The Experts below are selected from a list of 327 Experts worldwide ranked by ideXlab platform

Martha R Clarke - One of the best experts on this subject based on the ideXlab platform.

  • uterine malignant Mixed Mullerian Tumor in a patient on long term tamoxifen therapy for breast cancer
    Gynecologic Oncology, 1993
    Co-Authors: Martha R Clarke
    Abstract:

    Abstract A case of malignant Mixed Mullerian Tumor of the uterus, heterologous type, in an 83-year-old woman on tamoxifen (TAM) therapy for 9 years for breast cancer is presented. Benign endometrial polyps were diagnosed on endometrial curettings for postmenopausal bleeding after the patient had been on TAM for 5 years. Recurrent postmenopausal bleeding developed 4 years later. Endometrial curettings and hysterectomy revealed a 10-cm polypoid malignant Mixed Mullerian Tumor (MMMT) and endometrial polyps. There was no invasion of the myometrium or endocervix and no evidence of metastatic Tumor in 13 pelvic lymph nodes, peritoneal washings, or omentum. TAM has been associated with the development of endometrial polyps, hyperplasia, and adenocarcinoma possibly mediated through its agonistic estrogenic properties. Only one other case of MMMT arising in patients on TAM therapy has been previously reported, but may also be a consequence of the estrogenic effects of TAM therapy.

I D Miller - One of the best experts on this subject based on the ideXlab platform.

James Scurry - One of the best experts on this subject based on the ideXlab platform.

  • primary malignant Mixed Mullerian Tumor of the vagina
    Gynecologic Oncology, 1998
    Co-Authors: Deborah Neesham, Paul Kerdemelidis, James Scurry
    Abstract:

    A 74-year-old woman presented with postmenopausal bleeding. Examination showed a 5.5-cm ulcerated, partly necrotic vaginal polyp arising anteriorly near the hymenal ring. Histology showed a malignant Mixed Mullerian Tumor (MMMT) with squamous and glandular epithelial and undifferentiated spindle cell stromal components, cytological atypia, and frequent mitoses. The Tumor was closely associated with overlying vaginal intraepithelial neoplasia, grade III, from which it appeared to be arising. The patient was treated by surgical excision, followed by radiotherapy. Six months later, she developed a left supraclavicular lymph node metastasis. MMMT is a rare primary vaginal neoplasm, but, including this case, there have been at least 7 cases reported in the English language literature.

A De Barros Lopes - One of the best experts on this subject based on the ideXlab platform.

Brian T Wilson - One of the best experts on this subject based on the ideXlab platform.

  • uterine carcinosarcoma malignant Mixed Mullerian Tumor incidence is increased in women with breast cancer but independent of hormone therapy
    Journal of Gynecologic Oncology, 2015
    Co-Authors: Brian T Wilson, Heather J Cordell
    Abstract:

    Uterine carcinosarcoma/malignant Mixed Mullerian Tumor (UC/MMMT) is an uncommon and aggressive gynecological malignancy with poor prognosis. Tumors arise from monoclonal carcinoma cells derived from embryonal mesoderm, which exhibit sarcomatous metaplasia. UC/MMMT usually occurs in postmenopausal women and accounts for 2%-5% of all uterine malignancies [1,2]. The five-year survival rates are particularly poor (21%-39%). Several case reports and case series describe UC/MMMT occurring after tamoxifen therapy for breast cancer [3,4,5,6,7,8,9]. Retrospective studies suggest that the increased incidence of these high-risk malignancies is greater than the observed increase in incidence of endometrial Tumors generally following tamoxifen therapy [10,11,12,13], though the number of subjects with UC/MMMT in any of these studies is small. The increase in uterine cancers generally following tamoxifen therapy is thought to be driven by the estrogen receptor alpha (ERα) through a positive trophic effect on the uterine corpus. Although tamoxifen binds ERβ with equal affinity, there is no observed activation of this receptor [14,15]. Whether ER activation exerts any positive effect on UC/MMMTs remains equivocal. Other studies suggest that tamoxifen may upregulate expression of the HER2/neu oncogene in UC/MMMT cells [16,17], although any potential effect on the behavior of these malignancies is far from clear. As tamoxifen metabolites can covalently bind DNA, principally forming (E)- and (Z)-α-(deoxyguanosin-N2-yl)-4-hydroxytamoxifen adducts [18], the possibility that tamoxifen therapy is inherently carcinogenic has also been considered. However, tamoxifen-DNA adduct formation in uterine tissues following oral administration occurs at levels too low to be consistent with this being the mechanism driving such endometrial cancers [19]. We identified two unrelated women who developed UC/MMMT as a second primary malignancy following BRCA1-associated breast cancer. Neither of these women received hormone therapy, as their Tumors were histologically determined to be unresponsive to hormone therapy (i.e., ER-/progesterone receptor [PR]-). Patient 1 had BRCA1 c.5503C>T (p.Arg1835*), developed breast cancer at 36 years, which was managed with lumpectomy and local radiotherapy, and subsequently developed UC/MMMT at 48 years. Patient 2 had BRCA1 c.2560_2561dupGC (p.Gln855fs), developed breast cancer at 34 years, again treated with lumpectomy and local radiotherapy, and was found to have UC/MMMT at 56 years. Although BRCA1 mutation carriers are at increased risk of developing endometrial cancers compared to the general population, most of this risk is attributable to tamoxifen use [20]. It has also been suggested that BRCA1 mutations may predispose carriers to uterine papillary serous carcinoma specifically [21,22]. However, UC/MMMT is not recognized as part of the BRCA1 phenotype. Prompted by this unexpected finding, we conducted a retrospective population-based study to establish whether an association exists between breast cancer and UC/MMMT generally and whether a breast Tumor being ER-/PR- has any bearing on this.