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.
|percentage of SC||Stage 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)|