British Journal of Obstetrics and Gymecology November 1978. Vol85. pp 872-875

MIXED MESODERMAL TUMOUR OF THE CERVIX UTERI CASE REPORT BY

C. K. DAS,Senior Lecturer and Consultant Department of Obstetrics and Gynaecology Ahmadu Bello University Teaching Hospital, Kaduna, Nigeria AND

N. S . NIRODI, Lecturer Department of Pathology, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria Summary A 44-year-old African female with a mixed mesodermal tumour of the cervix is described and the literature briefly reviewed.

SARCOMAS of the cervix are extremely rare, the least rare being the mixed mesodermal tumour (Simpson, 1943). The mixed mesodermal tumour of the cervix resembles the corresponding tumour of the corpus but has a lower age incidence. Recently Ober (1959) divided uterine sarcomas into five subgroups : leiomyosarcoma, mixed mesodermal tumour, blood vessel sarcoma, unclassified sarcomas and metastatic sarcomas. Ober and Tovell (1959) further subdivided mixed mesodermal tumours into four groups: pure (composed of one cell type), mixed (composed of more than one cell type), homologous (containing uterine tissue elements) or heterologous (containing elements foreign to the uterus).

not enlarged. Vaginal examination showed a large, irregular, friable, polypoid and haemorrhagic growth arising from the cervix uteri. The uterus was not enlarged. Intravenous pyelography showed no abnormality except for slight dilatation of the left ureter. A biopsy of the growth was taken and histological examination showed a mixed mesodermal tumour. A week later the patient had a total hysterectomy and bilateral salpingooophorectomy. Her postoperative recovery was uneventful and the patient is now well.

PATHOLOGY The biopsy of the tumour showed a mixed mesodermal tumour with mesenchyme-like tissue (Fig. 1) within islands of cartilage and procartilage (Fig. 2). The operation specimen showed a large, irregular, haemorrhagic, polypoid neoplasm on the cervix (Fig. 3). The endometrium tubes and ovaries were normal. Further histological examination of the polyp confirmed the earlier diagnosis but the tumour was found to contain smooth muscle (Fig. 4) and epithelial components (Fig. 5).

CASEREPORT A 44-year-old African woman was admitted on 13th December, 1977, to the Ahmadu Bello University Hospital, Kaduna, Nigeria, with a history of heavy vaginal bleeding for three months. She also complained of anorexia and loss of weight but had no urinary or bowel symptoms. The menstrual history was normal. On examination the patient looked ill. There was no oedema, jaundice or peripheral lymphadenopathy. The liver and spleen were

DISCUSSION Sarcoma of the uterus is said to account for 872

MIXED MESODERMAL TUMOUR OF CERVIX

873

FIG.1 Area of mesenchyme-like tissue (H & E ~400).

FIG.2 Area of malignant cartilage cells in mixed mesodermal tumour (H & E x 100).

approximately 1 . 8 to 2.6 per cent of all uterine malignancies (Horlyck and Petri, 1964). Lack of agreement about classifications makes the incidence of different types of sarcoma difficult to ascertain. Our patient had a mixed mesodermal tumour

of the heterologous type. The presence of cartilage or striated muscle is said to be characteristic of a mixed mesodermal tumour of the heterologous type. In an analysis of 22 mixed mesodermal tumours of the cervix, Simpson (1943) noted cartilage in 17, striated

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DAS AND NIRODI

FIG.3 Uterus with the large, polypoid tumour arising from the cervix.

FIG.4 Smooth muscle component of tumour and the surrounding mesenchyme-like tissue (H & E X400).

MIXED MESODERMAL TUMOUR OF CERVIX

FIG.5 Two glands with some heaping up of epithelium surrounded by the mesenchyme-like tissue (H & E x 100).

muscle in 10, and both striated muscle and cartilage in 5. Osteoid tissue has been observed twice. Ackerman and Rosai (1974) considered the admixture of carcinomatous and sarcomatous elements to be an essential diagnostic feature. Malignant mixed mesodermal tumours are easily separated from teratomas by the absence of skin appendages, glia, and thyroid (Clark et al, 1952). They should also be clearly separated from botryoid rhabdomyosarcoma (sarcoma botryoides), a tumour of childhood arising from the cervix or vagina and lacking a carcinomatous component. Lymphatic and blood borne metastases are common. Kempson and Bari (1970) believe that extension of the tumour to the serosa of the uterus or beyond at the time of surgery carries a poor prognosis.

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Unlike Chuang et al (1970), Kempson and Bari (1970) and Norris and Taylor (1966), believe that homologous mesodermal tumours carry a better prognosis than do heterologous mixed mesodermal tumours. The presence of cartilage is said to be associated with a better prognosis, the reverse being true for the presence of skeletal muscle. It is thought that the mixed mesodermal sarcoma originates from Mullerian stroma. Response to radiotherapy and chemotherapy have been uniformly poor. The treatment of choice would appear to be total abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy. REFERENCES Ackerman, L. V., and Rosai, J. (1974): Surgical Pathology, 5th edition. The C. V. Mosby Company, St Louis. Chuang, J. T., and Van Velden, D. J. J. (1970): Obstetrics and Gynecology, 35, 1970. Clark, W. H. Jr., and Sternberg, W. H. (1952): American Journal of Pathology, 28,563. Horlyck, E., and Petri, C. (1964): Acta obstetriciu et gynecologica Scandinavica, 43, 279. Kempson, R. L., and Bari, W. (1970): Human Pathology, 1, 331. Norris, H. J., and Taylor, H. B. (1966): Cancer, 19,1459. Ober, W. B. (1959): Annals of the New York Academy of Sciences, 15, 568. Ober, W. B., and Tovell, H. M. M. (1959): American Journal of Obstetrics and Gynecology, 77,246. Simpson, E. E. (1943): Archives ofPathology, 35, 535.

Mixed mesodermal tumour of the cervix uteri. Case report.

British Journal of Obstetrics and Gymecology November 1978. Vol85. pp 872-875 MIXED MESODERMAL TUMOUR OF THE CERVIX UTERI CASE REPORT BY C. K. DAS,S...
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