Response of recurrent uterine high-grade malignant mixed mullerian tumor to letrozole

Abstract

Uterine malignant mixed müllerian tumor (MMMT) is a rare malignancy occurring most often in postmenopausal women. Despite the use of multimodality treatments including surgery, chemotherapy, and radiotherapy, prognosis is still poor in most cases. We report the case of a 69-year-old woman with recurrent metastatic high-grade MMMT that responded to letrozole, an aromatase inhibitor. At the initial diagnosis of high-grade uterine MMMT in February 2001, the patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy, and postoperative pelvic radiotherapy. Two years later, an asymptomatic retroperitoneal mass was discovered on surveillance abdominal computed tomography scanning. The 3.5- x 3.0-cm mass was considered inoperable owing to its location near the aorta at the level of the renal vessels. The patient declined radiation or chemotherapy. Treatment with letrozole was begun at 2.5 mg daily. Serial computed tomography scans demonstrated marked tumor shrinkage; after 11 months of letrozole therapy, the tumor had shrunk to less than 25% of its original volume. Further study of letrozole for high-grade uterine MMMT is warranted.

Disruption of estrogen homeostasis as a mechanism for uterine toxicity in Wistar Han rats treated with tetrabromobisphenol A

“…Atypical hyperplasia and carcinomas in the endometrium may be associated with elevated estrogen concentrations in humans (Lax, 2004). Further, malignant mixed Mullerian tumors in the myometrium may also arise from estrogen exposure and correlate with dysregulation of the cell cycle and apoptosis (Kanthan et al, 2010; Wang et al, 2005). A measurement of changes in estrogen concentrations in rat uterus was not technologically feasible for this short-term TBBPA exposure.…”

Metachronous small bowel metastasis from a mixed Müllerian mesodermal tumour

“…[6][7][8] Risk factors for MMMT include radiation, excessive oestrogen exposure, obesity and nulliparity. 9,10 The only risk factor in our case was obesity although the patient's history of previous breast cancer may implicate oestrogen exposure. The two-year survival rate for stage I disease is 53%, which decreases to 8.5% in stages II and III.…”

Malignant Mixed Mullerian Tumor of the Uterus– A Complication of Tamoxifen Therapy for Breast Carcinoma

“…Endometroid adenocarcinoma is the most common epithelial component but other variations such as clear cell, mucinous and papillary-serous also occur. The mesodermal component is most commonly undifferentiated sarcoma in homologous tumours and rhabdomyosarcoma in heterologous tumours 4 .…”

“…Two-year survival rates have been reported as 53% in stage I (confined to uterine corpus) and 8.5% in stages II (cervical metastases) and III (pelvic metastases), with none reported in Stage IV 7 . Number of researchers have worked to elucidate the etiopathogenesis of MMMT's and have found that exposure to radiation, excessive estrogen, obesity, and nulliparity 3,4 are believed to be associated with its development. Use of tamoxifen in the treatment of breast carcinoma has also been associated with an increased incidence of uterine sarcoma.…”

“…While it is presumed that MMMTs arise from pre-existing carcinomas, little is known about its etiopathogenesis. Exposure to radiation and excessive estrogen, obesity and nulliparity 3,4 are believed to be associated with their development. Use of tamoxifen in the treatment of breast carcinoma has also been associated with uterine sarcoma.…”