for changes and precarious states that can result in drug resistance, resistance to treatment, and reduction of differentiation, that is an increase of malignancy. Disclosure: All authors have declared no conflicts of interest.

MED12 and HMGA2 mutations: two independent genetic events in uterine leiomyoma and leiomyosarcoma

Recent identification of somatic MED12 mutations in most uterine leiomyomas brings a new venue for the study of the tumorigenesis of leiomyomas. We are particularly interested in the correlation of MED12 and HMGA2 gene products in leiomyomas and leiomyosarcomas with and without MED12 mutations. To address these issues, in this study we examined MED12 mutations in a large cohort of usual type leiomyomas (178 cases) and uterine leiomyosarcomas (32 cases). We found that 74.7% (133/178) of leiomyomas had MED12 mutations, which was consistent with several independent studies. In contrast, only 9.7% (3/32) of leiomyosarcomas harbored MED12 mutations. Expression analysis by western blot and immunohistochemistry revealed that those leiomyomas with complex MED12 mutations had significantly lower protein products than the matched myometrium. Interestingly, most leiomyosarcomas without MED12 mutations also had very low levels of MED12 expression in comparison to the matched myometrium. These findings suggest a potential functional role of MED12 in both benign and malignant uterine smooth muscle tumors. When we further examined HMGA2 expression in all leiomyomas and leiomyosarcomas, we found that HMGA2 overexpression was exclusively present in those leiomyomas with no MED12 mutation, accounting for 10.1% (18/178) of total leiomyomas and 40% (18/45) of non-MED12 mutant leiomyomas. Twenty-five percent (8/32) of leiomyosarcomas had HMGA2 overexpression, and no MED12 mutations were found in HMGA2 positive leiomyosarcoma. These findings strongly suggest that MED12 mutations and HMGA2 overexpression are independent genetic events that occur in leiomyomas, and they may act differently in the tumorigenesis of uterine leiomyomas.

Características clínicas y pronóstico de las pacientes con cáncer de cérvix tratadas en tres instituciones de salud en Barranquilla, Colombia, de 2005 a 2011

&lt;p&gt;&lt;strong&gt;Objetivo&lt;/strong&gt;: describir las características clínicas y el pronóstico de las pacientes con cáncer de cérvix tratadas en tres instituciones de salud en Barranquilla, Colombia.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Materiales y métodos:&lt;/strong&gt; estudio de cohorte retrospectiva descriptiva. Se revisaron las bases de datos de las tres instituciones participantes en donde se identificaron los casos que tuvieron diagnóstico CIE 10 de: tumor maligno de endocérvix, tumor maligno de exocérvix, tumor maligno del cuello del útero y tumor maligno del itsmo uterino. Se excluyeron pacientes remitidas por recidiva tumoral. En caso de deceso, este fue corroborado con el certificado de defunción. Se describe la mortalidad absoluta por estadio clínico. Para establecer el pronóstico se estimó la probabilidad de estar libre de enfermedad y de sobrevivir al primer, tercer y quinto año de seguimiento.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Resultados:&lt;/strong&gt; se identificaron 375 pacientes con diagnóstico de carcinoma de cérvix, de las cuales 27 se perdieron en el seguimiento para un total de 348 pacientes evaluadas. Se encontró una tasa de complicaciones cercana al 19% siendo más frecuentes en pacientes con radioterapia (94%) que en las que recibieron tratamiento quirúrgico (6%). La probabilidad de sobrevida a los 5 años es del 92% y la probabilidad de estar libre de enfermedad a los 5 años es del 89%.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusiones&lt;/strong&gt;: los resultados obtenidos en cuanto a complicaciones y sobrevida posterior al tratamiento fueron similares a lo reportado en la literatura. Se requieren más estudios con una mayor profundidad metodológica que caractericen el pronóstico de las pacientes con cáncer de cérvix en nuestra población.&lt;/p&gt;

Comparison of surgical indications for hysterectomy by age and approach in 4653 Chinese women

Approximately one million hysterectomies are performed each year in China. However, national data regarding the indications and the surgical approaches for hysterectomy are lacking. The aim of this study was to examine the surgical indications for hysterectomy in different age groups and the relative merits of different surgical approaches for hysterectomy in Chinese women. Clinical data from 4653 cases of hysterectomy performed in Tongji Hospital from 2004 to 2009 were analysed. Hysterectomy was most commonly performed among women aged 40-49 years (2299; 49.4%). Overall, colporrhagia and abdominal pain were the two most common indications for hysterectomy. The most common indications by age groups were as follows: malignant ovarian tumour, < 20 years; malignant uterine tumour, 20-29 and 30-39 years; uterine myoma, 40-49 and 50-59 years; and uterine prolapse, 60-69 and > 70 years. The proportion of malignant aetiology also varied by age, being the highest in women aged < 20 years (75.0%) and the lowest in those aged 40-49 years (19.9%). Approximately 35% women who had hysterectomies also had concomitant bilateral oophorectomy. The lowest rate of oophorectomy occurred in women aged 30-39 years (15.8%), whereas the highest rate was in those aged 50-59 years (75.9%). The abdominal surgical approach was used in 84% of all hysterectomies. Surgeries using the vaginal approach required a significantly shorter operating time (118 min average) than all other approaches (P < 0.05). Both the amount of bleeding and the blood transfusion volume required were smaller in vaginal approaches, with no significant differences between the others. The surgical approaches used were also related to the scope of surgery. Both the surgical indications and the rates of bilateral oophorectomy varied by age. In terms of both operating time and the amount of bleeding and blood transfusion volume required, the vaginal approach was superior to all other surgical approaches.

Epigenetic Silencing of Apoptosis-Inducing Gene Expression Can Be Efficiently Overcome by Combined SAHA and TRAIL Treatment in Uterine Sarcoma Cells

The lack of knowledge about molecular pathology of uterine sarcomas with a representation of 3–7% of all malignant uterine tumors prevents the establishment of effective therapy protocols. Here, we explored advanced therapeutic options to the previously discovered antitumorigenic effects of the histone deacetylase (HDAC) inhibitor suberoylanilide hydroxamic acid (SAHA) by combined treatment with the tumor necrosis factor-related apoptosis-inducing ligand (TRAIL/Apo-2L). In addition, we investigated the uterine sarcoma cell lines, MES-SA and ESS-1, regarding the underlying molecular mechanisms of SAHA and TRAIL-induced apoptosis and their resistance towards TRAIL. Compared to single SAHA or TRAIL treatment, the combination of SAHA with TRAIL led to complete cell death of both tumor cell lines after 24 to 48 hours. In contrast to single SAHA treatment, apoptosis occured faster and was more pronounced in ESS-1 cells than in MES-SA cells. Induction of SAHA- and TRAIL-induced apoptosis was accompanied by upregulation of the intrinsic apoptotic pathway via reduction of mitochondrial membrane potential, caspase-3, -6, and -7 activation, and PARP cleavage, but was also found to be partially caspase-independent. Apoptosis resistance was caused by reduced expression of caspase-8 and DR 4/TRAIL-R1 in ESS-1 and MES-SA cells, respectively, due to epigenetic silencing by DNA hypermethylation of gene promoter sequences. Treatment with the demethylating agent 5-Aza-2'-deoxycytidine or gene transfer therefore restored gene expression and increased the sensitivity of both cell lines against TRAIL-induced apoptosis. Our data provide evidence that deregulation of epigenetic silencing by histone acetylation and DNA hypermethylation might play a fundamental role in the origin of uterine sarcomas. Therefore, tumor growth might be efficiently overcome by a cytotoxic combinatorial treatment of HDAC inhibitors with TRAIL.

Fertility sparing treatment of a malignant uterine perivascular epithelioid cell tumor: A case report

•Perivascular epithelioid cell tumors (PEComas) are a family of rare, poorly defined mesenchymal tumors of uncertain malignant potential.•Treatment for PEComas has most commonly involved excisional biopsy or surgical resection.•The use of mTOR inhibitors may provide the best medical treatment as well as a fertility-sparing treatment option.

Alteration of Sex and Non-Sex Hormones and Distribution Features of Blood ABO System Groups among the Women with Uterine Body Tumors

Objectives: The aim of the investigation was to study the hormonal status (sex hormones: estradiol (E2), progesterone (P), testosterone (T); non-sex gonadotropic hormones-luteinizing hormone (LH) and follicle-stimulating hormone (FSH)) of women with benign and malignant tumors of uterine body in the reproductive, menopause and postmenopause periods. Also the distribution features of the blood ABO system phenotype groups and their link to the development of uterine body tumors have been studied. Methods: The determination of hormones was made by the enzyme analysis method (ELAIZA), provided by the proper ELAIZA kits. For the study of blood ABO system antigens, internationally recognized immunoserology methods were used. Results: Investigations revealed the increased level of E2 and T on the background of the reduced P in the blood of the women with uterine tumors in the reproductive, menopause and post-menopause period. As for gonadotropic hormones, the decreased levels of LH and FSH have also been detected. From the ABO system phenotype groups A(II) group had the highest frequency between the women with malignant uterine tumor in the reproductive age. O (I) phenotype group was the most frequent in case of menopause and post-menopause women with uterine malignant tumors. Conclusions: Hormonal imbalance creates good conditions for the proliferation of uterine tissues and hence causes the development of benign and malignant uterine tumors. The imbalance of the sex steroid and gonadotropic hormones in the blood of post-menopause women indicates on the genotoxic mechanism of cancer development on the background of age-related changes. A(II) group had the highest frequency between the reproductive age women with uterine malignant tumor, while O (I) group was the most frequent in case of menopause and post-menopause patients.

パウチ内モルセレーション法を用いた腹腔鏡下子宮筋腫核出術中の組織片飛散防止の工夫

The use of a power morcellator during laparoscopic myomectomy has been reported to be associated with the development of so-called parasitic myomas due to the dissemination and survival of morcellated tissue into the abdominal cavity. The U.S. Food and Drug Administration (FDA) released a safety communication, which stated that the agency discourages the use of a laparoscopic power morcellation during a hysterectomy or myomectomy due to the risk of disseminating unsuspected malignant tissue. Based on this situation, we developed a method to safely use the power morcellator in which tissue fragment dissemination is prevented. A fibroid was separated from the uterus with the use of a retrieval bag, and delivered from the abdominal using a power morcellator under direct vision with the pouch of the retrieval bag fully open. Using this method, no dissemination of tissue fragments was observed. The patient was diagnosed with an apoplectic leiomyoma. This is a rare histological type accompanied by petechial bleeding and the accumulation of infarcts in the fibroid; it differs from the most common type of leiomyoma. This case was diagnosed as a benign tumor; however, malignant uterine tumors cannot be excluded in some cases. Our method is useful not only for the prevention of parasitic tumors, but also when unsuspected malignant uterine tumors are encountered.

UTERINE ARTERY EMBOLIZATION FOR UTERINE ARTERIOVENOUS MALFORMATION IS ASSOCIATED WITH PLACENTAL ABNORMALITIES IN THE SUBSEQUENT PREGNANCY: TWO CASES REPORT

Uterine arteriovenous malformation (AVM) is generally associated with uterine trauma such as dilatation and curettage, therapeutic abortion, uterine surgery and uterine malignant tumors(1)). Uterine artery embolization (UAE) is performed on patients with uterine AVM who have desire for future pregnancy(2)). Some successful pregnancies were reported after UAE for uterine AVM(5,6)), however complication during pregnancy has not been described clearly. We herein for the first time report two cases of successful pregnancy and spontaneous delivery after UAE for uterine AVM who had placenta accreta and placental abruption respectively. Although successful pregnancy is possible after UAE for AVM, placenta abnormalities have to be considered during pregnancy and after delivery.

Revisiting Imaging and Pathology of Malignant Appearing Uterine Smooth Muscle Tumors: A Mistaken Identity of Leiomyosarcoma on MRI

Uterine leiomyoma is a relatively common condition occurring in a majority of African American and Caucasian women by age 50. Magnetic resonance imaging of the pelvis with contrast is the modality of choice when evaluating uterine tumors. We report a case of a patient with a four-day history of intra-menstrual vaginal bleeding who underwent magnetic resonance imaging of the pelvis that suggested the tumor was a leiomyosarcoma, the malignant counterpart of leiomyoma. Therefore, the patient underwent pre-operative uterine artery embolization to decrease blood loss with exploratory laparotomy, resection of pelvic mass and dilation and curettage. Pathologic evaluation of the mass returned a diagnosis of leiomyoma. Magnetic resonance imaging evaluation of leiomyomata remains difficult. Further development of imaging parameters could improve diagnosis of benign uterine fibroids.

Clinical and molecular features of uterine sarcomas

INTRODUCTION: Uterine sarcomas are rare forms of malignant neoplasm, comprising about 3% of all malignant uterine tumors, representing less than 1% of all gynecologic malignancies. Low cure rates often occur due mainly to distant metastases, usually to the lungs. Aggressiveness, high rates of local recurrence, distant metastasis and poor prognosis with overall two-year survival less than 50% are common features of uterine sarcomas. Despite the low prevalence, these tumors are of great interest because of their multiple morphological and clinical features. OBJECTIVE: This article will be focused on the uterine sarcomas general aspects, etiology, prognosis, treatment and molecular features. METHOD: This review was performed using the Pubmed database to search for published articles. RESULTS: Little is known about the etiology of uterine sarcomas. Some studies have demonstrated the association between genetic events involving mutations in genes of the cell cycle and apoptosis and epigenetic in gynecologic sarcomas. Previous studies showed that chromosomal translocations have been identified, resulting in fusion genes that are constitutive and might involve the activation of transcription factors. Advances in molecular techniques have improved the diagnostic possibilities and allowed an improved understanding of the various pathologies. CONCLUSIONS: There are several factors that make the study of sarcomas a challenging issue, since those tumors are rare and the cell origin of each histologic type is nor well known Thus, molecular study of the events involved in the development of different types of cancer may lead to new strategies used in the diagnosis and treatment of these tumors.

An Abnormal Cervicovaginal Cytology Test in Malignant Mixed Mullerian Uterine Tumor has a Predictive Value of Cervical Involvement Independent of Tumor Stage

Introduction: Malignant Mixed Mullerian Tumor/Carcinosarcoma (MMMT) is a clinically aggressive endometrial malignancy composed of mixture of carcinomatous and sarcomatous elements usually affecting postmenopausal women. As this tumor is relatively rare and morphologically diverse, the findings on cervicovaginal cytology, specifically liquid based “SurePath” cytology samples, are not well described. Here we describe the cytological features and correlation with histopathological and clinical findings of patients with MMMT. Material and Methods: A retrospective search (2001-2012) of patients with MMMT was performed. Available PAP smears, biopsies and surgical excisions were reviewed. Tumor characteristics including tumor size presence of heterologous elements, cervical involvement, lympho-vascular invasion (LVI) and tumor pathology staging were extracted from pathology reports and analyzed. Results: There were a total of 30 MMMT patients with available PAPs preceding surgery. All except two patients (28/30) were African American women with average age of 63.03. Ten patients (33.3%) had negative PAPs, eleven (36.7%) were diagnosed as malignant (carcinoma or adenocarcinoma) and nine (30%) as atypical (AGUS, ASCUS or squamous dysplasia). Patients with positive PAP smears had larger tumors and in almost all (90.9%) of the cases tumor showed cervical stromal involvement, and LVI (90.9%). Group with atypical pap smear result did not show correlation with any tumor characteristics or tumor stage. Negative results on PAP smears were seen more commonly in patients without cervical involvements (80%). Common cytology features were tumor diathesis, glandular atypia, squamous dysplasia, presence of nucleoli, multinuclear and anaplastic cells, while sarcomatous elements were rarely encountered. Conclusions: Two thirds of patients with MMMT had either positive or atypical PAPs prior to biopsy or surgery. Patients with cervical involvement of MMMT were more likely to have positive PAP smear independent of tumor staging.

Clinical Characteristics and Surgical Management Options for Ovarian Fibroma/Fibrothecoma: A Study of 97 Cases

Aims: The aims of this study were to analyze the clinical characteristics, diagnostic features, and operative outcomes of patients with ovarian fibroma/fibrothecoma and to discuss appropriate management options. Methods: We performed a retrospective comparative analysis of 97 patients with ovarian fibroma/fibrothecoma who underwent laparoscopic and laparotomic procedures, including tumorectomy between January 2008 and December 2011. Results: The mean patient age was 42.5 ± 11.4 years. Seventy-three patients (75.3%) were premenopausal women. A preoperative diagnosis of benign ovarian tumor or fibroma was made in only 49 cases (50.5%). We found that 42.2% of cases were misdiagnosed as uterine myomas (n = 41) and 6.2% were misdiagnosed as malignant ovarian tumors (n = 6). The presence of ascites was associated with larger tumor size (p < 0.05) but not higher CA125 levels (p = 0.159). Twenty-nine patients (29.9%) underwent laparotomy, and 68 (70.1%), laparoscopic surgery. Laparoscopic surgery facilitated shorter operation times than laparotomy (p < 0.05). Tumorectomy was performed in 40 patients (43.5%), 36 (90%) of whom underwent laparoscopy with operative outcomes comparable to those of patients who underwent laparotomy. Conclusions: Ovarian fibromas/fibrothecomas are often misdiagnosed as uterine myomas and malignant ovarian tumors. Laparoscopic surgery including tumorectomy may be an effective surgical approach in patients with ovarian fibromas/fibrothecomas.

Uterine sarcomas: Review of 26 years at The Instituto Nacional de Cancerologia of Mexico

Uterine sarcomas are a group of uncommon tumors that account for approximately 1% of malignant neoplasms of the female genital tract and between 3 and 8.4% of malignant uterine neoplasms. ObjectiveTo evaluate the factors associated with the clinical behavior of uterine sarcomas. Materials and methodsIn the period from October 1983 to December 2009, clinical files of patients with a confirmed diagnosis of uterine sarcoma at the National Institute of Cancerology of Mexico (INCan) were reviewed and evaluated. ResultsWe identified 77 cases with complete information; average age at presentation was 51.6 years (range, 14–78 years); most frequent histology was leiomyosarcoma (LMS) in 53/77 (68.8%) cases; most frequent symptom reported at the time of diagnosis was abnormal vaginal bleeding in 36/77 (46.7%) cases, and the most frequent clinical stage was clinical stage (CS) I in 31/77 (40.2%) cases. Initial treatment was total abdominal hysterectomy (TAH) and bilateral salpingo-oophrectomy (BSO) in 53/77 (68.9%) cases. Disease-free period was 27.8 months (range, 0–184 months), with disease recurrence in 33/77 (42.85%) cases, most frequent site as lung in 13/33 (39.39%) cases. Management of recurrences was surgery and chemotherapy (CT) in 5/33 (15.15%) and CT in 10/33 (30.30%) of cases. At present, 40.3% of the patients (31/77) are found to be Disease-free. ConclusionNotwithstanding that uterine sarcomas are aggressive neoplasms, most accepted management to date is TAH + BSO, observing that the fact that this procedure is not performed by oncologists does not affect the DFP nor OS, contrary to what occurs in other gynecological neoplasms.

Investigations on uterine fatty lesions

The aim of the study was to determine the occurrence of UFLs and the dynamics of their development, as well as to evaluate the histopathology and relationship with regressive stromal changes. 3750 uterine specimens were reviewed during the period between 1984 and 2003. In the examined series of 3750 uteruses removed due to tumors or prolapse, 50 cases with four types of changes were chosen: adipocytic metaplasia of primary uterine leiomyomas (70% of cases), adipocytic metaplasia of interlobular stroma of primary uterine tumors (16%), adipocytic aggregates in the uterine muscle (8%), and pure lipomas (6%). Additionally, the cases were divided into three groups depending on the extent of fatty changes. Group 1 (48% of cases) consisted of cases in which less than 25% of the changes were present in the examined material. In group 2 (28% of cases) the fatty changes were between 25 and 50%. In group 3 (16% of cases) fatty changes constituted more than 50% of the examined specimen. The extent of adipocytic changes was connected with patient age, being significant between groups 1 and 3 (p < 0.01). Regressive stromal changes in leiomyomas occurred more often in middle-aged patients, with stage 2 lipomatosis than in other subgroups. Among 46 cases of UFLs two patients were diagnosed with a coexisting malignant uterine neoplasm (4.35%). In four patients with muscular lipomatosis, two were diagnosed with a coexisting malignant uterine tumor too (50%). 1. Uterine fatty lesions are rarely diagnosed, although they occur more often than previously thought. 2. Mixed tumors predominate over pure lipomas. 3. The histogenesis of these lesions seems to be multi-factorial, considering the different types of UFLs. 4. The extent of uterine fatty metaplasia positively correlated with the age of operated women. 5. The coexistence of UFLs with other malignant uterine neoplasms is accidental.

ASGO 2nd International Workshop on Gynecologic Oncology

ASGO 2nd International Workshop on Gynecologic Oncology

MR Imaging in Corpus Neoplasia: Spectrum of MR Findings

MR imaging is a noninvasive and a useful modality for depicting a wide variety of uterine tumors with excellent tissue contrast. In case malignant uterine neoplasms are suspected, contrast-enhanced image is useful to delineate the tumor extent and internal architecture of the tumor. In cases of endometrial carcinomas, dynamic enhanced imaging is utilized for evaluating the depth of myometrial invasion. In differentiating malignant uterine tumors from benign conditions, in addition to filtration into the surrounding tissues, the presence of necrosis that is usually better demonstrated on postcontrast images is important imaging finding. Diffusion-weighted imaging is an emerging technique that depicts tissue contrast based on restricted diffusion of water molecules and demonstrates increased intensity in the malignant tumors. The recognition of typical MR imaging features in a wide variety of endometrial tumors may facilitate differentiation, thus better determining appropriate patient management.