Clinicopathological Characteristics of Endometrial Carcinosarcomas: A Single-Center Experience

Abstract

Endometrial carcinosarcoma (ECS) is epidemiologically and clinically similar to endometrial adenocarcinoma and is considered an aggressive variant. Considered as carcinomas with sarcomatous and carcinomatous components, these tumors are rare, with a very poor prognosis. The definitive diagnosis of ECS is based on histopathological examination. Here, we aimed to share the clinicopathological characteristics of histopathologically diagnosed ECS cases. We analyzed 26 materials diagnosed with ECS after necessary histopathological examinations that were sent to our department as total abdominal hysterectomy in the last 7 years. The histological carcinoma component was serous carcinoma in 14 cases and endometrioid adenocarcinoma in 12. The histological sarcoma component was endometrial stromal sarcoma in 16 cases, fibrosarcoma in 2, leiomyosarcoma in 2, and chondrosarcoma in 6. According to FIGO staging, 10 of the cases were stage IA, 2 was stage IB, 2 was stage IIIA, 10 were stage IIIC2, and 2 was stage IVB. According to pTNM pathological staging, 10 of the cases were pT1a, 6 were pT1b, 4 were pT3a, 4 were pT3b, and 2 was pT4. Since the sarcomatous component of ECS is unlikely to metastasize, the prognosis is believed to be shaped by the characteristics of the epithelial component. Consistent with the literature, we found all lymph node and distant organ metastases to be consisted of carcinomatous components. Currently, there is no typical laboratory finding or specific imaging for the definitive diagnosis of ECS, so it is based solely on histopathological examination. Accordingly, both FIGO and pTNM staging can be performed following histopathological examination by the appropriate procedure.

Keywords

• Endometrial carcinosarcoma
• Malignant mixed mullerian tumor
• Histopathology

References

1. 1. Hosh M, Antar S, Nazzal A, Warda M, Gibreel A, Refky B. Uterine sarcoma: analysis of 13,089 cases based on surveillance, epidemiology, and end results database. International Journal of Gynecologic Cancer. 2016;26(6).
2. 2. Amant F, Moerman P, Neven P, Timmerman D, Van Limbergen E, Vergote I. Endometrial cancer. The Lancet. 2005;366(9484):491-505.
3. 3. McCluggage W. Uterine carcinosarcomas (malignant mixed mullerian tumors) are metaplastic carcinomas. International Journal of Gynecologic Cancer. 2002;12(6).
4. 4. Akahira J-i, Tokunaga H, Toyoshima M, et al. Prognoses and prognostic factors of carcinosarcoma, endometrial stromal sarcoma and uterine leiomyosarcoma: a comparison with uterine endometrial adenocarcinoma. Oncology. 2006;71(5-6):333-40.
5. 5. El-Nashar SA, Mariani A. Uterine carcinosarcoma. Clinical obstetrics and gynecology. 2011;54(2):292-304.
6. 6. Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ. Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. International Journal of Radiation Oncology Biology Physics. 2004;58(3):786-96.
7. 7. Tanaka YO, Tsunoda H, Minami R, Yoshikawa H, Minami M. Carcinosarcoma of the uterus: MR findings. Journal of Magnetic Resonance Imaging: An Official Journal of the International Society for Magnetic Resonance in Medicine. 2008;28(2):434-9.
8. 8. Huang GS, Chiu LG, Gebb JS, et al. Serum CA125 predicts extrauterine disease and survival in uterine carcinosarcoma. Gynecologic oncology. 2007;107(3):513-7.

9. 9. Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer. 2003;98(1):176-86.
10. 10. Bosquet JG, Terstriep SA, Cliby WA, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecologic oncology. 2010;116(3):419-23.
11. 11. Prat J. FIGO staging for uterine sarcomas. International Journal of Gynecology & Obstetrics. 2009;104(3):177-8.
12. 12. Kalluri R, Weinberg RA. The basics of epithelial-mesenchymal transition. The Journal of clinical investigation. 2009;119(6):1420-8.
13. 13. Horn L, Dallacker M, Bilek K. Carcinosarcomas (malignant mixed mullerian tumors) of the uterus. Morphology, pathogenetic aspects and prognostic factors. Der Pathologe. 2009;30(4):292-301.
14. 14. Artioli G, Wabersich J, Ludwig K, Gardiman MP, Borgato L, Garbin F. Rare uterine cancer: carcinosarcomas. Review from histology to treatment. Critical reviews in oncology/hematology. 2015;94(1):98-104.
15. 15. Edge SB, Edge SB. AJCC Cancer Staging Manual 8th Ed: Springer; 2017.
16. 16. Amant F, Mirza MR, Koskas M, Creutzberg CL. Cancer of the corpus uteri. International Journal of Gynecology & Obstetrics. 2018;143:37-50.
17. 17. Temkin S, Hellmann M, Lee Y-C, Abulafia O. Early-stage carcinosarcoma of the uterus: the significance of lymph node count. International Journal of Gynecologic Cancer. 2007;17(1).
18. 18. Sreenan JJ, Hart WR. 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. The American journal of surgical pathology. 1995;19(6):666-74.
19. 19. Sagae S, Yamashita K, Ishioka S, et al. Preoperative diagnosis and treatment results in 106 patients with uterine sarcoma in Hokkaido, Japan. Oncology. 2004;67(1):33-9.