Ovarian and Uterine Carcinosarcomas

Garg, Gunjan; Shah, Jay P.; Kumar, Sanjeev; Bryant, Christopher S.; Munkarah, Adnan; Morris, Robert T.

doi:10.1111/igc.0b013e3181dc8292

Cited by 80 publications

(86 citation statements)

References 27 publications

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“…Bilateral salpingo-oophorectomy (BSO) may be considered, depending on menopausal status. Ovaries may be preserved in young patients with tumors confined to the uterus [2,11,12]. Intraperitoneal morcellation of uLMS is associated with poorer prognosis; endoscopic supracervical hysterectomy or tumor enucleation and morcellation should be avoided [13,14].…”

Section: Surgical Therapymentioning

confidence: 99%

“…Norwegian data show a 5-year overall survival (OAS) no better than 51% even in stage I tumors and 25% in stage II [17]. Only early-stage tumors (IA) seem have a more favorable prognosis, with an OAS of 76.6% [12], whereas stage IB tumors are significantly worse with an OAS of 48.4%. Prognostic factors are age, tumor stage, and tumor size.…”

Section: Prognosismentioning

confidence: 99%

“…OAS will decrease depending on tumor size: < 5 cm (76.6%), 5-10 cm (52.9%) and > 10 cm (41.9%). Involvement of the uterine cervix will reduce OAS to 28.5 vs. 55.3% without cervical involvement [12]. Additional prognostic factors under discussion are free margins, mitotic score, and vessel invasion [18].…”

Section: Prognosismentioning

confidence: 99%

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Uterine Leiomyosarcoma

et al. 2018

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Uterine leiomyosarcoma (uLMS) is a rare entity among malignant gynecologic tumors with a very unfavorable prognosis and the highest prevalence in the pre- and peri-menopause. Only early-stage tumors have an acceptable prognosis, provided the patient has been treated without injuring the uterus. uLMS is often diagnosed accidentally and the correct diagnosis ishampered by equivocal features similar to the far more frequent benign uterine fibroids. Surgery is the basis of therapy, and it should be done in order to remove the uterus intact. As vaginal, abdominal, and endoscopic surgery - possibly including morcellation - are the methods of choice for the treatment of uterine fibroids, pre-operatively undiagnosed leiomyosarcoma detected by pathologic examination will have a worsened prognosis. Systemic treatment and radiotherapy are of no proven value in the adjuvant setting. Thus, there is strong need for a reliable pre-operative risk score for leiomyosarcoma in order to justify diagnostic means beyond clinical routine and to choose the correct surgical pathway. The clinical problems in the diagnosis of leiomyosarcoma and treatment are exemplified by a case report of a 30-year-old childless patient. Diagnostic tools as well as treatment options in adjuvant and palliative situations are reviewed.

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Section: Surgical Therapymentioning

confidence: 99%

Section: Prognosismentioning

confidence: 99%

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Uterine Leiomyosarcoma

et al. 2018

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“…5,7,15 Patients with primary ovarian MMMTs are typically older than those with pure ovarian epithelial carcinomas. 5,7,15 The vast majority of patients with primary ovarian MMMTs present at advanced stage. Currently, surgical debulking and postoperative chemotherapy remain the standard treatment for primary ovarian MMMTs.…”

mentioning

confidence: 99%

“…Currently, surgical debulking and postoperative chemotherapy remain the standard treatment for primary ovarian MMMTs. 5,15 Although there have been a few studies on the prognostic significance of various histopathologic features in primary ovarian MMMTs, because of the relative rarity of ovarian MMMTs, most prior studies have had small sample sizes. 1,[3][4][5][6][7][8][9][10][11]16,17,20,22,23,25,28,30 MMMTs contain both carcinomatous components (CC) and sarcomatous components (SC).…”

mentioning

confidence: 99%

Presence of a Sarcomatous Component Outside the Ovary Is an Adverse Prognostic Factor for Primary Ovarian Malignant Mixed Mesodermal/Mullerian Tumors

Kunkel

Peng

et al. 2012

American Journal of Surgical Pathology

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Primary ovarian malignant mixed mesodermal tumors are uncommon. There exist few data in the literature on the significance of the sarcomatous component (SC) in these tumors. Here we investigated this aspect in 47 such tumors, with particular interest in whether the presence of SC outside the ovary confers a worse prognosis. We correlated various features of the SC (homologous vs. heterologous, type of heterologous SC, extent/percentage, mitotic count, necrosis, whether or not SC is present outside the ovary) with disease-specific survival (DSS) using the Kaplan-Meier method and log-rank test. We also correlated other clinicopathologic parameters with DSS: age, stage, tumor size, tumor laterality, type of the carcinomatous component (CC), lymph node status, vascular invasion, and degree of surgical debulking. The mean age was 69.0 years (range, 43 to 89 y). The tumor was located in the left and right ovary in 18 and 24 patients, respectively (laterality could not be determined in 5 cases). The mean tumor size was 13.6 cm. Surgical debulking was optimal in 28, suboptimal in 6, and unclear in 13 patients. FIGO stage was I in 1 patient, II in 5 patients, III in 40 (IIIA in 1, IIIB in 11, IIIC in 28), and IV in 1 patient. Node metastasis and vascular invasion were noted in 6/17 and 29/47 patients, respectively. The mean percentage of SC was 29% (median 20%; range, 1% to 90%). The SC was heterologous in 34 (72%) and homologous in 13 (28%) patients. The mitotic figures per 10 HPF in SC were 33 (0 to 128). Tumor necrosis was present in 45/47 cases (mean 10%; range, 1% to 40%, only in CC in 14, only in SC in 2, in both SC and CC in 29). The CC was high-grade serous in 27 patients, endometrioid in 2, mixed high-grade serous and endometrioid in 17, and mixed high-grade serous and clear cell carcinoma in 1 patient. The extraovarian tumor contained only CC in 17 cases, only SC in 1 case, and both SC and CC in 28 cases. The median follow-up was 29 months (range, 1 to 183 mo): 6 patients were lost to follow-up, 3 died postoperatively, 29 died from disease, 2 died from other causes, and 7 were still alive (14 to 183 mo). The DSS rate at 1, 2, and 5 years was 75%, 56%, and 21%, respectively. Presence of SC outside the ovary was a significant adverse prognostic factor (P=0.03), whereas other parameters were not. After adjusting for FIGO stage, presence of SC outside the ovary was still a significant adverse prognosticator for stage III patients (P=0.003), whereas others were not. Therefore, our findings showed that presence of SC outside the ovary was a significant adverse prognostic factor. We advocate listing the specific extraovarian tumor component (SC and/or CC) in the pathology report for primary ovarian malignant mixed mesodermal tumors.

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