Uterine Carcinosarcomas: Clinical, Histopathologic and Immunohistochemical Characteristics

Abstract

Carcinosarcomas (malignant mixed Müllerian tumors or MMMT) are rare malignant tumors in the female genital tract composed of both malignant epithelial and malignant mesenchymal components. They comprise <5% of all neoplasms in the gynecologic tract and have an aggressive clinical course. The purpose of this study is to evaluate the immunophenotype and possible histogenesis of carcinosarcomas of the uterus. Sixty-two cases of uterine carcinosarcomas diagnosed between 1995 and 2011 were retrieved from the gynecologic pathology files at Columbia University Medical Center. Representative tissue blocks containing both epithelial and mesenchymal components were selected from each case for histologic and immunohistochemical studies. Clinical data from each case were retrieved. The epithelial component was poorly differentiated adenocarcinoma in the majority (80.7%) of cases; in 17.7%, the carcinoma was moderately differentiated, and in only 1.6% the carcinoma was well differentiated. 53% of the tumors had homologous stromal elements and 47% displayed heterologous stromal elements. Immunohistochemical study revealed almost equal staining in both epithelial and mesenchymal components of carcinosarcomas for p16 and p53. PAX8 positivity was noted in 73% of epithelial components, but only 13% of stromal components, and PAX8 stromal positivity was never seen in the absence of PAX8 epithelial positivity. Expression of p16, p53, and PAX8 in both malignant components lends support to the monoclonal theory of uterine carcinosarcoma tumorigenesis. The roles of these tumor markers in the diagnosis and pathogenesis of this tumor and associations between clinical characteristics, tumor pathologic features, and prognosis are discussed.

The Effect of Fucoidan, a Potential New, Natural, Anti-Neoplastic Agent on Uterine Sarcomas and Carcinosarcoma Cell Lines: ENITEC Collaborative Study

“…The fact of dualistic nature of carcinosarcomas (Chen et al 2017) combined with revealed in this research fucoidan influence on cell viability, apoptosis as well as cell cycle arrest in carcinosarcoma cell lines may suggest fucoidan’s potential activity against endometrial cancer cells.…”

Corded and Hyalinized and Spindled Endometrioid Endometrial Carcinoma

“…6 CSs are composed of high-grade carcinomatous and sarcomatous elements often with a sharp demarcation between the 2. Heterologous elements most commonly rhabdomyosarcoma, but also chondrosarcoma, osteosarcoma, or rarely liposarcoma may be identified, 35,36 whereas CHEC/ECS lack malignant heterologous components although osseous metaplasia is enigmatically common in CHEC. 3,4 The key morphologic features that favor a diagnosis of CHEC or ECS over CS include conventional EC merging with the corded and hyalinized and spindle cell components, both typically lacking high-grade cytologic atypia.…”

Fbxw7 is a driver of uterine carcinosarcoma by promoting epithelial-mesenchymal transition

“…The mesenchymal component can be “homologous” with types of differentiation native to the uterus, such as smooth muscle or endometrial stroma. Remarkably, however, the mesenchymal component is conspicuously “heterologous” in half of cases, exhibiting, for example, obvious cartilaginous or osseous differentiation (chondrosarcoma or osteosarcoma) (5).…”