Presence of Sarcomatous Component outside the Ovary Is an Adverse Prognostic Factor for Primary Ovarian Malignant Mixed Mesodermal Tumors: A Study of 47 Cases.
Julie Kunkel, Yan Peng, Yu Tao, Hannah Krigman, Dengfeng Cao. Washington University School of Medicine, St. Louis; University of Texas-Southwestern Medical Center, Dallas
Background: Primary ovarian malignant mixed mesodermal tumors (POMMMTs) are rare. This study was to investigate their clinicopathologic prognostic factors.
Design: We analyzed 13 parameters in POMMMTs from 47 patients: patient age, FIGO stage, laterality, tumor size, types of carcinomatous component (CC) and sarcomatous component (SC) (heterologous or homologous), percentage of CC and SC, mitotic figures per 10 hpfs in SC, tumor necrosis (percent of tumor), lymph node status (LN), vascular invasion (VI), tumor components outside the ovary (OTO), and surgical debulking status. The patients were followed to the most recent visit or their death. We correlated these parameters with disease-specific survival (DSS) using Kaplan-Meier method and Log-rank test.
Results: The mean age was 69.0 years (> 60 in 33/47). The tumor, average 13.6 cm, was predominantly located in the left and right ovary in 18 and 24 cases, respectively (similar size in both ovaries in 5). FIGO stage was I in 1, II in 5, III in 40, and IV in 1 patient, respectively. LN metastasis and VI was seen in 6/17 and 29/47 patients, respectively. The CC was high-grade serous in 27, endometrioid in 2, mixed high-grade serous and endometrioid in 17, and mixed high-grade serous and clear cell carcinoma in 1. The mean percentage of CC was 70% (10% to 99%). The SC was heterologous in 34 (72%) and homologous in 13 (28%). The mitoses per 10 HPFs in SC averaged 33. Tumor necrosis was present in 45/47 cases (mean 10%, range 1-40%). Tumor OTO contained only CC in 17, only SC in 1, and both in 29 cases. Optimal and suboptimal surgical debulking was performed in 28 and 6 patients, respectively (degree of debulking unclear in 13). The patients were followed from 1 to 183 months: 6 patients lost to followup, 3 died postoperatively, 29 died from disease, 2 died from other causes, 7 still alive (14 to 183 months). The DSS at 1-year, 2-year, and 5-year was 75%, 56%, and 21% respectively. Presence of SC OTO was a significant prognostic factor (p = 0.03) whereas stage (only 6 patients with stage I-II) and other parameters were not. After adjusting FIGO stage, presence of SC OTO was still a significant prognosticator for patients with stage III-IV disease (p = 0.003) whereas others were not.
Conclusions: Most POMMMTs occurred in older patients with an advanced stage at diagnosis. Presence of SC OTO was a significant adverse prognostic factor. Specific tumor components OTO should be listed in pathology report.
Category: Gynecologic & Obstetrics
Tuesday, March 1, 2011 1:00 PM
Poster Session IV # 112, Tuesday Afternoon