Primary ovarian malignant mixed mullerian tumors / carcinosarcomas: a clinico-pathological and immunohistochemical analysis of four cases and review of literature
Keywords:
Primary, ovary, carcinosarcomas, malignant mixed mullerian, immunohistochemistryAbstract
Ovarian carcinosarcomas (OCS), also known as malignant mixed mullerian tumors (MMMTs) are among the rarest and most challenging malignancies arising from the female genital tract. This tumor is estimated to account for only 1-3% of all ovarian malignancies. The influence of proportion of the malignant epithelial or sarcomatous component on the disease progression is a matter of debate. Herein, we analysed clinico-pathological and immunohistochemical features of four cases of ovarian carcinosarcomas diagnosed over a period of seven years from 2008-2014. All the patients were post-menopausal with a mean age of 59.25 years. Carcinomatous component was high grade serous in three cases and high grade endometroid in one case. CK and EMA immunostains were used to highlight carcinomatous component while vimetin immunostain highlighted sarcomatous areas. Two patients had heterlogous sarcomatous components; rhabdomyosarcomatous and chondromatous areas which were highlighted by Myogenin, desmin and S-100 respectively. Immunohistochemistry is an essential ancillary technique in highlighting biphasic nature and areas of heterologous differentiation which may have a prognostic impact. The patients were treated with optimal debulking surgery followed by adjuvant platinum/taxane or platinum/ifosfamide combinations based chemotherapy.
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26. Cantrell LE, Van Le L. Carcinosarcoma of the ovary: a review. Obstet Gynecol Sur 2009;64:673-80.
2. Harris MA, Delap LM, Sengupta PS, Wilkinson PM, Welch RS, Swindell R, Shanks JH, et al. Carcinosarcoma of the ovary. Br J Cancer 2003;88(5):654-657.
3. del Carmen MG, Birrer M, Schorge JO. Carcinosarcoma of the ovary: a review of the literarture. Gynecol oncol 2012;125:271-277.
4. McCluggage WG. Malignant biphasic uterine tumours: carcinosarcomas or metaplastic carcinomas? J Clin Pathol 2002;55(5):321-325.
5. Brown E, Stewart M, Rye T, Al-Nafussi A, Williams AR, Bradburn M, Smyth J, et al. Carcinosarcoma of the ovary: 19 years of prospective data from a single center. Cancer 2004;100(10):2148-2153.
6. Chang J, Sharpe JC, A’Hern RP, Fisher C, Blake P, Shepherd J, Gore ME. Carcinosarcoma of the ovary: incidence, prognosis, treatment and survival of patients. Ann Oncol 1995;6(8):755-758.
7. Muntz HG, Jones MA, Goff BA, Fuller AF, Jr., Nikrui N, Rice LW, Tarraza HM. Malignant mixed mullerian tumors of the ovary: experience with surgical cytoreduction and combination chemotherapy. Cancer 1995;76(7):1209-1213.
8. Guarino M, Giordano F, Palloti F, Polizzotti G, Tricomi P, et al. Malignant mixed mullerian tumor of the uterus. Features favoring its origin from a common clone and epithelial-to-mesenchymal transformation mechanism of histogenesis. Tumori 1998;84:391-397.
9. Reed N, Millan D, Verheijen R, Castiglione M. ESMO Guideline Working Group. Non-epithelial ovarian cancer: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 2010;21Suppl 5:v31-6.
10. Morrow CP, D'ablaing G, Brady LW, Blessing JA & Hreshchyshyn MM. A clinical and pathologic study of 30 cases of malignant mixed mullerian epithelial and mesenchymal ovarian tumors: a gynecologic oncology group study. Gynecol Oncol 1984; 18:278-292.
11. Boucher D & Tetu B. Morphologic prognostic factors of malignant mixed mullerian tumors of the ovary: a clinicopathologic study of 15 cases. Int J Gynecol Pathol 1994;13:22-28.
12. Ariyoshi K, Kawauchi S, Kaku T, Nakano H, Tsuneyoshi M. Prognostic factors in ovarian carcinosarcoma: a clinicopathological and immunohistochemical analysis of 23 cases. Histopathology 2000;37:427-36.
13. Dictor M. Malignant mixed mesodermal tumor of the ovary: a report of 22 cases. Obstet Gynecol 1985;65;720-724.
14. Barwick KW & LiVolsi VA. Malignant mixed mesodermal tumors of the ovary. A clinicopathologic assessment of 12 cases. Am J Surg Pathol 1980; 4; 37–42.
15. Kunkel J, Peng Y, Tao Y, Krigman H, Cao D. Presence of a sarcomatous component outside the ovary is an adverse prognostic factor for primary ovarian malignant mixed mesodermal/mullerian tumors: A clinicopathologic study of 47 cases. Am J Surg Pathol 2012;36:831-7.
16. Menon S, Deodhar K, Rekhi B, Dhake R, Gupta S, Ghosh J, Maheshwari A, Mahantshetty U, Shrivastva S, Budukh A, Tongaonkar HB, Kerkar R. Clinico-pathological spectrum of primary ovarian malignant mixed mullerian tumors (OMMMT) from a tertiary cancer institute: A series of 27 cases. Indian J Pathol Microbiol 2013;56:365-71.
17. Meis JM, Lawrence WD. The immunohistochemical profile of malignant mixed mullerian tumor. Overlap with endometrial adenocarcinoma. Am J Clin Pathol 1990;94:1-7.
18. Costa MJ, Guinee Jr D. CD34 immunohistochemistry in female genital tract carcinosarcoma (malignant mixed mullerian tumors) supports a dominant role of the carcinomatous component. Appl Immunohistochem Mol Morphol 2000;8:293-299.
19. Liu FS, Kohler MF & Marks JR et al. Mutation and overexpression of the p53 tumor suppresser gene frequently occurs in uterine and ovarian sarcomas. Obstet. Gynecol. 1994;83:118-124.
20. Hellstrom AC, Tegerstedt G, Silfverswärd C, Pettersson F. Malignant mixed mullerian tumors of the ovary: Histopathologic and clinical review of 36 cases. Int J Gynecol Cancer 1999;9:312-6.
21. Athavale R, Thomakos N, Godfrey K, Kew F, Cross P, de Barros Lopes A, et al. The effect of epithelial and stromal tumor components on FIGO stages III and IV ovarian carcinosarcomas treated with primary surgery and chemotherapy. Int J Gynecol Cancer 2007;17:1025-30.
22. Sood AK, Sorosky JI, Gelder MS, Buller RE, Anderson B, Wilkinson EJ, et al. Primary ovarian sarcoma: Analysis of prognostic variables and the role of surgical cytoreduction. Cancer 1998;82:1731-7.
23. Barakat RR, Rubin SC, Wong G, Saigo PE, Markman M, Hoskins WJ. Mixed mesodermal tumor of the ovary: analysis of prognostic factors in 31 cases. Obstet Gynecol 1992;80(4):660-664.
24. Crotzer DR, Wolf JK, Gano JB, Gershenson DM, Levenback C. A pilot study of cisplatin, ifosfamide and mesna in the treatment of malignant mixed mesodermal tumors of the ovary. Gynecol Oncol 2007;105(2):399-403.
25. Duska LR, Garrett A, Eltabbakh GH, Oliva E, Penson R, Fuller AF. Paclitaxel and platinum chemotherapy for malignant mixed mullerian tumors of the ovary. Gynecol Oncol 2002;85:459-463.
26. Cantrell LE, Van Le L. Carcinosarcoma of the ovary: a review. Obstet Gynecol Sur 2009;64:673-80.
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05-05-2015
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Badyal RK, Dey P. Primary ovarian malignant mixed mullerian tumors / carcinosarcomas: a clinico-pathological and immunohistochemical analysis of four cases and review of literature. Ann of Pathol and Lab Med [Internet]. 2015 May 5 [cited 2024 Nov. 22];2(2):C50-57. Available from: http://pacificejournals.com/journal/index.php/apalm/article/view/200
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