Carcinosarcoma of the cervix: Clinicopathological features of 17 tumors diagnosed at a Tertiary Cancer Referral Centre, India.

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.