여성생식기의 악성 혼합성 중배엽 종양의 임상적 고찰

Abstract

Objective : To perform a retrospective analysis of the clinical entities, the treatment modalities and the prognosis of malignant mixed mullerian tumor (MMMT) of the female genital tract. Methods : From March 1997 to October 2003, 10 patients with MMMT’s of the uterus, ovary and fallopian tube at the Department of Obstetrics and Gynecology, Yonsei University Medical Center were retrospectively reviewed for their demographic factors, past histories, the type of surgery, the stage of disease and the type of adjuvant therapy employed. Results : The group consisted of 8 MMMT’s of the uterus, 1 MMMT of the ovary and 1 MMMT of the fallopian tube. 1 patient with MMMT of the uterus had concurrent papillary serous cystadenocarcinoma of the ovary. The median age was 54.5 years. 7 patients were postmenopausal with a median menopausal period of 6 years. A history of previous pelvic irradiation was not documented in any patient. Vaginal bleeding was the most common presenting symptom (5/10) followed by low abdominal pain (2/10), menorrhagia (1/10), palpable mass (1/10) and the absence of symptoms (1/10). Type I or II hysterectomy with bilateral salpingo-oophorectomy and pelvic, para-aortic lymphadenectomy was performed in 9 patients and type I hysterectomy with right salpingo-oophorectomy was performed in 1 patient. 5 of the 8 uterine MMMT cases were allotted to stage I, 2 to stage III and 1 to stage IV. The MMMT of the ovary was stage II and the MMMT of the fallopian tube was stage I. Concurrent postoperative adjuvant chemo-radiotherapy was performed in 4 patients, chemotherapy alone in 4 patients, neoadjuvant as well as postoperative adjuvant chemotherapy in 1 patient and no adjuvant therapy in 1 patient. Of the 8 survivors, 7 survivors are disease-free with follow-up periods ranging from 6 to 66 months. Conclusion : The most important factor of patient survival seems to be the extent of the disease and when MMMT is confined to the primary organ, postoperative adjuvant chemoradiotherapy or chemotherapy is recommended with anticipations for a fairly good prognosis