Poster
# 97
Poster |
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6th Internet World Congress for Biomedical Sciences |
Alberto Pizarro Gallardo(1)
(1)Facultad de Medicina U.A.N. - Tepic. Mexico
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 [Obstetrics & Gynecology] |
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[Oncology] |
[Pathology] |
Uterine sarcomas comprise less than 1 % of gynecologic malignancies nd 2-5 % of all uterine malignancies.(1-2)
The term “ Müllerian Adenosarcoma of the uterus” (MAU) was defined in 1974 by Clement and Scully (3).
The tumor arise primarily of the Müllerian mesodermal tissue from endometrial epithelium.
MAU usually occurs in older women, and vaginal bleeding in the most common presenting complaint. The lesion grows as a polypoid mass within the endometrial cavity, and composed of histologically benign glands within a sarcomatous stroma. (3-10)
These tumors generally have a low grade of malignancy in contrast to the other more aggresive uterine sarcomas and are often followed by local recurrence, but only rarely by metastases.
One etiologic risk factor is prior pelvic radiation.
MAU tumors are classified into homologous and heterologous tumors, depending on the characteristics of the mesenchymal elements. While mesenchymal elements are composed of nonspecific spindle-shaped sarcomatous cells in the homologous tumors; sarcomatous cells show special differentiation such as cartilage, osteoid and striated muscle in the heterologous tumors. (10)
The ultrastructure of MAU is : The epithelial cells in the glands are lined by simple o stratified columnar cells. The cytoplasm contained numerous mitochondria, glycogen, rough endoplasmic reticulum (rer), Golgu apparatus. Nucleoli are prominent, desmosomes are abundant, microvilli were numerous. Cilia and basal lamina in all cases. (10-13)
Mesenchymal cells. The cells were moderately pleomorphic and spindle shaped separated by bundles of irregularly arrenged collagen. The cells was fusiform nuclei and prominent often multiple, nucleoli, cellular cytoplasm was scanty. Cilia and microvilli is absent. Basal lamina is absent.
a. Immature stromal cells have cytoplasm scanty, with few mitochondrias and scattered rough endoplasmic reticulum (rer), the nucleus tended to be round or oval with little chromatin clumping.
b. Mature stromal cells have abundant cytoplasm, with prominent rer, and a well developed, Golgi apparatus, mitochondria present. Cytoplasm projections resembling pseudopods, and often containing large lipid inclussions.. The nuclei were irregular in shaped often with prominent lobulations.
Our objetives were to identify the ultrastructural differentiation between epithelial and sarcomatous cells of MAU.
In this report, we describe the ultrastructural features of seven MAU.
We identified seven cases in three hospital : Centro Médico La Raza IMSS (México DF) 2 cases, Hospital Oncología Centro Médico Nacional IMSS (México DF) 4 cases and Clínica hospital Dr. Aquiles Calles (Tepic Nayarit) one case. Our researched the records of patients. Material from all seven cases was received unfixed. Tissue for examination by light microscopy was fixed in 10 % neutral buffered formalin embedded in paraffin, and stained with hematoxilin and eosin. Material for electron microscopy was obteined fresh and were fixed in phosphate buffered 5 % glutaraldehyde, postfixed in 1% osmium tetroxide and dehydrated in graded alcohols, embebbed in Epon-araldite 812. One micron thick sections stained with toluidine blue were used to select appropiated areas for study ultrathin sections were stained with uranyl acetate and lead citrate and examed in a Philips EM-300 Trasmission electron microscope.
The variables of study were : type of cell (epithelial or stromal), type of gland( simple or irregular),type of epithelium( simple or stratified) type of nuclei(round, fusiform or irregular), number of nucleoli, giant cell( yes or not) rugous endoplasmic reticulum(yes o not), Golgi apparatus (yes or not) inclussions(yes or not) micovilli (yes or not) cilia (yes or not) index nuclei-cytoplasm (0.01-0.9), collagen(yes or not) basal lamina(yes o not) convoluted nuclei (yes or not). All dates were captured in basedates Access 97 and analysed in Excell 97 and Epiinfo 6.04.
All the patients were postmenopausal, they had irregular vaginal bleeding. Uterine enlargement was found in five patients and a mass was noted protruding from the endocervical canal in two; and never had been receiving strogen a radiation therapy. The patients were nuliparous and multiparous.
The AMU were composed of a mixture of histologically benign glands within a sarcomatous stroma. The most of the glands resembled endocervical epithelium or early prolifferative endometrium. (Fig1)
The stroma was hypercellular and composed of interwoven bundles of oval to spindle cells with hyperchromatic, often bizarre nuclei and prominent nucleoli. (fig2) Mitotic figures were atipical between 10 to 32 10 high power field (400x)
A. Epithelial cells. (24 cells)
The epithelium lining the gland was flat to cuboidal, with few foci of cellular stratification and minimal nuclear plemorphism. Many of the lining cells had a clear cytoplasm with an eccentrically nucleus suggestive of secretory activity. (Fig 3) Mitoses were not seen. The cells with abundant glycogen. The gland cells with microvilli in 92.3 %. The nuclei are fusiform, irregular and oval. In cytoplasm there are abundant RER in 95.2 %, golgi apparatus in 41 % the index nucleus-cytoplasm was 0.52, Cilia 40 % basal lamina in all cases. (Fig 4)
B. Mesenchymal cells. (30 cells)
The cells were moderately pleomorphic and spindle shaped separated by bundles of irregularly arrenged collagen. (Fig6) The cells was fusiform irregular and oval nuclei and prominent often multiple, nucleoli,(Fig5) index nuclei-cytoplasm means 0.58. No mitochondria means 8.6, rer means 7.2 and Golgi apparatus 6% Cilia and microvilli and basal lamina were absent.
Our identified 9 immature cells and 21 mature cells.
Six patient had homologous element and one heterologous element.
There was not transition between epithelium and stroma were observed. And there was not squamous metaplasia.
The MAU are rare biphasic neoplasm with two component benign glands and malignant stroma.
AMU tumors was separated from the othes uterine sarcomas because of its unique histologic features and its less agressive clinical behavior.
All cases of MAU tumors were in postmenopausal women with vaginal bleeding, five with enlargement of uterus and two with polyp in cervix. All arose within the endometrium and containedsix cases homologous stromal elements and one case heterologous element with cartilage.
Our studied 54 cells, 24 were epitelial and 30 mesenchymatous cells. There were differences in the epithelial and stromal cells on : form of cells, index nuclei- cytoplasm, Golgi apparatus, microvilli, cilia, inclusions, basal lamina.
The malignant stromal cells were 21 mature cells and 9 immature cells. One patient preseted heterologous elements with cartilage tissue in the MAU
The MAU is a biphasic malignant neoplasm with benign glands and malignant stromal cells.
The MAU have better prognosis in comparative with others malignant neoplasm of uterus.
In ultrastructure is easy the differentiation between epithelial y stromal cells.
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[Obstetrics & Gynecology] |
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[Oncology] |
[Pathology] |
