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Concurrent Malignant Solitary Fibrous Tumor Arising from the Omentum and Grade 3 Endometrial Endometrioid Adenocarcinoma of the Uterus with p53 Immunoreactivity.

Harada N, Nobuhara I, Haruta N, Higashiura Y, Watanabe H, Ohno S - Case Rep Obstet Gynecol (2014)

Bottom Line: A malignant solitary fibrous tumor of the omentum and grade 3 endometrioid adenocarcinoma of the uterus were diagnosed by pathohistological analysis.Interestingly, the tumor cells were immunoreactive for p53.These tumors may have become malignant due to the presence of p53 mutations.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara Prefecture 630-8305, Japan.

ABSTRACT
A malignant solitary fibrous tumor arising from the omentum is extremely rare. To our knowledge, this is the first case of a malignant solitary fibrous omentum tumor coexisting with uterine corpus cancer. A 62-year-old woman presented to our hospital with vaginal discharge. Endometrioid adenocarcinoma was diagnosed by endometrial curettage. In addition, a solid tumor in front of the uterus was detected following computed tomography and/or magnetic resonance imaging, which was suspected to be a primary (or secondary) malignant tumor arising from the omentum. Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy were performed. A malignant solitary fibrous tumor of the omentum and grade 3 endometrioid adenocarcinoma of the uterus were diagnosed by pathohistological analysis. Interestingly, the tumor cells were immunoreactive for p53. Adjuvant chemotherapy was administered for the uterine corpus cancer and the patient remains healthy 48 months after the surgery. These tumors may have become malignant due to the presence of p53 mutations.

No MeSH data available.


Related in: MedlinePlus

Axial (a) and coronal (b) computed tomography and sagittal magnetic resonance imaging (c, d). (a) Two tumors were detected in both the uterus (triangle) and the peritoneal cavity (arrow). The bilateral ovaries (circle) could be observed. (b) The tumor in the peritoneal cavity originated from the omentum (arrow). (c) The tumor in the peritoneal cavity heterogeneously exhibited an isointense-to-hyperintense signal on T2-weighed images. (d) The tumor was prominently enhanced on contrast-enhanced T1-weighted images. The flow void from the omentum to the tumor (arrow) and ascites (triangle) could also be detected.
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fig1: Axial (a) and coronal (b) computed tomography and sagittal magnetic resonance imaging (c, d). (a) Two tumors were detected in both the uterus (triangle) and the peritoneal cavity (arrow). The bilateral ovaries (circle) could be observed. (b) The tumor in the peritoneal cavity originated from the omentum (arrow). (c) The tumor in the peritoneal cavity heterogeneously exhibited an isointense-to-hyperintense signal on T2-weighed images. (d) The tumor was prominently enhanced on contrast-enhanced T1-weighted images. The flow void from the omentum to the tumor (arrow) and ascites (triangle) could also be detected.

Mentions: A 62-year-old menopausal woman presented to our hospital with vaginal discharge. The uterus, which was slightly larger than a hen's egg, along with a movable goose-egg-sized hard tumor in front of the uterus, was palpable during the internal examination. Grade 3 endometrioid adenocarcinoma of the uterus was detected by endometrial curettage. Computed tomography (CT) and/or magnetic resonance imaging (MRI) detected 2 solid tumors in both the uterus and the peritoneal cavity, measuring approximately 4 cm and 10 cm, respectively. Bilateral ovaries could also be detected (Figure 1(a)). The tumor in front of the uterus originated from the omentum on coronal CT (Figure 1(b)). On MRI, the tumors exhibited a hypointense signal on T1-weighted images (T1WI) and a heterogeneous isointense-to-hyperintense signal on T2-weighted images (Figure 1(c)). They were prominently enhanced on contrast-enhanced T1WI (Figure 1(d)), and high-intensity areas were visible in the diffusion-weighted images. The flow void from the omentum to the tumor could be also detected. Preoperatively, these results were highly suggestive of uterine corpus cancer and a primary (or secondary) malignant tumor of the omentum. The patient's serum CA125 and serum CA19-9 levels were 38.7 U/mL and 35.1 U/mL, respectively. As expected, a laparotomy revealed that the tumor in the peritoneal cavity originated from the omentum, and it was well circumscribed with a gross maximum dimension of 10 cm (Figure 2(a)). It was diagnosed as a sarcoma by pathohistological analysis during surgery, and then a hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy were performed. Histological examination revealed that the tumor in the uterus was a grade 3 endometrial endometrioid adenocarcinoma (pT1bN0M0). The tumor cells were strongly immunoreactive for p53. Tumor in the peritoneal cavity was hypercellular and exhibited a patternless arrangement of fibroblastic spindle cells. It was composed of markedly atypical cells with a high mitotic activity (>10 mitotic figures/10 high power fields (HPF); Figure 2(b)) and the proliferative index as assessed by Ki-67 labeling index positivity was >30%. Immunohistochemical staining demonstrated that the tumor cells were positive for vimentin, bcl-2, CD34 (Figure 2(c)), CD99, CD10, S-100, c-kit, epithelial membrane antigen, cytokeratin AE1/AE3, progesterone receptor, p16 (Figure 2(d)), and p53 (Figure 2(e)), according to various grades of intensity (Table 1). They were negative for smooth muscle actin, desmin, D2-40, calretinin, estrogen receptor, and CD31. Therefore, we determined that the omentum tumor was a malignant SFT with sarcomatous growth. Six cycles of adjuvant chemotherapy (paclitaxel, 175 mg/m2 and carboplatin, AUC 5) were administered for the uterine corpus cancer. The patient remains healthy 48 months after the surgery.


Concurrent Malignant Solitary Fibrous Tumor Arising from the Omentum and Grade 3 Endometrial Endometrioid Adenocarcinoma of the Uterus with p53 Immunoreactivity.

Harada N, Nobuhara I, Haruta N, Higashiura Y, Watanabe H, Ohno S - Case Rep Obstet Gynecol (2014)

Axial (a) and coronal (b) computed tomography and sagittal magnetic resonance imaging (c, d). (a) Two tumors were detected in both the uterus (triangle) and the peritoneal cavity (arrow). The bilateral ovaries (circle) could be observed. (b) The tumor in the peritoneal cavity originated from the omentum (arrow). (c) The tumor in the peritoneal cavity heterogeneously exhibited an isointense-to-hyperintense signal on T2-weighed images. (d) The tumor was prominently enhanced on contrast-enhanced T1-weighted images. The flow void from the omentum to the tumor (arrow) and ascites (triangle) could also be detected.
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Related In: Results  -  Collection

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Show All Figures
getmorefigures.php?uid=PMC4120779&req=5

fig1: Axial (a) and coronal (b) computed tomography and sagittal magnetic resonance imaging (c, d). (a) Two tumors were detected in both the uterus (triangle) and the peritoneal cavity (arrow). The bilateral ovaries (circle) could be observed. (b) The tumor in the peritoneal cavity originated from the omentum (arrow). (c) The tumor in the peritoneal cavity heterogeneously exhibited an isointense-to-hyperintense signal on T2-weighed images. (d) The tumor was prominently enhanced on contrast-enhanced T1-weighted images. The flow void from the omentum to the tumor (arrow) and ascites (triangle) could also be detected.
Mentions: A 62-year-old menopausal woman presented to our hospital with vaginal discharge. The uterus, which was slightly larger than a hen's egg, along with a movable goose-egg-sized hard tumor in front of the uterus, was palpable during the internal examination. Grade 3 endometrioid adenocarcinoma of the uterus was detected by endometrial curettage. Computed tomography (CT) and/or magnetic resonance imaging (MRI) detected 2 solid tumors in both the uterus and the peritoneal cavity, measuring approximately 4 cm and 10 cm, respectively. Bilateral ovaries could also be detected (Figure 1(a)). The tumor in front of the uterus originated from the omentum on coronal CT (Figure 1(b)). On MRI, the tumors exhibited a hypointense signal on T1-weighted images (T1WI) and a heterogeneous isointense-to-hyperintense signal on T2-weighted images (Figure 1(c)). They were prominently enhanced on contrast-enhanced T1WI (Figure 1(d)), and high-intensity areas were visible in the diffusion-weighted images. The flow void from the omentum to the tumor could be also detected. Preoperatively, these results were highly suggestive of uterine corpus cancer and a primary (or secondary) malignant tumor of the omentum. The patient's serum CA125 and serum CA19-9 levels were 38.7 U/mL and 35.1 U/mL, respectively. As expected, a laparotomy revealed that the tumor in the peritoneal cavity originated from the omentum, and it was well circumscribed with a gross maximum dimension of 10 cm (Figure 2(a)). It was diagnosed as a sarcoma by pathohistological analysis during surgery, and then a hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy were performed. Histological examination revealed that the tumor in the uterus was a grade 3 endometrial endometrioid adenocarcinoma (pT1bN0M0). The tumor cells were strongly immunoreactive for p53. Tumor in the peritoneal cavity was hypercellular and exhibited a patternless arrangement of fibroblastic spindle cells. It was composed of markedly atypical cells with a high mitotic activity (>10 mitotic figures/10 high power fields (HPF); Figure 2(b)) and the proliferative index as assessed by Ki-67 labeling index positivity was >30%. Immunohistochemical staining demonstrated that the tumor cells were positive for vimentin, bcl-2, CD34 (Figure 2(c)), CD99, CD10, S-100, c-kit, epithelial membrane antigen, cytokeratin AE1/AE3, progesterone receptor, p16 (Figure 2(d)), and p53 (Figure 2(e)), according to various grades of intensity (Table 1). They were negative for smooth muscle actin, desmin, D2-40, calretinin, estrogen receptor, and CD31. Therefore, we determined that the omentum tumor was a malignant SFT with sarcomatous growth. Six cycles of adjuvant chemotherapy (paclitaxel, 175 mg/m2 and carboplatin, AUC 5) were administered for the uterine corpus cancer. The patient remains healthy 48 months after the surgery.

Bottom Line: A malignant solitary fibrous tumor of the omentum and grade 3 endometrioid adenocarcinoma of the uterus were diagnosed by pathohistological analysis.Interestingly, the tumor cells were immunoreactive for p53.These tumors may have become malignant due to the presence of p53 mutations.

View Article: PubMed Central - PubMed

Affiliation: Department of Obstetrics and Gynecology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara Prefecture 630-8305, Japan.

ABSTRACT
A malignant solitary fibrous tumor arising from the omentum is extremely rare. To our knowledge, this is the first case of a malignant solitary fibrous omentum tumor coexisting with uterine corpus cancer. A 62-year-old woman presented to our hospital with vaginal discharge. Endometrioid adenocarcinoma was diagnosed by endometrial curettage. In addition, a solid tumor in front of the uterus was detected following computed tomography and/or magnetic resonance imaging, which was suspected to be a primary (or secondary) malignant tumor arising from the omentum. Hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and lymphadenectomy were performed. A malignant solitary fibrous tumor of the omentum and grade 3 endometrioid adenocarcinoma of the uterus were diagnosed by pathohistological analysis. Interestingly, the tumor cells were immunoreactive for p53. Adjuvant chemotherapy was administered for the uterine corpus cancer and the patient remains healthy 48 months after the surgery. These tumors may have become malignant due to the presence of p53 mutations.

No MeSH data available.


Related in: MedlinePlus