• Title/Summary/Keyword: Uterine sarcoma

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Uterine Sarcoma: Clinical Presentation, Treatment and Survival Outcomes in Thailand

  • Potikul, Chalermrat;Tangjitgamol, Siriwan;Khunnarong, Jakkapan;Srijaipracharoen, Sunamchok;Thavaramara, Thaovalai;Pataradool, Kamol
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.4
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    • pp.1759-1767
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    • 2016
  • Background: Uterine sarcoma is a group of rare gynecologic tumors with various natures, and different lines of treatment. Most have a poor treatment outcome. This study targeted clinical characteristics, treatment, overall survival (OS), progression-free survival (PFS), and prognostic factors in uterine sarcoma patients in one tertiary center for cancer care. Materials and Methods: Uterine sarcoma patients who were treated at the Department of Obstetrics and Gynecology, Faculty of Medicine Vajira Hospital between January 1994 and December 2014 were identified. Clinico-pathological data were analyzed. Prognostic outcomes were examined by Kaplan-Meier curves and Cox regression analysis. Results: We identified 46 uterine sarcoma patients: 25 carcinosarcoma (CS) (54.3%), 15 leiomyosarcoma (LMS) (32.6%), and 6 undifferentiated uterine sarcoma (UUS) (13.1%) cases. Mean age was $54.0{\pm}11.9years$ (range 25-82 years). Abnormal uterine bleeding was the most common presenting symptom (63.0%). Among 33 patients (71.7%) who had pre-operative tissue collected, diagnosis of malignancy was correct in 29 (87.9%). All patients received primary surgery and retroperitoneal lymph nodes were resected in 34 (73.9%). After surgery, 5 (10.9%) had gross residual tumors. Stage I disease was most commonly found (56.5%). Adjuvant treatment was given to 27 (58.7%), most commonly chemotherapy. After a median follow-up of 16.0 months (range 0.8-187.4 months), recurrence was encountered in 22 patients (47.8%). Median time to recurrence was 5.8 months (range1.0-105.5 months). Distant metastasis was more common than local or locoregional failure. The 2-year PFS was 45.2% (95% confidence interval [CI], 30.6%-59.7%) and the 2-year OS was 48.3% (95% CI, 33.3%-60.7%). Multivariable analyses found residual disease after surgery as a significant factor only for PFS. Conclusions: Uterine sarcoma is a rare tumor entity. Even with multimodalities of treatment, the prognosis is still poor. Successful cytoreductive surgery is a key factor for a good survival outcome.

Differentiating Uterine Sarcoma From Atypical Leiomyoma on Preoperative Magnetic Resonance Imaging Using Logistic Regression Classifier: Added Value of Diffusion-Weighted Imaging-Based Quantitative Parameters

  • Hokun Kim;Sung Eun Rha;Yu Ri Shin;Eu Hyun Kim;Soo Youn Park;Su-Lim Lee;Ahwon Lee;Mee-Ran Kim
    • Korean Journal of Radiology
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    • v.25 no.1
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    • pp.43-54
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    • 2024
  • Objective: To evaluate the added value of diffusion-weighted imaging (DWI)-based quantitative parameters to distinguish uterine sarcomas from atypical leiomyomas on preoperative magnetic resonance imaging (MRI). Materials and Methods: A total of 138 patients (age, 43.7 ± 10.3 years) with uterine sarcoma (n = 44) and atypical leiomyoma (n = 94) were retrospectively collected from four institutions. The cohort was randomly divided into training (84/138, 60.0%) and validation (54/138, 40.0%) sets. Two independent readers evaluated six qualitative MRI features and two DWI-based quantitative parameters for each index tumor. Multivariable logistic regression was used to identify the relevant qualitative MRI features. Diagnostic classifiers based on qualitative MRI features alone and in combination with DWI-based quantitative parameters were developed using a logistic regression algorithm. The diagnostic performance of the classifiers was evaluated using a cross-table analysis and calculation of the area under the receiver operating characteristic curve (AUC). Results: Mean apparent diffusion coefficient value of uterine sarcoma was lower than that of atypical leiomyoma (mean ± standard deviation, 0.94 ± 0.30 10-3 mm2/s vs. 1.23 ± 0.25 10-3 mm2/s; P < 0.001), and the relative contrast ratio was higher in the uterine sarcoma (8.16 ± 2.94 vs. 4.19 ± 2.66; P < 0.001). Selected qualitative MRI features included ill-defined margin (adjusted odds ratio [aOR], 17.9; 95% confidence interval [CI], 1.41-503, P = 0.040), intratumoral hemorrhage (aOR, 27.3; 95% CI, 3.74-596, P = 0.006), and absence of T2 dark area (aOR, 83.5; 95% CI, 12.4-1916, P < 0.001). The classifier that combined qualitative MRI features and DWI-based quantitative parameters showed significantly better performance than without DWI-based parameters in the validation set (AUC, 0.92 vs. 0.78; P < 0.001). Conclusion: The addition of DWI-based quantitative parameters to qualitative MRI features improved the diagnostic performance of the logistic regression classifier in differentiating uterine sarcomas from atypical leiomyomas on preoperative MRI.

Outcome analysis in patients with uterine sarcoma

  • Yu, Tosol;Kim, Hak Jae;Wu, Hong-Gyun;Ha, Sung Whan;Song, Yong-Sang;Park, Noh-Hyun;Kim, Jae-Won
    • Radiation Oncology Journal
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    • v.33 no.1
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    • pp.29-35
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    • 2015
  • Purpose: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. Materials and Methods: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). Results: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. Conclusion: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.

Effect of Flavonoids on Efflux and Cytotoxicity of Daunomycin (도노마이신의 세포 외 배출 및 세포 독성에 미치는 플라보노이드의 효과)

  • Chung, Soo-Yeon;Go, Eun-Jung;Kim, Na-Hyung;Lee, Hwa-Jeong
    • Journal of Pharmaceutical Investigation
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    • v.34 no.2
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    • pp.95-99
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    • 2004
  • One mechanism which plays a prominent role in development of multi-drug resistance seen in cancer cells is the over-expression of P-glycoprotein (P-gp). It is known that compounds found in vegetables and fruits not only have anticarcinogenic properties but may also modulate P-gp activity. The effect of some dietary components on efflux of daunomycin (DNM), a P-gp substrate, was examined in P-gp over-expressed human uterine sarcoma cell line, MES-SA/DX5. The efflux of DNM from the cells was significantly inhibited by quercetin and verapamil, but not by 1-naphtyl-isothiocyanate (NITC). The $IC_{50}$ values for DNM in MES-SA/DX5 cells were increased by flavonoids (quercetin and fisetin), but not by NITC after 72 hour incubation with dietary constituents. In conclusion, flavonoids may play a role in the modulation of P­-gp activity in human uterine sarcoma cells.

Endometrial Stromal Sarcoma Presented as an Incidental Lung Mass with Multiple Pulmonary Nodules

  • Kang, Dong Oh;Choi, Sue In;Oh, Jee Youn;Sim, Jae Kyeom;Choi, Jong Hyun;Choo, Ji Yung;Hwang, Jin Wook;Lee, Seung Heon;Lee, Ju-Han;Lee, Ki Yeol;Shin, Chol;Kim, Je Hyeong
    • Tuberculosis and Respiratory Diseases
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    • v.76 no.3
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    • pp.131-135
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    • 2014
  • Low-grade endometrial stromal sarcoma (ESS) is an uncommon gynecologic malignancy of mesodermal origin. Pulmonary metastasis of low-grade ESS can occur years and decades after the treatment of the primary disease. Low-grade ESS is frequently mistaken as benign uterine neoplasm like uterine leiomyoma, which can potentially lead to a misdiagnosis. We present a case of a 42-year-old woman with low-grade ESS, that initially presented as an incidental lung mass with multiple pulmonary nodules, seven years after an uterine myomectomy. A $6.9{\times}5.8cm-sized$ intrapelvic mass suspected of uterine origin was discovered while searching for potential extrathoracic primary origin. A pelviscopy and simultaneous thoracoscopic lung biopsy were conducted for pathologic diagnosis. Finally, the diagnosis was confirmed as low-grade ESS with lung metastasis based on the histopathologic examination with immunohistochemical stain, which was showed positive for CD10 and hormone receptor markers (estrogen and progesterone receptors) in both pelvic and lung specimens.

Modulation of P-glycoprotein Activity by Flavonoids in Human Uterine Sarcoma Cells (인체 자궁암 세포에서 플라보노이드에 의한 P-당단백질의 활성 조절)

  • Go, Eun-Jung;Chung, Soo-Yeon;Kim, Na-Hyung;Lee, Hwa-Jeong
    • Journal of Pharmaceutical Investigation
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    • v.33 no.4
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    • pp.305-310
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    • 2003
  • One of the possible mechanisms of multi-drug resistance found in cancer cells is the over-expression of P­glycoprotein (P-gp). Studies have shown that compounds in plants including vegetables and fruits not only have anticancer activities but may also modulate P-gp activity. The effect of flavonoids and organic isothiocyanate on P-gp activity was studied in human uterine sarcoma cell lines, MES-SA (sensitive) and MES-SA/DX5 (resistant) cells. The accumulation of daunomycin (DNM), a P-gp substrate, was approximately 10 times greater in the sensitive cell as compared to the resistant cells over the entire time course (up to 2 hours). The positive control, verapamil increased the two hour accumulation of DNM while quercetin decreased that of DNM in the resistant cells. 1-Naphtyl-isothiocyanate (NITC) showed no effect on the two hour accumulation of DNM. The $IC_{50}$ values for DNM in the resistant cells was about 20 times higher than that observed in the sensitive cells $(10.1{\pm}1.7\;{\mu}M\;vs.\;0.58{\pm}0.28\;{\mu}M)$. Verapamil reduced the $IC_{50}$ value for DNM whereas flavonoids (quercetin and fisetin) increased those for DNM in the resistant cells.

Incidental Multiple Pulmonary Nodules: Benign Metastasizing Leiomyoma and $^{18}F-FDG$ PET/CT (우연히 발견된 다발성 폐결절: 양성 전이성 근종과 $^{18}F-FDG$ PET/CT)

  • Lee, Seok-Mo
    • Nuclear Medicine and Molecular Imaging
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    • v.41 no.3
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    • pp.258-259
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    • 2007
  • Benign metastasizing leiomyoma(BML) is a rare condition affecting women with a history of having undergone hysterectomy or myomectomy for a benign uterine fibroid, that is found to have metastasized to extrauterine sites, usually many years after hysterectomy. 1,2) Patient with BML almost always asymptomatic, although if the lesions are large enough, they can cause compressive symptoms. Among several hypothesis of pathogenesis, most plausible theory is that these tumors represent a true metastatic lesion but are very low-grade sarcoma. 3) Because the tumor is responsive to estrogen, menopause and pregnancy have slowed the growth of these lesion 4) and it seems reasonable to perform hysterectomy in patients with a uterine mass and, at the same time, perform oophorectomy for hormonal control. BML is an unusual cause of diffuse pulmonary nodules which should be considered in females with unexplained nodules and a history of surgery for uterine leiomyoma.

Studies on the Effect of Guichoolpajing-Tang and Gamiguichoolpajing-Tang (징하에 응용(應用)되는 귀출파징탕과 가미귀출파징탕의 효능(效能)에 관(關)한 연구(硏究))

  • Song, Seog-Ho;Song, Byoung-Key;Lee, Kyoung-Sup
    • THE JOURNAL OF KOREAN ORIENTAL ONCOLOGY
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    • v.1 no.1
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    • pp.213-230
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    • 1995
  • The present work was done to investigate the pharmacological effectiveness of Guichoolpajing-Tang and Gamiguichoolpajing-Tang. The extracted water of those two prescription were administered to experimintal animals and determined analgesic, anti-pyretic, anti-inflammatory effects and effects on intravascular coagulation, spontaneous morements of the isolated rat uterus, the uterine contracion induced by oxytocin or $PGF_{20}$, lifespan of mice implanted intraperitoneally with Sarcoma 180. The following results were obtained. 1) The extracted water of Guichoolpajing-Tang and Gamiguichoolpajing-Tang were revealed significant analgesic effect. 2) The extracted water of Guichoolpajing-Tang and Gamiguichoolpajing-Tang showed anti-pyretic effect. 3) The extracted water of Guichoolpajing-tang and Gamiguichoolpajing-Tang showed anti-inflammatory effect. Especially, the extracted water of Gamiguichoolpajing-Tang showed more significant dffect than another. 4) Concerning the degree of concentration of FDP, Gamiguichoolpajing-Tang treated groups tevealed significant decreases. 5) The extracted water of both prescriptions revealed uterus relaxation on the spontaneous movement of the isolated rat uterus and showed uterine contraction induced by oxytocin or $PDF_{2}$. Especially Guichoolpajing-Tang showed more significant effect than another. 6) The extracted water of both prescription both prescriptions showed effect on lifespan of mice implanted intraperitoneally with Sarcoma 180.

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A Clinical Study of 20 Uterine Sarcomas (자궁육종 20례에 대한 임상적 고찰)

  • Lee, Young-Gi;Park, Yoon-Ki;Lee, Doo-Jin
    • Journal of Yeungnam Medical Science
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    • v.15 no.2
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    • pp.275-285
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    • 1998
  • Sarcoma of the uterus is very rare malignant tumor originating from uterine muscle or connective tissue. We have experienced 20 cases of uterine sarcoma from January 1991 to June 1998. The results were as follows: 1. The pathologic types were 13 cases(65.0%) of leiomyosarcoma, 5 cases(25.0%) of malignant mixed Mullerian tumor, 1 case of rhabdomyosarcoma, and 1 case of angiosarcoma. 2. The average age and parity was 50.2 and 3.7. The chief complaints were irregular vaginal bleeding(35.0%), lower abdominal pain(25.0%), and abdominal mass(25.0%). 3. Nine cases(45.0%) were FIGO stage I, 1 case(5.0%) was stage II, 6 cases(30.0%) were stage III, and 4 cases(20.0%) were stage IV. 4. The survival was from 1.5 months to over 130 months(median 16.5 months), and there was no correlation between survival and FIGO stage or pathologic type. The correlation between survival and number of mitotic figure was incalcurable. 5. CA 125 levels were serially measured as a tumor marker in monitoring patients and the positive rate was 40%. Further study was needed to make a conclusion for usefulness of CA 125 as a tumor marker.

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Prognostic Factors and Treatment Outcomes in 93 Patients with Uterine Sarcoma from 4 Centers in Turkey

  • Durnali, Ayse;Tokluoglu, Saadet;Ozdemir, Nuriye;Inanc, Mevlude;Alkis, Necati;Zengin, Nurullah;Sonmez, Ozlem Uysal;Kucukoner, Mehmet;Anatolian Society of Medical Oncology (ASMO), Anatolian Society of Medical Oncology (ASMO)
    • Asian Pacific Journal of Cancer Prevention
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    • v.13 no.5
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    • pp.1935-1941
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    • 2012
  • Introduction: Uterine sarcomas are a group of heterogenous and rare malignancies of the female genital tract and there is a lack of consensus on prognostic factors and optimal treatment. Objective and Methodology: To perform a retrospective evaluation of clinicopathological characteristics, prognostic factors and treatment outcomes of 93 patients with uterine sarcomas who were diagnosed and treated at 4 different centers from November 2000 to October 2010. Results: Of the 93 patients, 58.0% had leiomyosarcomas, 26.9% malignant mixed Mullerian tumors, 9.7% endometrial stromal sarcomas, and 5.4% other histological types. According to the last International Federation of Gynecology and Obstetrics (FIGO) staging, 43.0% were stage I, 20.4% were stage II, 22.6% were stage III and 14.0 % were stage IV. Median relapse free survival (RFS) was 20 months (95% confidence interval (CI), 12.4-27.6 months), RFS after 1, 2, 5 years were 66.6%, 44.1%, 16.5% respectively. Median overall survival (OS) was 56 months (95% CI, 22.5-89.5 months), and OS after 1, 2, 5 years was 84.7%, 78%, 49.4% respectively. Multivariate analysis showed that age ${\geq}60$ years and high grade tumor were significantly associated with poor OS and RFS; patients administered adjuvant treatment with sequential chemotherapy and radiotherapy had longer RFS time. Among patients with leiomyosarcoma, in addition to age and grade, adjuvant treatment with sequential chemotherapy and radiotherapy after surgery had significant effects on OS. Conclusion: Uterine sarcomas have poor progrosis even at early stages. Prognostic factors affecting OS were found to be age and grade.