[1205] Prognostic Impact of Sarcomatous Component in Uterine Carcinosarcoma

Mana Moghadamfalahi, Houda Alatassi. University of Louisville Hospital, Louisville, KY

Background: Uterine carcinosarcomas are rare and highly aggressive tumors. Prognostic factors influencing clinical outcome remains conteroversional. However, stage at the time of presentation is the most important prognostic factor. We assessed the impact of the sarcomatous component (SC), estimated as the percentage of tumor volume on clinical stage at the time of initial diagnosis.
Design: All cases of carcinosarcoma between 2006 to current were retrieved. We found 21 cases. Stage was determined using the clinical staging system of the International Federation of Gynecology and Obstetrics (FIGO). All tumor slides were reviewed. The volume of the SC was estimated based on the number of the 10x power fields of the tumor slides showing SC then calculating the mean of all tumor slides from each case. These findings were correlated with the disease stage.
Results: In our assessment of the SC percentage, four cases showed less than 10%, four cases had 10-30%, five cases had 30-60% and eight cases showed more than 60% SC. Ten (48%,10/21) cases presented with advanced stage with extrauterine extension or lymph node involvement. Nine (90%, 9/10) of these showed 30% or more SC. In one additional case with > 60% SC, the patient presented with stage II and had positive pelvic washings. All four patients with <10% SC presented at stage IA or IB. The carcinoma component was composed of endometrioid in eight cases, mixed serous / clear cell and endometrioid in five cases, serous/clear cell in six cases and two dedifferentiated carcinoma. The distribution of SC percentage, carcinomatous component, and staging are illustrated in.

Table 1
percentage of SCStage and carcinomatous component
10%IA (SE&EN)IA (EN)IB (EN)IA (EN)  
10-30%II (EN)IIIB (SE)IB (SE&EN)IA (CC)  
30-60%IIIB (EN)IA (SE&EN)IIIC2 (SE)IIIC2 (EN)IVB (CC&EN) 
>60%IA (CC&EN)IIIA (DD)IA (SE)II(PW+)*(EN)IIIB (DD)IVB(x3) (SE, EN, CC)
SE: Serous carcinoma, CC: clear cell carcinoma, EN: endometrioid carcinoma, DD: dedifferentiated carcinoma *PW+: positive pelvic washing


Conclusions: The tumor stage and histologic grade of the carcinomatous component are among the most important prognostic factors cited in the literature. This study shows that the percentage of the SC is a useful prognostic indicator. According to our data almost 70% of the patients with 30% or more SC presented in an advanced stage, on the other hand, six out of eight patients (75%) with less than 30% SC were stage I. These findings demonstrate the importance of reporting SC percentage as a useful prognostic indicator, and suggest that more than 30% SC is associated with an unfavorable outcome.
Category: Gynecologic & Obstetrics

Wednesday, March 6, 2013 1:00 PM

Poster Session VI # 199, Wednesday Afternoon

 

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