An Abnormal Cervicovaginal Cytology Smear in Uterine Carcinosarcoma Is an Adverse Prognostic Sign
Analysis of 25 Cases
Matthew J. Snyder, MD, etal.
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Am J Clin Pathol 2004;122:434-439 Abstract quote
Carcinosarcoma of the uterus has been poorly characterized on cervicovaginal (Pap) smears, and we examine whether they effectively screen for carcinosarcoma and whether an abnormal Pap smear result has any clinical importance.
Twenty-five patients with histologically confirmed carcinosarcoma had a conventional Pap smear shortly before diagnosis. Eleven smears (44%) originally were read as abnormal (malignant or atypical), and 4 additional cases were read as abnormal on retrospective review (15/25 [60%]). All malignant elements were epithelial, and 2 cases (8%) had atypical spindle cells, but no diagnostic sarcoma.
Cervical involvement was the only histologic parameter correlating with an abnormal Pap smear result (P = .04). Univariate analysis found stage III or IV disease was an adverse prognostic sign compared with stage I or II disease (mean survival, 8 vs 36 months, respectively; P = .001), and multivariate analysis indicated that an abnormal Pap smear result correlated with worse survival (P = .023).
The conventional Pap smear is insensitive (60%) for detecting carcinosarcoma, but when the result is abnormal, the Pap is an important stage-independent adverse prognosticator. |
Proliferation indices and p53-immunocytochemistry in uterine mixed mullerian tumors.
Nicotina PA, Ferlazzo G, Vincelli AM.
Department of Human Pathology, University of Messina, Italy. |
Histol Histopathol 1997 Oct;12(4):967-72 Abstract quote
Mixed mullerian tumor (MMT) is a biphasic malignancy of elderly women. It, including both a carcinomatous and a sarcomatous component (CC and SC), is regarded as a female genital tract carcinosarcoma (FGTCS). Since current methods to grade CC and SC are not still univocal, the authors estimate mitotic index (MI) and MIB 1-immunolabeling index (MIB 1-LI) as common prognostic indices for the MMT components. They also compare above prognostic indices with p-53 immunocytochemistry, in MMTs.
The present study thus points out that: (a) MI of CC and SC areas is consistent with the respective conventional tumor grades; (b) MI averages of CC are higher than those observed in the SC areas; (c) MI and MIB 1-LI of the CC-tumor cells correlate reciprocally in a very significant fashion; (d) A diffuse strong p53 nuclear immunostaining (> 50% cells) is often patent where the highest MI and MIB 1-LI are found.
In conclusion, the authors propose MI and MIB 1-LI as two complementary useful indices to assess prognosis of MMTs. They also suggest p53 nuclear immunolabeling should be regarded as an independent biomarker of unfavourable MMT behaviour. |
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Is vascular and lymphatic space invasion a main prognostic factor in
uterine neoplasms with a sarcomatous component? A retrospective study
of prognostic factors of 60 patients stratified by stages.
Rovirosa A, Ascaso C, Ordi J, Abellana R, Arenas M, Lejarcegui JA,
Pahisa J, Puig-Tintore LM, Mellado B, Armenteros B, Iglesias X, Biete
A.
Department of Radiation Oncology, Hospital Clinic i Universitari,
Barcelona, Spain.
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Int J Radiat Oncol Biol Phys 2002 Apr 1;52(5):1320-9 Abstract
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BACKGROUND: Sarcomatous neoplasms of the uterine corpus are still a
challenge in terms of obtaining prognostic factors and the most optimum
complementary treatment to surgery. The most important prognostic factor
is stage; relapses usually appear during the first 2 years, and most
patients die within the first 3 years. We have performed a multivariate
study of prognostic factors, stratifying patients by stage, to determine
their impact on overall survival, disease-free survival, local relapse-free
survival, and distant metastasis-free survival. Special emphasis has
been given to vascular and lymphatic space invasion (VLSI).
METHODS: Sixty patients diagnosed with uterine neoplasms with a main
sarcomatous component were treated at Hospital Clinic i Universitari
of Barcelona between January 1975 and June 1999. Pathologic type: 32
carcinosarcomas, 14 leiomyosarcomas, 9 adenosarcomas, and 5 endometrial
stromal sarcomas. Treatment: 58/60 surgery, 35/60 postoperative radiotherapy,
2/60 exclusive chemotherapy, and 3/60 complementary chemotherapy. FIGO
stages: 43 Stage I, 4 Stage II, 11 Stage III, and 2 Stage IV. Variables
analyzed: age, stage, vascular and lymphatic space invasion, myometrial
invasion, mitotic index, tumor size, unicentricity/multicentricity,
necrosis, and radiotherapy. Statistics: the S and Cox proportional risk
models. The partial effect of each risk factor was calculated by hazard
ratio (HR) with a confidence interval of 95%.
RESULTS: Early stages: Multivariate analysis showed that tumor size
larger than 8 cm and VLSI had an impact on overall survival (HR = 4.01
and HR = 24.45, respectively). VLSI was present in 23% of the cases.
Myometrial invasion greater than 50% had an impact on disease-free survival
and local relapse-free survival (HR was 9.75 and 3.20, respectively).
VLSI had an impact on distant metastasis-free survival (HR = 2.92).
Advanced stages: VLSI was present in 89% of the cases. Only leiomyosarcoma
type made the overall survival worse (HR = 10.54).
CONCLUSIONS: Vascular and lymphatic space invasion was a relevant prognostic
factor in our series, with an impact on overall survival and distant
metastasis-free survival in early stages. In advanced stages, VLSI had
no impact on survival, but was present in 89% of cases. Myometrial invasion
>50% had an impact on local relapse. Advanced stages had a more aggressive
behavior, and there was a higher incidence of poor prognostic factors
in these stages. Nevertheless, prospective studies are still needed
on prognostic factors and on the best treatment option.
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