Histology and Pattern of Recurrence in Uterine Malignant Mixed Mullerian Tumor
ED Euscher, A Malpica. MD Anderson Cancer Center, Houston, TX
Background: Malignant Mixed Mullerian Tumor (MMMT) is an uncommon uterine malignancy associated with high rates of recurrence, particularly distant recurrence, and mortality. A contemporary study of a large case series of MMMT addressing the pattern and histology of recurrences with emphasis on the pathologic findings has not been done. In this study, we analyzed 67 such cases.
Design: One hundred fifty cases of MMMT from a 20 year period were retrieved from the files of the Department of Pathology at our institution. Sixty-seven (44.6%) cases with recurrent MMMT noted either in the pathology files or medical record were identified for review. Clinicopathologic features documented in the selected cases included: patient (pt) age, FIGO stage, time to first recurrence, recurrence histology and ratio of sarcoma (SA) to carcinoma (CA) in the primary tumor. All cases were reviewed by a gynecologic pathologist to confirm the H&E diagnosis.
Results: Pts' ages ranged from 39-82 years (median 63 years) with time to first recurrence ranging from 2-87 months (mos) (median 12 mos overall). By FIGO stage, the median time to recurrence was as follows: Stage 1 (32 pts), 10 mos; Stage 2 (14 pts), 14 mos; Stage III (14 pts), 15 mos; Stage IV (6 pts), 12 mos. Ninety-five sites of recurrence (43 pts with single recurrences; 24 pts with multiple recurrences) were noted: 38 local recurrences (27 vaginal, 11 pelvic) and 57 distant recurrences (20 lung/thorax, 14 omentum/peritoneum, 6 extra pelvic lymph node, 6 bone, 4 liver, 4 brain, 1 adrenal gland, 1 kidney, and 1 not specified). Forty-eight (50.5%) recurrences were composed entirely of CA, 10 (10.5%) of both CA and SA, and 6 (6.3%) of entirely SA. In 31 recurrences, histologic composition was not stated and slides were not available for review. Twelve of 48 (25%) recurrences composed entirely of CA had >50% SA in the primary tumor. Of the 6 recurrences composed entirely of SA (2 vaginal, 2 lung, 2 peritoneal), five (83%) had >50% SA in the primary tumor.
Conclusions: Nearly half of pts with MMMT experience recurrent disease, and of those, nearly 50% are FIGO stage I at diagnosis. While vaginal recurrence is most common, extrapelvic recurrence is a significant problem occurring in 44 pts (65.6%) in this series. The ratio of CA/SA does not necessarily predict the histology of the recurrence except in rare cases where the recurrence is composed entirely of SA. Biopsy of recurrent MMMT is essential to confirm the recurrence histology as this could direct or alter the chemotherapeutic regimen.
Wednesday, March 11, 2009 1:00 PM
Poster Session VI # 160, Wednesday Afternoon