Carcinosarcoma of the cervix: Clinicopathological features of 17 tumors diagnosed at a Tertiary Cancer Referral Centre, India
ABSTRACT
Background and Objectives:
Carcinosarcoma of the uterine cervix is a rare entity. There are fewer reported series of this tumor. This study aims to evaluate clinico-pathological features of 17 carcinosarcomas primarily involving the cervix over a 14-year duration.
Materials and Methods:
This was a retrospective observational study conducted over the period of 14 years. Cases were critically evaluated and only tumors with the epicenter in the cervix were included.
Results:
Ten patients had cervical tumors; three had primary cervical masses, secondarily involving the lower uterine segment; 2 had cervicovaginal masses, and two patients had distinct tumors in the cervix and endometrium. Eight biopsies and 9 resections were evaluated. Patients with an age range of 44-68 years (median = 60), commonly presented with vaginal bleeding and whitish discharge and harbored a tumor with an average size ( n = 11) of 6.9 cm. The commonest gross appearance ( n = 9) was a polypoidal ulcerated tumor. Histopathologically, most common pattern included high-grade malignant glandular/epithelial and undifferentiated sarcomatous components. Two tumors morphologically revealed squamous differentiation; 4 exhibited chondromyxoid differentiation, while one each displayed rhabdomyoblastic, and osteosarcomatous differentiation. HPV-associated morphological features were seen in 13/17 tumors, in the carcinomatous components. Immunohistochemically, AE1/AE3 (12/12), EMA (7/7) and CK7 (3/3) highlighted epithelial components. Additionally, tumor cells expressed PAX8 (2/3), estrogen receptor (ER) (variable, 5/10), p53 (6/6, mutation-type), p16INK4a (diffuse, 4/5), SATB2 (1/1), GATA3 (1/1) and TTF1 (1/1) the latter 2 indicating mesonephric origin in one tumor. Desmin and myogenin positivity confirmed rhabdomyoblastic differentiation in one tumor. Therapeutically ( n = 14), 9 patients underwent surgery (TAH-BSO/radical hysterectomy, with adjuvant chemoradiotherapy (8/9) and 2 with neoadjuvant chemotherapy. Five (inoperable) underwent palliative chemoradiotherapy. During follow-up (7/17) (median = 8 months), one patient developed vault recurrence and two developed brain metastasis.
Conclusions:
All 7 patients in the study were alive with disease. Cervical carcinosarcoma is an uncommon tumor with a wide clinicopathological spectrum, invariably high-grade. Rare tumors exhibit a mesonephric type of differentiation. These tumors are associated with an aggressive clinical outcome.