Mixed mullerian tumor: Difference between revisions

Jump to navigation Jump to search
← Older editNewer edit →
VisualWikitext
Maria Villarreal (talk | contribs)
CMEUser, nocaptcha, nukepages, Administrators
7,149 edits
Maria Villarreal (talk | contribs)
CMEUser, nocaptcha, nukepages, Administrators
7,149 edits
No edit summary
Line 3: Line 3:
{{CMG}} {{AE}} {{MV}}
{{CMG}} {{AE}} {{MV}}
   
   
{{SK}} Mixed Müllerian tumor; MMMT; Malignant mixed Müllerian tumor
{{SK}} Mixed Müllerian tumor; MMMT; Malignant mixed Müllerian tumor; Carcinosarcoma of the uterus; Sarcomatoid carcinoma of the uterus; Malignant mesodermal mixed tumor; Metaplastic carcinoma
 
==Overview==
==Overview==
'''Mixed Mullerian tumor''' (MMMT) is a rare [[uterine sarcoma]] or carcinosarcoma.


==Historical Perspective==
==Historical Perspective==
*[Disease name] was first discovered by [scientist name], a [nationality + occupation], in [year] during/following [event].
*Mixed Mullerian tumor was first described by Ferriera and colleagues in 1951.<ref name="pmid16051326">{{cite journal |vauthors=Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK |title=Cervical sarcomas: an analysis of incidence and outcome |journal=Gynecol. Oncol. |volume=99 |issue=2 |pages=348–51 |year=2005 |pmid=16051326 |doi=10.1016/j.ygyno.2005.06.021 |url=}}</ref>
*In [year], [gene] mutations were first identified in the pathogenesis of [disease name].
*In [year], the first [discovery] was developed by [scientist] to treat/diagnose [disease name].
   
   
==Classification==
==Classification==
*[Disease name] may be classified according to [classification method] into [number] subtypes/groups:
*Mixed Mullerian tumors are normally composed of both carcinomatous (epithelial) and sarcomatous (mesodermal) components.
:*[group1]
*Mixed Mullerian tumor may be classified according to pathology findings into 2 types:  
:*[group2]
'''Epitheloid subtype'''
:*[group3]
:*Endometroid adenocarcinoma (most common)
*Other variants of [disease name] include [disease subtype 1], [disease subtype 2], and [disease subtype 3].
:*Clear cell carcinoma
:*Mucinous carcinoma
:*Papillary-serous carcinoma
'''Sarcomatoid subtype'''
:*Undifferentiated sarcoma
:*Rhabdomyosarcoma
 
*Mixed Mullerian tumor may also be classified according to antomical location into 7 types:
:*Uterine corpus
:*Cervix
:*Ovaries
:*Fallopian tubes
:*Vagina
:*Peritoneum
:*Extragenital sites
 
==Pathophysiology==
==Pathophysiology==
*The pathogenesis of [disease name] is characterized by [feature1], [feature2], and [feature3].
*The pathogenesis of mixed Mullerian tumor is characterized by  
*The [gene name] gene/Mutation in [gene name] has been associated with the development of [disease name], involving the [molecular pathway] pathway.
*Mixed Mullerian tumor
*On gross pathology, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On gross pathology, a large cervical mass is a characteristic finding of mixed Mullerian tumor.
*On microscopic histopathological analysis, [feature1], [feature2], and [feature3] are characteristic findings of [disease name].
*On microscopic histopathological analysis, high-grade stromal sarcoma, poorly differentiated epithelial cells, and angiolymphatic invasion are characteristic findings of mixed Mullerian tumor.
   
   
==Causes==
==Causes==
* [Disease name] may be caused by either [cause1], [cause2], or [cause3].
* Mixed Mullerian tumor may be caused by precursor lesions, such as
* [Disease name] is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
* Mixed Mullerian tumor is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
* There are no established causes for [disease name].
* There are no established causes for mixed Mullerian tumor.
   
   
==Differentiating [disease name] from other Diseases==
==Differentiating mixed Mullerian tumor from other Diseases==
*[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as:
 
:*[Differential dx1]
*Mixed Mullerian tumor must be differentiated from other diseases that cause abnormal vaginal bleeding, abdominal pain, and metrorrhagia, such as:
:*[Differential dx2]
:*Uterine leiomyosarcoma
:*[Differential dx3]
:*Adenocarcinoma of the uterus
:*Endometrial cancer
   
   
==Epidemiology and Demographics==
==Epidemiology and Demographics==
* The prevalence of [disease name] is approximately [number or range] per 100,000 individuals worldwide.
* The prevalence of mixed Mullerian tumor is approximately [number or range] per 100,000 individuals worldwide.
* In [year], the incidence of [disease name] was estimated to be [number or range] cases per 100,000 individuals in [location].
* In [year], the incidence of mixed Mullerian tumor was estimated to be [number or range] cases per 100,000 individuals in [location].
   
   
===Age===
===Age===
*Patients of all age groups may develop [disease name].
*The median age at diagnosis of Mixed Mullerian tumor is 66 years
*Mixed Mullerian tumor is more commonly observed among patients aged between 50 and 60 years old.
*[Disease name] is more commonly observed among patients aged [age range] years old.
*Mixed Mullerian tumor is more commonly observed among postmenopausal women
*[Disease name] is more commonly observed among [elderly patients/young patients/children].
===Gender===
*[Disease name] affects men and women equally.
*[Gender 1] are more commonly affected with [disease name] than [gender 2].
* The [gender 1] to [Gender 2] ratio is approximately [number > 1] to 1.
   
   
===Race===
===Race===
*There is no racial predilection for [disease name].
*There is no racial predilection for mixed Mullerian tumor.
*[Disease name] usually affects individuals of the [race 1] race.
*[Race 2] individuals are less likely to develop [disease name].
   
   
==Risk Factors==
==Risk Factors==
*Common risk factors in the development of [disease name] are [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*Common risk factors in the development of mixed Mullerian tumor are exposure to radiation, excessive estrogen exposure, obesity, and nulliparity.<ref name="pmid20642852">{{cite journal |vauthors=Kanthan R, Senger JL, Diudea D |title=Malignant mixed Mullerian tumors of the uterus: histopathological evaluation of cell cycle and apoptotic regulatory proteins |journal=World J Surg Oncol |volume=8 |issue= |pages=60 |year=2010 |pmid=20642852 |pmc=2913917 |doi=10.1186/1477-7819-8-60 |url=}}</ref>
   
   
== Natural History, Complications and Prognosis==
== Natural History, Complications and Prognosis==
*The majority of patients with [disease name] remain asymptomatic for [duration/years].
*Early clinical features include postmenopausal vaginal bleeding, abdominal pain, and metrorrhagia.
*Early clinical features include [manifestation 1], [manifestation 2], and [manifestation 3].
*If left untreated, the majority of patients with mixed Mullerian tumor may progress quickly to develop lymph node invasion, metastasis, and death.  
*If left untreated, [#%] of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].
*Common complications of mixed Mullerian tumor include  
*Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
*Prognosis is generally poor, and the 5-year survival rate of patients with Mixed Mullerian tumor is approximately 33% to 39%.
*Prognosis is generally poor, and the 5-year survival rate of patients with Mixed Mullerian tumor is approximately 33% to 39%.
*Findings associated with good prognosis includes p16 and Mcl-1 genetic expression.


== Diagnosis ==
== Diagnosis ==
===Diagnostic Criteria===
===Diagnostic Criteria===
*The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met:
*The diagnosis of mixed Mullerian tumor is made with biopsy.
:*[criterion 1]
*Biopsy findings of mixed Mullerian tumor, include:
:*[criterion 2]
:*Tumor with carcinomatous and sarcoma-like elements
:*[criterion 3]
:*Angiolymphatic invasion
:*[criterion 4]
 
=== Symptoms ===
=== Symptoms ===
*[Disease name] is usually asymptomatic.
*Mixed Mullerian tumor is usually asymptomatic.
*Symptoms of [disease name] may include the following:
*Symptoms of mixed Mullerian tumor may include the following:<ref name="pmid20642852">{{cite journal |vauthors=Kanthan R, Senger JL, Diudea D |title=Malignant mixed Mullerian tumors of the uterus: histopathological evaluation of cell cycle and apoptotic regulatory proteins |journal=World J Surg Oncol |volume=8 |issue= |pages=60 |year=2010 |pmid=20642852 |pmc=2913917 |doi=10.1186/1477-7819-8-60 |url=}}</ref>
:*[symptom 1]
*Early symptoms may include:  
:*[symptom 2]
:* Abnormal [[vaginal bleeding]], abnormal menstrual periods
:*[symptom 3]
:* [[Metrorrhagia]] in premenopausal women
:*[symptom 4]
:* Postmenopausal [[vaginal bleeding]] <ref name="pmid22513918">{{cite journal| author=Kong A, Johnson N, Kitchener HC, Lawrie TA| title=Adjuvant radiotherapy for stage I endometrial cancer. | journal=Cochrane Database Syst Rev | year= 2012 | volume= 4 | issue=  | pages= CD003916 | pmid=22513918 | doi=10.1002/14651858.CD003916.pub4 | pmc=PMC4164955 | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=22513918  }} </ref>
:*[symptom 5]
:* Postcoital bleeding
:*[symptom 6]
*Advanced symptoms may include:
:* [[Polyuria]] and [[dysuria]], If a tumor places pressure on the bladder or urethra
:* [[Pelvic pain]] and [[dyspareunia]]
:* [[Fatigue]] and unexplained [[weight loss]]
 
=== Physical Examination ===
=== Physical Examination ===
*Patients with [disease name] usually appear [general appearance].
*Patients with mixed Mullerian tumor may have a normal appearance.
*Physical examination may be remarkable for:
*Pelvic examination may be remarkable for:
:*[finding 1]
:*Vaginal bleeding
:*[finding 2]
:*Enlarged uterus (advanced stage)
:*[finding 3]
 
:*[finding 4]
:*[finding 5]
:*[finding 6]
=== Laboratory Findings ===
=== Laboratory Findings ===
*There are no specific laboratory findings associated with [disease name].
*There are no specific laboratory findings associated with mixed Mullerian tumor.


*A  [positive/negative] [test name] is diagnostic of [disease name].
*An [elevated/reduced] concentration of [serum/blood/urinary/CSF/other] [lab test] is diagnostic of [disease name].
*Other laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
===Imaging Findings===
===Imaging Findings===
*There are no [imaging study] findings associated with [disease name].
*Enhanced CT scan and MRI is the imaging modalities of choice for mixed Mullerian tumor.
*On MRI, findings of mixed Mullerian tumor, may include: 
*[Imaging study 1] is the imaging modality of choice for [disease name].
:*T1: predominantly isointense to both myometrium (75%) and endometrium (70%)
*On [imaging study 1], [disease name] is characterized by [finding 1], [finding 2], and [finding 3].
:*T2:hyper-intense to myometrium (90%) either hypo-intense (55%) or isointense (41%) to endometrium.  
*[Imaging study 2] may demonstrate [finding 1], [finding 2], and [finding 3].
*On enhanced CT, findings of mixed Mullerian tumor, may include: 
:*Heterogeneously hypodense and ill defined mass
:*Dilatation of uterine cavity
   
   
=== Other Diagnostic Studies ===
=== Other Diagnostic Studies ===
*[Disease name] may also be diagnosed using [diagnostic study name].
*Mixed Mullerian tumor may also be diagnosed using laparoscopy.  
*Findings on [diagnostic study name] include [finding 1], [finding 2], and [finding 3].
   
   
== Treatment ==
== Treatment ==
=== Medical Therapy ===
=== Medical Therapy ===
*There is no treatment for [disease name]; the mainstay of therapy is supportive care.
*There is no treatment for mixed Mullerian tumor; the mainstay of therapy is supportive care.
*The medical management for mixed Mullerian tumor, include:
*The mainstay of therapy for [disease name] is [medical therapy 1] and [medical therapy 2].
*[Medical therapy 1] acts by [mechanism of action1].
*Response to [medical therapy 1] can be monitored with [test/physical finding/imaging] every [frequency/duration].
   
   
=== Surgery ===
=== Surgery ===
*Surgery is the mainstay of therapy for [disease name].
*Surgery is the mainstay of therapy for mixed Mullerian tumor.
*[Surgical procedure] in conjunction with [chemotherapy/radiation] is the most common approach to the treatment of [disease name].
*Total hysterectomy in conjunction with surgical staging is the most common approach to the treatment of mixed Mullerian tumor.
*[Surgical procedure] can only be performed for patients with [disease stage] [disease name].
*Different surgical procedures for the treatment of  mixed Mullerian tumor, include:
:*Total hysterectomy
:*Bilateral salpingo-oophorectomy
:*Pelvic and para-aortic lymph node dissection
:*Cytology of peritoneal washings
:*Omentectomy
:*Biopsies of peritoneal surfaces
   
   
=== Prevention ===
=== Prevention ===
*There are no primary preventive measures available for [disease name].
*There are no primary preventive measures available for mixed Mullerian tumor.
*Once diagnosed and successfully treated, patients with mixed Mullerian tumor are followed-up every 6 or 12 months.
*Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
*Follow-up testing include pelvic examination, ultrasound, and biomarker monitorization.  
 
*Once diagnosed and successfully treated, patients with [disease name] are followed-up every [duration]. Follow-up testing includes [test 1], [test 2], and [test 3].  


==References==
==References==

Revision as of 19:19, 5 April 2016

WikiDoc Resources for Mixed mullerian tumor

Articles

Most recent articles on Mixed mullerian tumor

Most cited articles on Mixed mullerian tumor

Review articles on Mixed mullerian tumor

Articles on Mixed mullerian tumor in N Eng J Med, Lancet, BMJ

Media

Powerpoint slides on Mixed mullerian tumor

Images of Mixed mullerian tumor

Photos of Mixed mullerian tumor

Podcasts & MP3s on Mixed mullerian tumor

Videos on Mixed mullerian tumor

Evidence Based Medicine

Cochrane Collaboration on Mixed mullerian tumor

Bandolier on Mixed mullerian tumor

TRIP on Mixed mullerian tumor

Clinical Trials

Ongoing Trials on Mixed mullerian tumor at Clinical Trials.gov

Trial results on Mixed mullerian tumor

Clinical Trials on Mixed mullerian tumor at Google

Guidelines / Policies / Govt

US National Guidelines Clearinghouse on Mixed mullerian tumor

NICE Guidance on Mixed mullerian tumor

NHS PRODIGY Guidance

FDA on Mixed mullerian tumor

CDC on Mixed mullerian tumor

Books

Books on Mixed mullerian tumor

News

Mixed mullerian tumor in the news

Be alerted to news on Mixed mullerian tumor

News trends on Mixed mullerian tumor

Commentary

Blogs on Mixed mullerian tumor

Definitions

Definitions of Mixed mullerian tumor

Patient Resources / Community

Patient resources on Mixed mullerian tumor

Discussion groups on Mixed mullerian tumor

Patient Handouts on Mixed mullerian tumor

Directions to Hospitals Treating Mixed mullerian tumor

Risk calculators and risk factors for Mixed mullerian tumor

Healthcare Provider Resources

Symptoms of Mixed mullerian tumor

Causes & Risk Factors for Mixed mullerian tumor

Diagnostic studies for Mixed mullerian tumor

Treatment of Mixed mullerian tumor

Continuing Medical Education (CME)

CME Programs on Mixed mullerian tumor

International

Mixed mullerian tumor en Espanol

Mixed mullerian tumor en Francais

Business

Mixed mullerian tumor in the Marketplace

Patents on Mixed mullerian tumor

Experimental / Informatics

List of terms related to Mixed mullerian tumor

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Maria Fernanda Villarreal, M.D. [2]

Synonyms and keywords: Mixed Müllerian tumor; MMMT; Malignant mixed Müllerian tumor; Carcinosarcoma of the uterus; Sarcomatoid carcinoma of the uterus; Malignant mesodermal mixed tumor; Metaplastic carcinoma

Overview

Mixed Mullerian tumor (MMMT) is a rare uterine sarcoma or carcinosarcoma.

Historical Perspective

  • Mixed Mullerian tumor was first described by Ferriera and colleagues in 1951.[1]

Classification

  • Mixed Mullerian tumors are normally composed of both carcinomatous (epithelial) and sarcomatous (mesodermal) components.
  • Mixed Mullerian tumor may be classified according to pathology findings into 2 types:

Epitheloid subtype

  • Endometroid adenocarcinoma (most common)
  • Clear cell carcinoma
  • Mucinous carcinoma
  • Papillary-serous carcinoma

Sarcomatoid subtype

  • Undifferentiated sarcoma
  • Rhabdomyosarcoma
  • Mixed Mullerian tumor may also be classified according to antomical location into 7 types:
  • Uterine corpus
  • Cervix
  • Ovaries
  • Fallopian tubes
  • Vagina
  • Peritoneum
  • Extragenital sites

Pathophysiology

  • The pathogenesis of mixed Mullerian tumor is characterized by
  • Mixed Mullerian tumor
  • On gross pathology, a large cervical mass is a characteristic finding of mixed Mullerian tumor.
  • On microscopic histopathological analysis, high-grade stromal sarcoma, poorly differentiated epithelial cells, and angiolymphatic invasion are characteristic findings of mixed Mullerian tumor.

Causes

  • Mixed Mullerian tumor may be caused by precursor lesions, such as
  • Mixed Mullerian tumor is caused by a mutation in the [gene1], [gene2], or [gene3] gene[s].
  • There are no established causes for mixed Mullerian tumor.

Differentiating mixed Mullerian tumor from other Diseases

  • Mixed Mullerian tumor must be differentiated from other diseases that cause abnormal vaginal bleeding, abdominal pain, and metrorrhagia, such as:
  • Uterine leiomyosarcoma
  • Adenocarcinoma of the uterus
  • Endometrial cancer

Epidemiology and Demographics

  • The prevalence of mixed Mullerian tumor is approximately [number or range] per 100,000 individuals worldwide.
  • In [year], the incidence of mixed Mullerian tumor was estimated to be [number or range] cases per 100,000 individuals in [location].

Age

  • The median age at diagnosis of Mixed Mullerian tumor is 66 years
  • Mixed Mullerian tumor is more commonly observed among patients aged between 50 and 60 years old.
  • Mixed Mullerian tumor is more commonly observed among postmenopausal women

Race

  • There is no racial predilection for mixed Mullerian tumor.

Risk Factors

  • Common risk factors in the development of mixed Mullerian tumor are exposure to radiation, excessive estrogen exposure, obesity, and nulliparity.[2]

Natural History, Complications and Prognosis

  • Early clinical features include postmenopausal vaginal bleeding, abdominal pain, and metrorrhagia.
  • If left untreated, the majority of patients with mixed Mullerian tumor may progress quickly to develop lymph node invasion, metastasis, and death.
  • Common complications of mixed Mullerian tumor include
  • Prognosis is generally poor, and the 5-year survival rate of patients with Mixed Mullerian tumor is approximately 33% to 39%.
  • Findings associated with good prognosis includes p16 and Mcl-1 genetic expression.

Diagnosis

Diagnostic Criteria

  • The diagnosis of mixed Mullerian tumor is made with biopsy.
  • Biopsy findings of mixed Mullerian tumor, include:
  • Tumor with carcinomatous and sarcoma-like elements
  • Angiolymphatic invasion

Symptoms

  • Mixed Mullerian tumor is usually asymptomatic.
  • Symptoms of mixed Mullerian tumor may include the following:[2]
  • Early symptoms may include:
  • Advanced symptoms may include:

Physical Examination

  • Patients with mixed Mullerian tumor may have a normal appearance.
  • Pelvic examination may be remarkable for:
  • Vaginal bleeding
  • Enlarged uterus (advanced stage)

Laboratory Findings

  • There are no specific laboratory findings associated with mixed Mullerian tumor.

Imaging Findings

  • Enhanced CT scan and MRI is the imaging modalities of choice for mixed Mullerian tumor.
  • On MRI, findings of mixed Mullerian tumor, may include:
  • T1: predominantly isointense to both myometrium (75%) and endometrium (70%)
  • T2:hyper-intense to myometrium (90%) either hypo-intense (55%) or isointense (41%) to endometrium.
  • On enhanced CT, findings of mixed Mullerian tumor, may include:
  • Heterogeneously hypodense and ill defined mass
  • Dilatation of uterine cavity

Other Diagnostic Studies

  • Mixed Mullerian tumor may also be diagnosed using laparoscopy.

Treatment

Medical Therapy

  • There is no treatment for mixed Mullerian tumor; the mainstay of therapy is supportive care.
  • The medical management for mixed Mullerian tumor, include:

Surgery

  • Surgery is the mainstay of therapy for mixed Mullerian tumor.
  • Total hysterectomy in conjunction with surgical staging is the most common approach to the treatment of mixed Mullerian tumor.
  • Different surgical procedures for the treatment of mixed Mullerian tumor, include:
  • Total hysterectomy
  • Bilateral salpingo-oophorectomy
  • Pelvic and para-aortic lymph node dissection
  • Cytology of peritoneal washings
  • Omentectomy
  • Biopsies of peritoneal surfaces

Prevention

  • There are no primary preventive measures available for mixed Mullerian tumor.
  • Once diagnosed and successfully treated, patients with mixed Mullerian tumor are followed-up every 6 or 12 months.
  • Follow-up testing include pelvic examination, ultrasound, and biomarker monitorization.

References

  1. ↑ Wright JD, Rosenblum K, Huettner PC, Mutch DG, Rader JS, Powell MA, Gibb RK (2005). "Cervical sarcomas: an analysis of incidence and outcome". Gynecol. Oncol. 99 (2): 348–51. doi:10.1016/j.ygyno.2005.06.021. PMID 16051326.
  2. ↑ 2.0 2.1 Kanthan R, Senger JL, Diudea D (2010). "Malignant mixed Mullerian tumors of the uterus: histopathological evaluation of cell cycle and apoptotic regulatory proteins". World J Surg Oncol. 8: 60. doi:10.1186/1477-7819-8-60. PMC 2913917. PMID 20642852.
  3. ↑ Kong A, Johnson N, Kitchener HC, Lawrie TA (2012). "Adjuvant radiotherapy for stage I endometrial cancer". Cochrane Database Syst Rev. 4: CD003916. doi:10.1002/14651858.CD003916.pub4. PMC 4164955. PMID 22513918.
Retrieved from "https://www.wikidoc.org/index.php?title=Mixed_mullerian_tumor&oldid=1229352"