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Carcinosarcoma of the uterus: a case report and review of the literature

  • E. Spaziani1
  • M. Picchio2,*,
  • V. Petrozza3
  • M. Briganti4
  • F. Ceci2
  • A. Di Filippo1
  • B. Sardella3
  • F. De Angelis1
  • C. Della Rocca3
  • F. Stagnitti1

1Medicine and Surgery, “A. Fiorini” Hospital, University of Rome “La Sapienza”, Polo Pontino, Italy

2A.S.L. Latina, Surgery Unit “A. Fiorini” Hospital, Terracina, Italy

3Department of Experimental Medicine, Medicine and Surgery, University of Rome “La Sapienza”, Polo Pontino, Italy

4A.S.L. Latina, Radiology Unit, “A. Fiorini” Hospital, Terracina, Italy

DOI: 10.12892/ejgo200805531 Vol.29,Issue 5,September 2008 pp.531-534

Published: 10 September 2008

*Corresponding Author(s): M. Picchio E-mail: marcellopicchio@libero.it

Abstract

Carcinosarcoma is a rare tumor of the uterus with a poor prognosis. We present a case of uterine carcinosarcoma in an 82-year-old woman who suffered from pervaginal bleeding for ten months duration with progressive anemia. Abdominopelvic nuclear magnetic resonance (NMR) imaging showed the presence of an intrauterine mass, infiltrating the myometrium and reaching the cervix. The patient was submitted to total abdominal hysterectomy with bilateral salpingo-oophorectomy. The carcinosarcoma, arising from the lumen of the uterus, infiltrated the inner one-third of the myometrial layer (pT1b, pNx, pMx; FIGO Stage 1B). A CT of the total body performed six months after surgery showed no signs of recurrent and/or metastatic tumor.

Keywords

Carcinosarcoma, Uterus

Cite and Share

E. Spaziani,M. Picchio,V. Petrozza,M. Briganti,F. Ceci,A. Di Filippo,B. Sardella,F. De Angelis,C. Della Rocca,F. Stagnitti. Carcinosarcoma of the uterus: a case report and review of the literature. European Journal of Gynaecological Oncology. 2008. 29(5);531-534.

References

[1] Chuang J.T., Van Velden D.J.J., Graham J.B.: “Carcinosarcoma and mixed mesodermal tumors of the uterine corpus”. Obstet. Gynaecol., 1970, 35, 769.

[2] Barwick K.W., LiVolsi V.A.: “Malignant mixed Mullerian tumors of the uterus. A clinicopathologic assessment of 34 cases”. Am. J. Surg. Pathol., l979, 3, 125.

[3] Williamson E.O., Christopherson W.M.: “Malignant mixed Mullerian tumours of the uterus”. Cancer, 1972, 29, 585.

[4] Issa A.A., Madanat F.F.: “Mixed mesodermal tumor in a four-year old girl”. Int. J. Gynecol. Pathol., 1986, 5, 371.

[5] Ali S.,Wells M.: “Mixed Mullerian tumours of the uterine corpus: a review”. Int. J. Gynecol. Cancer, 1993, 3, 1.

[6] Fortune D.W., Oster A.G.: “Mixed Mullerian tumours of the uterus”. In: Fox H. (ed.) Haines and Taylor Obstetrical and Gynaecological Pathology, Edinburgh: Churchill Livingstone, 1987, 457.

[7] Macasaet M.A., Waxman M., Fructer R.G., Boyce J., Hong P., Nicastri A.D. et al.: “Prognostic factors in malignant mesodermal (Mullerian) mixed tumors of the uterus”. Gynecol. Oncol., 1985, 20, 32.

[8] Marchese M.J., Liskow A.S., Crum C.P., McCaffrey R.M., Frick H.C.: “Uterine sarcomas: a clinicopathologic study, 1965-1981”. Gynecol. Oncol., 1984, 18, 229.

[9] Gallup D.G., Gable D.S., Talledo O.K., Otken L.B. Jr.: “A clinical- pathologic study of mixed Mullerian tumors of the uterus over a 16 year period - The Medical College of Georgia experience”. Am. J. Obstet. Gynecol., 1989, 161, 533.

[10] Sternberg W.H., Clark W.H., Smith R.C.: “Malignant mixed Mullerian tumour (mixed mesodermal tumour of the uterus). A study of 21 cases”. Cancer, 1954, 7, 704.

[11] Zelmanowicz A., Hildesheim A., Sherman M.E., Sturgeon S.R., Kurman R.J., Barrett R.J. et al.: “Evidence for a common etiology for endometrial carcinomas and malignat mixed Mullerian tumors”. Gynecol. Oncol., 1998, 69, 253.

[12] Schwartz S.M.,Weiss N.S., Daling J.R., Gammon M.D., Liff J.M., Watt J. et al.: “Exogenous sex hormone use, correlates of endogenous hormone levels and the incidence of histologic types of sarcoma of the uterus”. Cancer, 1996, 77, 717.

[13] McCluggage W.G., Abdulkadir M., Price J.H., Kelehan P., Hamilton S., Beattie J. et al.: “Uterine carcinosarcomas in patients receiving tamoxifen therapy. A report of 19 cases”. Int. J. Gynecol. Cancer, 2000, 37, 285.

[14] McCluggage W.G., McManus D.T., Lioe T.F., Hill C.M.: “Uterine carcinosarcoma in association with tamoxifen therapy”. Br. J. Obstet. Gynecol., 1997, 104, 748.

[15] Fotiou S., Hatjieleftheriou G., Kyrousis G., Kokka F., Apostolikas N.: “Long-term tamoxifen treatment. A possible aetiological factor in the development of uterine carcinosarcoma: two case reports”. Anticancer Res., 2000, 20, 2015.

[16] Treilleux I., Mignotte H., Clement-Chassagne C., Guastalla P., Bailly C.: “Tamoxifen and malignant epithelial-nonepithelial tumors of the endometrium: report of six cases and review of the literaute”. Eur. J. Surg. Oncol., 1999, 25, 477.

[17] Friedrich M., Villena-Hensen C., Mink D., Bonkhoff H., Schmidt W.: “Carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer”. Eur. J. Surg. Obstet. Gynecol., 1999, 82, 85.

[18] Evans M.J., Langlois N.E.I., Kitchener H.C., Miller I.D.: “Is there any association between long-term tamoxifen treatment and the development of carcinosarcoma (malignant mixed Mullerian tumor) of the uterus?”. Int. J. Gynecol. Cancer, 1995, 5, 310.

[19] Villena-Heinsen C., Diesing D., Fischer D., Griesinger G., Maas N., Diedrich K., Friedrich M.: “Carcinosarcomas - a retrospective analysis on 21 patients”. Anticancer Res., 2006, 26, 4817.

[20] Masterson J.F., Kremper J.: “Mixed mesodermal tumors”. Am. J. Obstet. Gynaecol., 1969, 104, 693.

[21] Dinh T.V., Salvin R.E., Bhagavan B.S., Hannigan E.V., Tiamson E.M.,Yandell R.B.: “Mixed Mullerian tumors of the uterus: a clinicopathologic study”. Obstet. Gynecol., 1989, 74, 388.

[22] Boram L.H., Erlandson R.A., Hajdu S.I.: “Mesodermal mixed tumor of the uterus. A cytologic, histologic and electron microscopic correlation”. Cancer, 1972, 30, 1295.

[23] Piver M.S., Lurain J.R.: “Uterine sarcomas: Clinical features and management”. In: Coppleson M. (ed.). Gynecologic Oncology. Fundamental Principles and Clinical Practice. Edinburgh: Churchill Livingstone, 1981, 608.

[24] Norris H.J., Roth E., Taylor H.B.: “Mesenchymal tumors of the uterus II. A clinical and pathologic study of 31 mixed mesodermal tumors”. Obstet. Gynaecol., 1966, 28, 57.

[25] Krupp P.J. Jr., Sternberg W.H., Clark W.H., St. Romain M.J. Jr, Smith R.C.: “Malignant mixed Mullerian neoplasms (mixed mesodermal tumors)”. Am. J. Obstet. Gynecol., 1961, 81, 959.

[26] Larson B., Silfversward C., Nilsson B., Pettersson F.: “Mixed Mullerian tumors of the uterus - Prognostic factors: a clinical and histopathologic study of 147 cases”. Radioth. Oncol., 1990, 17, 123.

[27] Salazar O.M., Bonfiglio T.A., Pattern S.F., Keller B.E., Feldstein M., Dunne M.E. et al.: “Uterine sarcomas. Natural history treatment and prognosis”. Cancer, 1978, 42, 1152.

[28] Peters W.A. III, Kumar N.B., Fleming W.P., Morley G.W.: “Prognostic features of sarcomas and mixed tumors of the endometrium”. Obstet. Gynecol., 1984, 63, 550.

[29] Nielson S.N., Podrate K.C., Scheithauer B.W., O Brien C.O.: “Clinicopathologic analysis of uterine malignant mixed Mullerian tumors”. Gynecol. Oncol., 1989, 34, 372.

[30] Wheelock J.B., Krebs H.B., Schneider V., Goplerud D.R.: “Uterine sarcoma: analysis of prognostic variables in 71 cases”. Am. J. Obstet. Gynecol., 1985, 151, 1016.

[31] Spanos W.J., Wharton J.T., Gomez L., Fletcher G.H., Oswald M.J.: “Malignant mixed Mullerian tumors of the uterus”. Cancer, 1984, 53, 311.

[32] George E., Lillemoe T.J., Twiggs L.B., Perrone T.: “Malignant mixed mullerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival”. Int. J. Gynecol. Pathol., 1995, 14, 39.

[33] Arrastia C.D., Fruchter R.G., Clark M., Maiman M., Remy J.C., Macasaet M. et al.: “Uterine carcinosarcomas: incidence and trends in management and survival”. Gynecol. Oncol., 1997, 65, 158.

[34] Major F.J., Blessing J.A., Silverberg S.G., Morrow C.P., Creasman W.T., Currie J.L. et al.: “Prognostic factors in early-stage uterine sarcoma: a Gynecologic Oncology Group study”. Cancer, 1993, 71, 1702.

[35] Yamada S.D., Burger R.A., Brewster W.R., Anton D., Kohler M.F., Monk B.J.: “Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus”. Cancer, 2000, 88, 2782.

[36] Podzaski E.S., Woomert C.A., Stevens C.W. Jr., Manetta A., Larson J.E., Zaino R.J. et al.: “Management of malignant, mixed, mesodermal tumors of the uterus”. Gynecol. Oncol., 1989, 32, 240.

[37] Sartori E., Bazzurini L., Galducci A., Landoni F., Lissoni A. Maggino T. et al.: “Carcinosarcoma of the uterus: a clinicopathologic multicenter CTF study”. Gynecol. Oncol., 1997, 67, 70.

[38] King M.E., Kramer E.E.: “Malignant Mullerian mixed tumors of the uterus”. Cancer, 1980, 45, 188.

[39] Lotocki R., Rosenshein N.B., Grumbine F., Dillon M., Parmley T., Woodruff J.D.: “Mixed Mullerian tumours of the uterus, clinical and pathologic correlation”. Int. J. Gynaecol. Obstet., 1982, 20, 237.

[40] Perez C.A., Askin F., Baglan R.J., Kao M.S., Kraus F.T., Perez B.M. et al.: “Effects of irradiation on mixed Mullerian tumors of the uterus”. Cancer, 1979, 43, 1274.

[41] Hayes D.: “Mixed Mullerian tumor of the corpus uteri”. J. Obstet. Gynecol. Br. Comm., 1974, 81, 160.

[42] Marchese M.J., Liskow A.S., Crum C.P., McCaffrey R.M., Frick H.C.: “Uterine sarcomas: a clinicopathologic study, 1965-1981”. Gynecol. Oncol., 1984, 18, 229.

[43] Silverberg S.G., Major F.J., Blessing J.A., Fetter B., Askin F.B., Liao S.Y. et al.: “Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases”. Int. J. Gynecol. Pathol., 1990, 9, 1.

[44] Kempson R.L., Bari W.: “Uterine sarcomas. Classification diagnosis and prognosis”. Human Pathology, 1970, 1, 331.

[45] Vongtama V., Karten J.R., Piver S.M., Tsukada Y., Moore R.H.: “Treatment, results and prognostic factors in Stage I and II sarcomas of the corpus uteri”. Am. J. Roentgenol., 1976, 126, 139.

[46] Temkin S.M., Hellemann M., Lee Y.C., Abulafi O.: “Early-stage carcinosarcoma of the uterus: the significance of lymph node count”. Int. J. Gynecol. Cancer, 2007, 17, 215.

[47] Nordal R.R., Kristensen G.B., Stenwig A.E., Nesland J.M., Pettersen E.O., Trope C.G.: “An evaluation of prognostic factors in uterine carcinosarcoma”. Gynecol. Oncol., 1997, 67, 316.

[48] Screenan J.J., Hart W.R.: “Carcinosarcomas of the female genital tract. A pathologic study of 29 metastatic tumors: further evidence for the dominant role of the epithelial component and the conversion theory of histogenesis”. Am. J. Surg. Pathol., 1995, 19, 666.

[49] Bitterman P., Chun B., Kurman R.J.: “The significance of epithelial differentiation in mixed mesodermal tumors of the uterus”. Am. J. Surg. Pathol., 1990, 14, 317.

[50] George E., Manivel J.C., Dehner L.P., Wick M.R.: “Malignant mixed Mullerian tumors. An immunohistochemical study of 47 cases, with histogenetic considerations and clinical correlation”. Hum. Pathol., 1991, 22, 215.

[51] Mayall F., Rutty K., Campbell F., Goddard H.: “p53 immunostaining suggests that uterine carcinosarcomas are monoclonal”. Histopathology, 1994, 24, 211.

[52] Szukala S.A., Marks J.R., Burchette J.L., Elbendary A.A., Krigman H.R.: “Coexpression of p53 by epithelial and stromal elements in carcinosarcoma of the female genital tract: an immunohistocemical study of 19 cases”. Int. J. Gynecol. Cancer, 1999, 9, 131.

[53] Emoto M., Iawasaka H., Ishiguro M., Kikuchi M., Horiuchi S., Saito T. et al.: “Angiogenesis in carcinosarcoma of the uterus: differences in the microvessel density and expression of vascular endothelial growth factor between the epithelial and mesenchymal elements”. Hum. Pathol., 1999, 30, 1232.

[54] Nictoina P.A., Ferlazzo G., Vincelli A.M.: “Proliferation indeces and p53 immunocytochemistry in uterine mixed mullerian tumors”. Histol. Histopathol., 1997, 12, 967.

[55] Yoshida Y., Kurokawa T., Fukuno N., Nishikawa Y., Kamitani N., Kotsuji F.: “Markers of apoptosis and angiogenesis indicate that carcinomatous components play an important role in the malignant behavior of uterine carcinosarcoma”. Hum. Pathol., 2000, 31, 1448.

[56] McCluggage W.G.: “Uterine carcinosarcomas (malignant mixed mullerian tumors) are metaplastic carcinomas”. Int. J. Gynecol. Cancer, 2002, 12, 687.

[57] Manfredi R., Mirk P., Maresca G., Margariti P.A., Testa A., Zannoni G.F. et al.: “Local-regional staging of endometrial carcinoma: role of MR imaging in surgical planning”. Radiology, 2004, 231, 372.

[58] Amant F., Cadron I., Fuso L., Berteloot P., de Jonge E., Jacomen G. et al.: “Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer”. Gynecol. Oncol., 2005, 98, 274

[59] Sutton G., Kauderer J., Carson L., Lentz S.S., Whitney C.W., Gallion H.: “Adjuvant ifosomide and cisplatin in patients with completely resected Stage I or II carcinosarcomas (mixed mesodermal tumors) of the uterus: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2005, 96, 630.

[60] Wolfson A.H., Brady M.F., Mannel S., Lee Y., Futoran J., Cohn D. et al.: “A Gynecologic Oncology Group randomized trial of whole abdominal irradiation (WAI) vs cisplatin-ifosfamide+mesna (CIM) in optimally debulked Stage I-IV carcinosarcoma (CS) of the uterus”. Proc. Am. Soc. Clin. Oncol., 2006, 24, 256s.

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