UTERİN KARSİNOSARKOMLAR: 18 OLGUDA HİSTOPATOLOJİK GÖZDEN GEÇİRME

Year 2015, Volume: 78 Issue: 1, 1 - 5, 18.05.2015

Ecmel Kaygusuz , Meryem Eken , Dilşad Herkiloğlu , Ebru Çöğendez , Ateş Karateke

https://doi.org/10.18017/iuitfd.m.13056441.2015.78/1.1-5

Abstract

Amaç: Uterin karsinosarkomlar nadir görülen oldukça kötü prognozlu tümörlerdir. Daha önceleri uterin sarkomların bir alt grubu olarak değerlendirilen bu tümörler artık karsinom grubu içinde değerlendirilmektedir. Yeni yapılan çalışmalarda bu tümörlerin klinik davranışının epitelyal komponentin özelliklerine bağlı olduğu belirtilmektedir.Çalışmamızda kliniğimizde tanı alan ve oldukça agresif davranışlı olan bu tümorleri literatür ışığında histopatolojik özellikleriyle tartışmayı amaçladık.

Gereç ve Yöntemler: Hastanemiz obstetrik ve onkoloji bölümünde 2004-2014 yılları arasında opere edilen uterin karsinosarkom olguları retrospektif olarak incelendi. Bölümümüzde karsinosarkom veya malign mikst Müllerian tümör tanısı alan olgular çalışmaya dahil edildi. Tümör boyutları, myometriyal invazyon varlığı, pelvik lenf nodu metastazları gözden geçirildi. Demografik veriler kayıt edildi. Evreleme FIGO (1988) protokolüne göre yapıldı.

Sonuçlar: Hastanemizde karsinosarkom tanısı alan 18 hastanın %95 i postmenopozal dönemde olup ortalama yaş 64,6 (47-85) olarak izlendi. 13 hastaya evreleme cerrahisi (total histerektomi+ bilateral salpingooferektomi+ pelvik paraaortik lenfadenektomi+omentektomi+appendektomi) 5 olguya ise ileri evrede olması sebebiyle suboptimal debulking yapıldı. 7 olgumuz evre-I iken, 11 olgumuz evre II-IV idi. Myometriyal invazyon17 hastada mevcutken, bunların 9 tanesinde invazyon myometriyumun ½’den fazlasını tutmuş görünümdeydi. Lenfovasküler invazyon 11 hastada izlendi.

Tartışma ve Sonuç: Uterin karsinosarkomlar oldukça agresif neoplazmalardır. Önceden sarkomlar grubunda incelenirlerken, son çalışmalar uterin karsinosarkomların sarkomatöz metaplazi içeren yüksek dereceli endometriyal karsinomlar olduklarını göstermiştir. Tedavide ilk seçenek cerrahi olup, adjuvan kemoterapi ve radyoterapi kombinasyonları tamamlayıcı tedavi olarak kullanılmaktadır.

Keywords

Karsinosarkom, Uterus, Malign mikst Müllerian tümör

UTERINE CARCINOSARCOMAS: HISTOPATHOLOGICAL ASPECTS REPORT ON 18 CASES

Abstract

Objective: Uterine carcinosarcomas are relatively rare tumors with poor prognosis. These tumors were considered as a subset of uterine sarcomas; however currently they are classified within the carcinoma group. Recent studies have revealed that these tumors behave according to the characteristics of the epithelial component. The aim of the study was to discuss the histopathological characteristics of these quite aggressive tumors, which were diagnosed in our clinic, in the light of the literature.

Materials and Methods: We performed a retrospective analysis of 18 patients with uterine sarcoma, who were operated at our oncology department between 2004 and 2014. Cases with a pathology result of either carcinosarcoma or malignant mixed Müllerian tumor were included in the study pathologically. Tumor size, presence of myometrial invasion and pelvic lymph node metastases were reviewed. Demographic data were recorded. Staging was performed according to FIGO (1988) protocol.

Results: 18 patients were diagnosed with carcinosarcoma. 95% of the patients were in postmenopausal period. The mean age was 64.6 . 13 patients underwent comprehensive surgical staging (total hysterectomy + bilateral salpingo-oophorectomy + pelvic para-aortic lymphadenectomy + omentectomy + appendectomy). 5 patients with advanced stage disease underwent suboptimal debulking. 7 patients were stage I and 11 patients were stage II-IV. Myometriyal invasion was present in 17 patients and for 9 of these patients the invasion was observed in more than ½ of the myometrium. Lymphovascular invasion was observed in 11 patients.

Conclusion: Uterine carcinosarcomas are extremely aggressive neoplasms. Although they used to be categorized under the group of sarcoma, recent studies have shown that uterine carcinosarcomas are high-grade endometrial carcinomas, which include sarcomatous metaplasia. First-line treatment for uterine carcinosarcomas is surgery. Adjuvant chemotherapy and radiation therapy combinations are used as complementary therapies

Keywords

Carcinosarcoma, Uterus, Malign mixed Müllerian tumor

References

• Amant F, Moerman P, Neven P et al. Endometrial cancer. Lancet 2005;366(9484):491-505. WG. 2. McCluggage Uterine carcinosarcomas
• (malignant mixed mullarian tumors) are metaplastic
• carcinomas. Int J Gynecol Cancer 2002;12:687-90.
• Gadducci A, Sartori E, Landoni F, Zola P et al. The prognostic relevance of histological type in uterine sarcomas: a Coorperation Task Force (CTF) multivariate analysis of 249 cases. Eur J Gynecol Oncol 2002;23:295-9.
• Bittermen P, Chun B, Kurman RJ. The significance of epithelial differentiation in mixed meodermal tumors of the uterus. A clinicopathologic and immunohistochemical study. Am J Surg Pathol 1990;14:317-28.
• Silverberg SG, Major FJ, Blessing JA et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 1990;9:1-19.
• Major F, Blessing J, Silverberg S, et al. Prognostic factors Gynecologic Oncology Group study. Cancer 1993;71:1702-9. uterine sarcoma. A
• El-Nashar SA, Mairani A. Uterine Carcinosarcoma. Clin Obstet Gynecol 2011;54:292-304.
• Raspollini MR, Tommano S, Amunni G et al. COX- 2, c-KIT and HER-2/neu expression in uterine carcinomas: prognostic factors or potential markers for 2005;96(1):159-67. Gynecol Oncol
• Chauveinc L, Deniaud E, Plancher C, Sastre X, et al. Uterine sarcomas: the Crue Insitute experience. Prognosis factors and adjuvant treatments. Gynecol Oncol 1999;72:232-37.
• Kurman RJ, Ellenson LH, Ronnet BM. Blaustein’s pathology of the Female Genital Tract. Sixth edition. Springer. Chapter 10.
• Anupama R, Kuriakose S; Vijaykumar DK, et al. Carcinosarcoma of the Uterus – A single Institution Retrospective Anlysis of the Management and Outcome and a Brief Review of Literature. Indian J Surg Oncol 2013;4(3):222-8.
• Gonzalez Bosquet J, Terstriep SA, Clby WA et al. The impact of multi-modal therapy on survival for uterine 2010;116:419-23. Gynecol Oncol
• Chuang JT, Van Velden DJ, Graham JB. Carcinosarcoma and mixed mesodermal tumor of the uterine corpus. Review of 49 cases. Obstet Gynecol 1970;35:769-80
• Fleming WP. Et al. Autopsy findings in patients with uterine sarcoma. Gynecol Oncol 1984;19:168- 72.
• Norris HJ, Roth E, Taylor HB. Mesencymal tumors of the uterus. II. A clinical and pathologic study of 31 mixed mesodermal tumors. Obstet Gynecol 1966;28:57-63.
• Bodner-Adler B et al. Prognostic parameters in carcinosarcomas of the uterus: a clinico-pathologic study. Anticancer Res 2001;21:3069-3074.
• Sreenan JJ, Hart WR. Carcinosarcomas of the female genital tract. A pathologic study of 29 metastatic tumors: further evidence for the dominant role of the epithelial component and the conversion theory of histogenesis. Am J Surg Pathol 2003;19:666-674.
• Creasman WT, Odicino F, Maisonneuve P et al. Carcinoma of the uteri. FIGO 26th annual report on the results of treatment in Gynecological Cancer. Int J Gynaecol Obstet 2006;95:105-43.
• Nam JH. Surgical treatment of the uterine sarcoma. Best Pract Res Clin Obstet Gynaecol 2011;25:751- 60.
• Sutton G. Uterine Sarcomas. Gynecol Oncol 2013;130:3-5.