Malignant mixed müllerian tumors: An immunohistochemical study of 47 cases, with histogenetic considerations and clinical correlation

George, Evan; Manivel, J. Carlos; Dehner, Louis P.; Wick, Mark R.

doi:10.1016/0046-8177(91)90153-g

Cited by 145 publications

(79 citation statements)

References 25 publications

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“…The neoplasm we report showed prominent neuroendocrine differentiation, including an extensive small cell neuroendocrine carcinoma component, with strong and consistent positivity for chromogranin A, synaptophysin, NSE and Leu-7. These findings could have been anticipated, in keeping with the Lauchlan theory, since, although sparsely mentioned, neuroendocrine differentiation has been recognized in uterine MMMTs (24,(31)(32)(33), as it has recently in an ovarian example (34). Some of these uterine MMMTs featured a small cell neuroendocrine carcinoma component, analogous to their infamous counterparts in the lung (32).…”

Section: Discussionsupporting

confidence: 65%

“…Not including MMMTs arising from the specialized ovarian surface epithelium (differing from the extraovarian peritoneal surface epithelium on a histochemical, enzymatic, biological and immunohistochemical level (30)), 24 examples of these tumors can be found in the literature, some of which could be questioned as to their primary peritoneal nature. In addition, 2 cases originating from the peritoneum were included in a large review on immunohistochemical properties of MMMTs, but were not amenable to proper analysis (24).…”

Section: Discussionmentioning

confidence: 99%

“…Primary peritoneal neoplasms composed of both malignant epithelial and stromal elements have variously been referred to as extragenital malignant mixed mesodermal tumors (1)(2)(3)(4)(5), malignant mixed müllerian tumors (6 -18), carcinosarcomas (19 -21) and mixed tumors of müllerian type (22)(23)(24). This lack of consistent terminology reflects both the rarity of these lesions, mostly described in single case reports, as well as the uncertainties concerning the histogenesis.…”

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confidence: 99%

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Primary Mesenteric Malignant Mixed Mesodermal (Müllerian) Tumor with Neuroendocrine Differentiation

Cokelaere¹,

Michielsen

Vos³

et al. 2001

Modern Pathology

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Extragenital malignant mixed mesodermal (mülle-rian) tumors (MMMT) are rare neoplasms, with but 24 well documented cases in the literature. Neuroendocrine differentiation in mixed müllerian neoplasms has been mentioned only anecdotally. We report on the clinical, pathological, and immunohistochemical features of a hitherto-undescribed extragenital MMMT with prominent neuroendocrine differentiation arising from the jejunal mesentery. This lesion was composed of a poorly differentiated epithelial component and a spindle cell component with heterologous (rhabdomyoblastic) differentiation. The bulk of the tumor consisted of small cell neuroendocrine carcinoma, which exhibited strong immunoreactivity for NSE, LEU-7, chromogranin A and synaptophysin. Electronmicroscopy confirmed the presence of neurosecretory dense-core granules. The primary mesenteric origin of the tumor was established at autopsy. Along with a brief review of previously reported extragenital MMMT some histogenetic concepts relevant to this case are discussed.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Primary Mesenteric Malignant Mixed Mesodermal (Müllerian) Tumor with Neuroendocrine Differentiation

Cokelaere¹,

Michielsen

Vos³

et al. 2001

Modern Pathology

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“…Co-expression of CK18 and/or CK6 and vimentin in this cell line and its clones supports the above suggestion that they show IF expression characteristic of müllerian-duct-derived tumors. Moreover, expression of markers of epithelial differentiation in all carcinomatous components and within sarcomatous areas in 60% of tumors and co-expression of epithelial and mesenchymal phenotypic markers in individual cells could be attributed to the neoplastic process (George et al, 1991). These findings provide compelling evidence for a common cellular origin of the carcinomatous and sarcomatous elements of uterine carcinosarcomas.…”

Section: Discussionsupporting

confidence: 49%

“…Studies based on clinicopathologic and immunohistochemical analyses have suggested that carcinosarcomas could represent biphasic (metaplastic) carcinomas (De Brito et al, 1993). A common stem-cell precursor, presumably multipotential, of the epithelial and stromal components (monophasic or combination theory) has been proposed in the light of results of tissue culture (Emoto et al, 1993;Gorai et al, 1993;Masuda et al, 1987), heterotransplantation (Ishiwata et al, 1987) and of ultrastructural (Silverberg et al, 1971) and immunohistochemical (Auerbach et al, 1988;George et al, 1991) studies.…”

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confidence: 99%

Uterine carcinosarcoma is derived from a single stem cell: Anin vitro study

et al. 1997

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Expression of intermediate filaments (IFs) has been suggested to be a reliable marker for differentiating epithelial and non‐epithelial tumors. Moreover, the c‐erbB‐2 and p53 genes are considered to be involved relatively early in the process of human carcinogenesis. In order to elucidate the origin of uterine carcinosarcomas, we analyzed IF, c‐erbB‐2 and p53 expression in and the ultrastructural characteristics of clones derived from a human uterine‐carcinosarcoma cell line, EMTOKA. The expression of IFs and other proteins in the EMTOKA clones was identical to that in the EMTOKA cell line. It and its 7 clones all expressed cytokeratins 8, 17, 18 and 19, vimentin, epithelial membrane antigen, S‐100, myoglobin, type‐II collagen, α‐smooth‐muscle actin, placental alkaline phosphatase and epidermal‐growth‐factor receptor. The c‐erbB‐2 and p53 expression levels of all the cell types of the EMTOKA cell line and its clones were the same. Interestingly, an ultrastructural study showed that the EMTOKA cell line and its clones at early and late passages possessed the characteristics of epithelial cell types without either transitional forms between the epithelial and stromal components or differentiation into sarcomatous components. The results of this study lend particular support to the combination tumor hypothesis that a precursor (stem) cell gives rise both to epithelial and to mesenchymal components during the histogenesis of uterine carcinosarcoma, the epithelial component of which appears to be dominant, suggesting that the established cell lines derived from a common stem cell. Int. J. Cancer 72:821–827, 1997. © 1997 Wiley‐Liss, Inc.

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Molecular genetic evidence for the conversion hypothesis of the origin of malignant mixed Müllerian tumours

et al. 1997

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The origin of malignant mixed Müllerian tumours (MMMTs) has long been debated, due to the indefinite relationship between epithelial and mesenchymal malignant cells. In order to obtain insight into the clonal relationship between the two components of these tumours, molecular genetic changes were investigated at the level of loss of heterozygosity (LOH) in both cells types. LOH was studied in a series of six cases with 74 polymorphic microsatellite markers mapping to 19 different chromosomes. The epithelial and the mesenchymal neoplastic cells were separately microdissected from formalin‐fixed, paraffin‐embedded tissue, prior to DNA isolation. LOH was observed for 35 different markers mapping to chromosomes 3, 6, 8, 11, 15, 16, 17, 18, 21, and X. The most frequently involved chromosomes were 17p, 17q, 11q, 15q, and 21q. LOH was observed in five out of six cases and identical alleles were lost in the epithelial and in the mesenchymal cells. No genetic differences were observed between the two cell types for any of the informative markers. Immunohistochemistry (IHC) and TP53 mutation analysis revealed involvement of TP53 in all cases. Mutations were identified in five MMMTs. In four tumours, of which three had a missense mutation, strong nuclear staining for p53 was observed. In the remaining two cases, the mutation resulted in a stop codon, with no nuclear staining for p53 by IHC. The results support a monoclonal origin of MMMTs, with the absence of genetic changes uniquely associated with either of the phenotypes. The latter finding is compatible with current opinion that these neoplasms should be considered as metaplastic carcinomas and supports the conversion hypothesis. © 1997 John Wiley & Sons, Ltd.

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Malignant mixed müllerian tumors: An immunohistochemical study of 47 cases, with histogenetic considerations and clinical correlation

Cited by 145 publications

References 25 publications

Primary Mesenteric Malignant Mixed Mesodermal (Müllerian) Tumor with Neuroendocrine Differentiation

Primary Mesenteric Malignant Mixed Mesodermal (Müllerian) Tumor with Neuroendocrine Differentiation

Uterine carcinosarcoma is derived from a single stem cell: Anin vitro study

Molecular genetic evidence for the conversion hypothesis of the origin of malignant mixed Müllerian tumours

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