Primary Uterine Endometrial Stromal Neoplasms

Chang, Karen L.; Crabtree, Gertrude S.; Lim-Tan, Soo Kim; Kempson, Richard L.; Hendrickson, Michael

doi:10.1097/00000478-199005000-00002

Cited by 394 publications

(50 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…However, this patient subsequently developed lung-and intra-abdominal metastases. The low retroperitoneal Pelvic lymphadenectomy and bilateral salpingo-oophorectomy F Amant et al recurrence rate (3%) in our study and the tendency of ESS to recur at different sites (Chang et al, 1990) suggest systematic lymphadenectomy to bear little clinical benefit in early-stage ESS. Tumours arising in young women reduce the serendipity (oncological mindset) of the pathologist, and this adds to the diagnostic problem and delay in diagnosis .…”

Section: Discussionmentioning

confidence: 52%

“…Endometrial stromal sarcoma development and/or recurrences can be induced by oestrogen-replacement therapy and tamoxifen (Beer et al, 1995;Chu et al, 2003), whereas progestins (Gloor et al, 1982), gonadotropin-releasing hormone analogues (Burke and Hickey, 2004) and aromatase inhibitors inhibit tumour growth (Maluf et al, 2001;Leunen et al, 2004). Recurrence rates in early-stage ESS are high (Chang et al, 1990), and the impact of surgical castration and adjuvant hormonal treatment needs to be investigated further.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

View full text Add to dashboard Cite

The objective of this study is to assess the therapeutic importance of surgical castration, adjuvant hormonal treatment and lymphadenectomy in endometrial stromal sarcoma (ESS). A retrospective and multicentric search was performed. Clinicopathologic data were retrieved from cases that were confirmed to be ESS after central pathology review. The protocol was approved by the Ethical Committee. ESS was confirmed histopathologically in 34 women, but follow-up data were available in only 31 women. Surgical treatment (n ¼ 31) included hysterectomy with or without bilateral salpingo-oophorectomy (BSO) in 23 out of 31 (74%) and 8 out of 31 (26%) cases, respectively. Debulking surgery was performed in 6 out of 31 cases (19%). Stage distribution was as follows: 22 stage I, 4 stage III and 5 stage IV. Women with stage I disease recurred in 4 out of 22 (18%) cases. Among stage I women undergoing hormonal treatment with or without BSO, 3 out of 15 (20%) and 1 out of 7 (14%) relapsed, respectively. Among stages III -IV women receiving adjuvant hormonal treatment or not, 1 out of 5 (20%) and 3 out of 4 (75%) relapsed, respectively (differences ¼ 55.0%, 95% CI ¼ À6.8 -81.2%). Kaplan -Meier curves show comparable recurrence rates for stage I disease without adjuvant hormonal treatment when compared to stages III -IV disease treated with surgery and adjuvant hormonal treatment. Furthermore, women taking hormones at diagnosis have a better outcome when compared to women not taking hormonal treatment. Three out of 31 (9%) patients had a systematic lymphadenectomy whereas 3 out of 31 (9%) had a lymph node sampling. In one case, obvious nodal disease was encountered at presentation. Isolated retroperitoneal recurrence occurred in 1 out of 31 (3%) of all cases and in 1 out of 8 (13%) recurrences. This single woman later also developed lung and abdominal metastases. Leaving lymph nodes in situ does not appear to alter the clinical outcome of ESS. Although numbers are low, the retrospective data suggest that the need for surgical castration (BSO) in premenopausal women with early-stage disease should be discussed with the patient on an individual basis. The data support the current practice in some centres to administer adjuvant hormonal treatment.

show abstract

Section: Discussionmentioning

confidence: 52%

mentioning

confidence: 99%

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

et al. 2007

View full text Add to dashboard Cite

show abstract

“…These included tumour size, 10 11 tumour grade, 10 11 involvement of surgical margins by tumour, 11 patient age 12 and menopausal status, 11 flow cytometry criteria and chromosomal aberrations, [12][13][14][15] and tumour stage. [9][10][11][12] The role of some of these variables in predicting disease outcome has not been supported by other studies. 2 9 11 Matrix metalloproteinases (MMP), a family of zinc and calcium dependent enzymes, appear to play a central role in the process of basement membrane and extracellular matrix degradation involved in tumour invasion and metastasis.…”

mentioning

confidence: 94%

Expression of metalloproteinases endometrial stromal sarcoma: immunohistochemical study using image analysis.

et al. 1999

View full text Add to dashboard Cite

Aim-To investigate the expression of matrix metalloproteinases (MMP), a group of proteolytic enzymes with a central role in extracellular matrix invasion and degradation, in stromal sarcomas. Methods-11 endometrial stromal sarcomas (four low grade tumours, seven high grade) were stained for MMP-2, MMP-3, and MMP-9 using immunohistochemical stains. The surgical material consisted of nine hysterectomy specimens and two pelvic recurrences. Three hysterectomy specimens, removed for leiomyomas, were studied as controls. Staining area was evaluated using image analysis. Results-Age at the time of diagnosis ranged from 21 to 67 years. Four of the 11 patients (three with high grade tumours and one with a low grade tumour) died of the disease, six remained free of disease, and one was lost to follow up. Staining for MMP-2, MMP-3, and MMP-9 was more diVuse in high grade tumours than in low grade tumours and controls. Staining for MMP-3 and MMP-9 was more pronounced in high grade than in low grade tumours (p = 0.04; p = 0.05). Staining for MMP-9 was significantly greater in all stromal sarcomas than in controls (p < 0.001 for high grade tumours v controls; p < 0.01 for low grade tumours v controls). DiVuse staining for MMP-2, exceeding 90% of the tumour area, was observed in three of seven high grade tumours but in no low grade tumours. There was no apparent correlation between staining for any of the three enzymes and survival. Conclusions-Both low and high grade endometrial stromal tumours express matrix metalloproteinases. MMP-3 and MMP-9 are expressed more diVusely in high grade than in low grade tumours. In the individual case, diVuse staining for MMP-2 appears to best characterise the high grade tumours. Thus staining for MMP-2 may aid in diVerentiating high grade from low grade tumours, and MMP-9 in diVerentiating normal endometrial stroma from low and high grade endometrial stromal sarcomas. MMP expression does not appear to predict disease outcome in endometrial stromal sarcoma. (J Clin Pathol 1999;52:198-202)

show abstract

“…These tumors arise in the mesenchymal tissue that underlies the surface epithelium of the uterine cavity and surrounds endometrial glands formed by invaginations of the surface epithelium. Three major types of tumors derive from this tissue: endometrial stromal nodules (SNs), endometrial stromal sarcomas (ESSs), and undifferentiated uterine sarcomas (8)(9)(10). Whereas the latter tumor shows highly atypical cytological features, the other two tumors are both composed of cells that histologically resemble the cells of normal endometrial stroma during the proliferative phase of the menstrual cycle (8)(9)(10).…”

mentioning

confidence: 99%

“…Three major types of tumors derive from this tissue: endometrial stromal nodules (SNs), endometrial stromal sarcomas (ESSs), and undifferentiated uterine sarcomas (8)(9)(10). Whereas the latter tumor shows highly atypical cytological features, the other two tumors are both composed of cells that histologically resemble the cells of normal endometrial stroma during the proliferative phase of the menstrual cycle (8)(9)(10). The principal difference between these two tumors is that SNs do not show invasion of surrounding tissues within the uterus and are therefore considered benign.…”

mentioning

confidence: 99%

Effects of rearrangement and allelic exclusion of JJAZ1 / SUZ12 on cell proliferation and survival

Wang

et al. 2007

Proc. Natl. Acad. Sci. U.S.A.

View full text Add to dashboard Cite

Polycomb group genes (PcGs) have been implicated in cancer based on altered levels of expression observed in certain tumors and the behavior of cultured cells containing inserted PcG transgenes. Endometrial stromal tumors provide evidence for a direct causal relationship because they contain several chromosomal translocations and resultant gene fusions involving PcGs, the most common of which joins portions of the JAZF1 gene to the PcG JJAZ1/SUZ12. We show here that both benign and malignant forms of this tumor have the JAZF1-JJAZ1 fusion but only the malignant form also exhibits exclusion of the unrearranged JJAZ1 allele. To evaluate the effects of both the JJAZ1/SUZ12 fusion and allelic exclusion on functions related to cell growth, we studied HEK293 cells that were modified with respect to JJAZ1 expression. We found that the JAZF1-JJAZ1 fusion restored levels of the polycomb protein EZH2 and histone 3 lysine 27 trimethylation, which were reduced by knockdown of endogenous JJAZ1. At the same time, the presence of JAZF1-JJAZ1 markedly inhibited apoptosis and induced above normal proliferation rates, although the latter effect occurred only when normal JJAZ1 was suppressed. Our findings suggest a genetic pathway for progression of a benign precursor to a sarcoma involving increased cell survival associated with acquisition of a PcG rearrangement, followed by accelerated cellular proliferation upon allelic exclusion of the unrearranged copy of that gene. Furthermore, these results indicate the likely functional importance of allelic exclusion of genes disrupted by chromosomal translocations, as seen in a variety of other cancers.chromosomal translocation ͉ endometrial stromal tumor ͉ polycomb group gene ͉ chromatin remodeling ͉ apoptosis

show abstract

Primary Uterine Endometrial Stromal Neoplasms

Cited by 394 publications

References 0 publications

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Clinical study investigating the role of lymphadenectomy, surgical castration and adjuvant hormonal treatment in endometrial stromal sarcoma

Expression of metalloproteinases endometrial stromal sarcoma: immunohistochemical study using image analysis.

Effects of rearrangement and allelic exclusion of JJAZ1 / SUZ12 on cell proliferation and survival

Contact Info

Product

Resources

About