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PubMed1995

[A case of remission of recurrent carcinosarcoma of the uterus with massive ascites by carboplatin].

A case of remission of recurrent carcinosarcoma of the uterus with massive ascites by chemotherapy using carboplatin (CBDCA) is reported. A 75-year-old female was diagnosed with cancer of the uterine body. She underwent abdominal total hysterectomy with bilateral salpingo-oophorectomy, which revealed carcinosarcoma of the uterus penetrating the myometrium and reaching the serosa of the uterus. Eight weeks after, she developed abdominal distension, obstruction of bilateral ureters and bleeding tumor measuring 5 cm in diameter at the vaginal cuff ending. Acute retention of bloody ascites of more than 2500 ml was demonstrated. Abdominal centesis, aspiration of ascites and intraperitoneal administration of 600 mg of CBDCA were performed. Two weeks after single use of CBDCA, the ascites completely disappeared and there was recovery from anuria. The remission has lasted more than 4 months, which has suggested the efficacy of CBDCA for uterine carcinosarcoma.

Aged↗

PubMed1995

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.

Carcinosarcomas of the female genital tract have generally been regarded as a type of sarcoma. Recent evidence suggests, however, that they may be more closely related to carcinoma. The histologic features of 29 carcinosarcomas with documented metastases were analyzed to study the relative importance of the carcinomatous and sarcomatous components and attempt to provide further evidence on the histogenesis of these neoplasms. Patients' ages ranged from 33 to 81 years (mean, 68). The primary tumor originated in the uterus in 17 cases, the ovary in 11, and the fallopian tube in one. Heterologous sarcoma was present in 21 of the primary tumors (72%). Myometrial invasion was present in all 15 of the uterine tumors treated with hysterectomy and consisted only of the carcinomatous component in 12 cases (80%). In two cases, which possibly developed as "collision"-type carcinosarcomas, the myometrium was separately invaded by carcinoma and sarcoma. Myoinvasive tumor consisted solely of sarcoma in one case. Lymphatic-vascular invasion was found in 10 of the primary tumors (eight uterine, two extrauterine) and consisted of pure carcinoma in all instances. The cellular composition of 62 metastases was evaluated. Of these, 51 metastases were diagnosed concurrently with the primary tumor in 21 patients (73%). Eleven metastases were diagnosed from 2 to 26 months after initial treatment. Carcinoma only was found in 43 metastases (70%), both carcinoma and sarcoma in 15 (24%), and sarcoma alone in four (6%). A total of 35 lymph node metastases occurred in 10 cases, consisting of carcinoma alone at 34 sites. The sole example of a purely sarcomatous lymph node metastasis occurred in one of the possible uterine "collision"-type tumors. Intraperitoneal metastases to serosal surfaces or the omentum occurred in 19 cases and consisted of both carcinoma and sarcoma in 14 and carcinoma only in five. Vaginal metastases occurred in four cases and consisted of only carcinoma in two, carcinoma and sarcoma in one and only sarcoma in one. Four patients had distant organ metastases, including one each to the liver (carcinoma only), breast (carcinoma only), bone marrow (sarcoma only), and brain (sarcoma only). Of the 51 concurrent metastases, only carcinoma was present in 37 (73%), both carcinoma and sarcoma in 13 (26%), and sarcoma alone in one. Of the 11 subsequent metastases, carcinoma alone was found in six (55%), sarcoma alone in three (27%), and both carcinoma and sarcoma in two (18%).(ABSTRACT TRUNCATED AT 400 WORDS)

Adult↗

PubMed1993

[The morphological and immunohistochemical study of esophageal pseudosarcomatous and carcinosarcomas--report of 10 cases].

Twenty cases of esophageal carcinosarcoma were diagnosed and treated in this hospital during 1958-1990. Of which, 10 cases were reexamined by morphology and immunohistochemistry stained with 17 different antibodies. The results showed that: (1) There were 6 cases of true carcinosarcoma, 3 of pseudosarcoma and 1 case belonging to primary esophageal malignant fibrohistiocytoma; (2) In the cases of true carcinosarcoma, the tumor tissue displayed certain heterogeneity of carcinomatous and/or sarcomatous components, suggesting a potential for multi-directional differentiation; (3) It may be important that most of the tumors showed an intra-luminal or polypoid growth pattern and fewer metastasis, with a better prognosis. There are 6 surviving cases among 9 followed up over 2 years and the longest survivor has been up to 15 years.

Adult↗

PubMed1993

[Carcinosarcoma of the esophagus].

Carcinosarcoma of the esophagus is a rare neoplasm of the esophagus, composes both of carcinomatous and sarcomatous elements. From Oct. 1982 to Sept. 1991, there were 516 neoplasms of the esophagus, 2 (0.39%) carcinosarcoma, treated at our hospital. The first patient was a 62-year-old man, pathological stage III (T3N2M0). The second patient was a 68-year-old man, pathological stage I (T1N0M0). The tumors were polypoid and located at the middle portion of the esophagus. They had received subtotal esophagectomy, mediastinal lymph node dissection and cervical esophagogastrostomy, retrosternally. The first patient has still lived disease free for seven years. The second patient died one year after the operation due to intra-abdominal lymphadenopathy, liver metastasis and massive ascites. As epidermoid carcinoma, radical esophagectomy with lymph node dissection is the standard procedure for carcinosarcoma of the esophagus.

Aged↗

PubMed1995

[A case of so-called carcinosarcoma of the esophagus].

So-called carcinosarcoma of the esophagus is rare malignant tumors composed of carcinoma and sarcomataous components. We described a case of so-called carcinosarcoma and reviewed some literature. A 67-year-old man visited our hospital because of difficulty in swallowing, general fatigue, and sore throat. Barium swallow esophagogram showed a large polypoid lesion in the middle, lower thoracic esophagus. Endoscopy also demonstrated a pedunculated polypoid tumor. Histological examination of the biopsy specimen revealed malignant findings. Thoracic esophagectomy with cervical, thoracic, abdominal dissection was performed. A polypoid tumor, 10.5 x 5.2 x 3.5 cm in size, was removed. In the polypoid lesion, spindle-shaped cells made interlacing bundles similar to sarcoma and surrounded nests of squamous cell carcinoma. Near the pedicle, squamous cell carcinoma invaded muscularis mocosae. And lymph node metastasis was detected. Epitherial membrane antigen (EMA) was detected in some parts of the polypoid lesion. So according to Guide Lines for Clinical and Pathological Studies on Carcinoma of the Esophagus, this case was diagnosed as so called carcinosarcoma.

Aged↗

PubMed1997

[Carcinosarcoma of the colon, one or two tumors?].

Carcinosarcoma is a rare neoplasm that displays morphological features of both an adenocarcinoma and a sarcoma. The question is whether two tumors co-exist or whether the two morphological aspects represent sequential steps in tumor progression. We report a case of carcinosarcoma of the caecum in a young female. To characterize the two tumor cell populations and to gain insight into the pathogenesis of the lesion, we conducted immunohistochemical and ultrastructural analyses of the tumor. The biphasic aspect of the tumor showed an admixture of carcinoma and spindle-cell sarcomatoid areas. Both adenocarcinoma and sarcomatous cells were positive for cytokeratins. Vimentin was undetectable in the epithelial portion, but many of the sarcomatous cells stained for vimentin. Electron microscopic analyses of the sarcomatous portion revealed budding of "retroviral particles" from the rough endoplasmic reticulum cisternae. Our data support the contention that "carcinosarcoma" is a part of a single clinicopathological continuum with "spindle-cell carcinoma", the former being the biphasic expression of the neoplasia, the latter the monophasic expression; the presence of productive retroviral infection in the sarcomatous cells could constitute one of the additional support in tumor progression from the carcinomatous to the sarcomatous phase.

Adenocarcinoma↗

PubMed1998

Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients.

BACKGROUND: Carcinosarcoma (malignant mixed mullerian tumor) of the female genital tract is a highly malignant neoplasm. The tumor stage and histologic grade of the carcinomatous component are among the important prognostic indicators cited in the literature for this tumor. METHODS: Twenty-five patients with uterine carcinosarcoma at 4 hospitals in the Kyoto and Nara areas of Japan were studied retrospectively. The clinicopathologic and immunohistochemical data including p53, bcl-2, Ki-67, and proliferating cell nuclear antigen (PCNA) staining were analyzed using univariate and multivariate analysis with the Cox proportional hazards model to investigate potential prognostic indicators for this neoplasm. RESULTS: The 5-year survival rate was 36.4% for all stages, 62.3% for Stage I, and 0% for Stages II-IV. From the univariate analysis, stage (P = 0.0001), endometrioid adenocarcinoma as a carcinomatous component (P = 0.0006), age (P = 0.0355), and a heterologous sarcomatous component (P = 0.0421) were found to be prognostically significant for patient survival. Stage was the only independent significant factor in the multivariate analysis (t = 2.212). None of the other factors (history of pregnancy and gestation, gross appearance of the tumors, grade of the carcinomatous component, mitotic count of the sarcomatous component, Ki-67 and PCNA reactivity, or p53 or bcl-2 positive staining) was found to be a significant prognostic indicator. CONCLUSIONS: Stage appears to be the only definite independent prognostic indicator of survival in patients with uterine carcinosarcoma. It is uncertain whether age, endometrioid adenocarcinoma as a carcinomatous component, or absence of a heterologous component in the sarcomatous area are prognostic factors. Immunohistochemical expression of p53, bcl-2, Ki-67, or PCNA is not a prognostic indicator. The immunohistochemical results of the current study may support the hypothesis of a common stem cell origin of this tumor.

Adult↗

PubMed1998

Primary heterologous carcinosarcoma (metaplastic carcinoma) of the urinary bladder: a clinicopathologic, immunohistochemical, and ultrastructural analysis of eight cases and a review of the literature.

BACKGROUND: Heterologous carcinosarcomas of the urinary bladder are rare neoplasms, the histogenesis of which is still disputed. METHODS: The clinicopathologic, immunohistochemical, and ultrastructural features of eight cases were analyzed. RESULTS: The patients, 5 males and 3 females, had a median age of 70 years. Gross hematuria, dysuria, and urinary tract infections were the main presenting symptoms. Tumors were solitary in all cases and located in the right wall in six cases. Tumor size ranged from 2 to 12 cm (median, 5 cm). Four patients died of disease 2, 6, 17, and 42 months postoperatively, respectively. Microscopically, the tumors consisted mostly of a varied mixture of high grade transitional cell carcinoma with chondrosarcoma, osteosarcoma, rhabdomyosarcoma, and undifferentiated spindle cell (leiomyosarcoma-like) components with occasional transitional features between one component and another. All tumors but one invaded the muscularis propria or the perivesical fatty tissue. Immunohistochemically, keratin expression was observed focally in the sarcoma component as well as the carcinoma component. Reactivity for vimentin, desmin, muscle specific actin, and S-100 protein was observed in poorly differentiated areas in addition to the expected positivity of each histologic subtype of sarcoma. Ultrastructurally, one tumor showed evidence of both epithelial and chondrosarcomatous differentiation, whereas three contained rhabdomyosarcomatous elements. CONCLUSIONS: On the basis of the current series and a review of 55 reports from the literature, primary heterologous carcinosarcoma of the urinary bladder proved to be a highly malignant type of neoplasm occurring predominantly in elderly males that was most often in an advanced stage at presentation and rapidly became lethal. Histogenetically, some heterologous carcinosarcomas should be regarded as a variant of sarcomatoid carcinoma (metaplastic carcinoma) that shows prominent heterologous differentiation.

Aged↗

PubMed1996

Inhibition of protein kinase C-dependent protein phosphorylation correlates with increased polarity and locomotion in Walker 256 carcinosarcoma cells.

Signal transduction pathways controlling tumor cell locomotion are not yet well understood. We have studied the role of protein kinase C (PKC)-dependent protein phosphorylation associated with changes in cell shape and locomotor activity of Walker carcinosarcoma cells in culture. We show that the inhibitory effect of phorbol-12-myristate-13-acetate (PMA), an activator of PKC, on cell polarity and locomotion can be suppressed by the PKC-selective inhibitor Ro 31-8220. PMA induces increased phosphorylation of at least 2 proteins, of 65 and 80 kDa, in intact Walker carcinosarcoma cells. These bands are enriched in cytosolic fractions isolated from cells incubated with 32PO4. Pre-incubation with Ro 31-8220 inhibits the PMA-induced phosphorylation of both bands in a concentration-dependent manner. This effect is very likely not due to inhibition of translocation of PKC to the membrane as Ro 31-8220 enhances, rather than inhibits, PMA-induced transfer of PKC beta(II) to the particulate fraction. We have carried out a quantitative analysis of phosphorylation of the 80-kDa band. Ro 31-8220 reverses both PMA-induced phosphorylation of this band and PMA-induced suppression of cell polarity in parallel. Increased phosphorylation of proteins via PKC may thus be a stop signal for locomoting Walker carcinosarcoma cells.

Animals↗

PubMed1999

Role of protein kinase C isoforms in locomotion of Walker 256 carcinosarcoma cells.

Treatment with low (nanomolar) concentrations of phorbol-12-myristate-13-acetate (PMA) for 5 to 30 min suppresses locomotion of Walker 256 carcinosarcoma cells, suggesting that activation of protein kinase C (PKC) is a stop signal for tumor cell locomotion. We have compared the effects of PMA on cell shape and motility with down-regulation of specific PKC isoforms. Using specific antibodies, we show that Walker carcinosarcoma cells express PKC isoforms alpha, betaI, betaII, gamma, lambda, mu, eta and zeta. Short-term incubation with PMA induced a marked shift of isoforms alpha, betaI, betaII, gamma and eta to the particulate fraction. Long-term incubation with PMA (0.1 microM, 6 hr) resulted in significant reduction of expression of conventional PKCs alpha, betaI, betaII and gamma and of the novel PKC eta to 10% to 26% of controls. Down-regulation of PKC alpha, betaI and betaII by long-term incubation with PMA was reversible after removal of PMA, whereas that of isoforms gamma and eta was not. The motile properties of cells after down-regulation of PKC isoforms were investigated. Concomitant with down-regulation of PKC isoforms, long-term incubation of cells with PMA resulted in recovery of the polar shape and the ability to migrate. Motility and polarized shape of the down-regulated cells were no longer susceptible to short-term treatment with PMA, showing that active PKC is indeed responsible for the inhibitory effects of PMA. Effects of long-term incubation with PMA on cell shape and motility were reversible. Our findings strongly suggest that PKCs alpha, betaI and betaII activated by PMA are involved in stopping Walker carcinosarcoma cell locomotion.

Animals↗

PubMed2004

Chemotherapeutic management of recurrent/metastatic uterine carcinosarcomas (malignant mixed mullerian tumors): time for a re-appraisal?

PURPOSE: Optimal chemotherapeutic management of recurrent/metastatic uterine carcinosarcomas remains undefined. Despite this fact, the selection of a cytotoxic anti-neoplastic drug regimen for an individual patient with this rare malignancy may substantially impact both short-term symptomatic improvement and overall quality-of-life, which includes the toxicity of therapy. PATIENTS AND METHODS: Two women with metastatic uterine carcinosarcomas recently treated at the Cleveland Clinic received therapy (carboplatin/paclitaxel) directly aimed at the "adenocarcinoma" component of their mixed endometrial cancers. RESULTS: Both patients achieved substantial short-term objective and subjective improvement in cancer-related signs and symptoms, while experiencing limited treatment-associated toxicities. CONCLUSION: This limited experience, and additional available data, suggest it is rational to initially treat patients with recurrent/metastatic uterine carcinosarcomas with anti-neoplastic drug strategies currently employed in the management of endometrial adenocarcinomas.

Aged↗

PubMed1999

Co-expression of p53 by epithelial and stromal elements in carcinosarcoma of the female genital tract: an immunohistochemical study of 19 cases.

Carcinosarcoma is an aggressive neoplasm of the female genital tract, which comprises 1-2% of malignancies of the uterine corpus. Because of the broad range of differentiation exhibited by these tumors, the precise nature of the relationship between epithelial and stromal components in this unique tumor remain unclear. Previous studies have demonstrated that mutation and consequent overexpression of the tumor suppressor gene p53 occurs frequently in carcinosarcoma and is conserved from primary to metastastic sites. We examined p53 accumulation in formalin-fixed, paraffin-embedded archival sections in 19 cases previously shown to have mutations in the p53 gene and performed semi-quantitative analysis of the intensity of staining and relative density of positive cells and stromal and glandular elements. There was a high level of concordance of immunohistochemical staining for the p53 oncoprotein between glandular and stromal elements. These results further suggest a clonal origin for the diverse elements of carcinosarcoma.

Journal Article↗

PubMed2000

Combined diagnostic imaging of uterine carcinosarcoma: A case report.

The diagnostic imaging characteristics of uterine carcinosarcoma have not been established because the tumor is very rare. We studied magnetic resonance (MR) imaging, power Doppler ultrasonography, and positron emission tomography (PET) in one such carcinosarcoma to define its imaging characteristics. On T1-weighted MR images, the tumor mass in the uterus was low-signal intensity and had a slight inhomogeneous appearance. On T2-weighted images, it had a heterogeneous appearance and was of medium- or high-signal intensity; marked flow void was apparent from the myometrium to the tumor mass. The MR flow void was also detected by power Doppler ultrasonography. Increased glucose metabolism was detected on PET images, suggesting a malignant tumor in the endometrial cavity. Combined diagnostic images with MR, power Doppler ultrasonography, and PET is recommended as the diagnostic method for uterine carcinosarcoma.

Journal Article↗

PubMed2003

Carcinosarcomas (malignant mullerian mixed tumors) of the uterus and ovary: a genetic study with special reference to histogenesis.

The histogenesis of carcinosarcomas (malignant mullerian mixed tumors) of the female genital tract is still not completely understood. In the present study, several different molecular pathologic techniques were applied to determine the histogenesis of 15 uterine and ovarian carcinosarcomas. The patterns of X-chromosome inactivation and the presence of p53 and K-ras mutations were analyzed in the carcinomatous and sarcomatous components. Microsatellite analysis was also performed. Ten tumors were monoclonal, one was biclonal (collision tumor), and another was probably biclonal; the other three were of indeterminate histogenesis. These data indicate that most uterine and ovarian carcinosarcomas are monoclonal.

Adult↗

PubMed1997

Carcinosarcoma of penis. Case report and review of the literature.

AIMS OF THE STUDY: Carcinosarcomas (sarcomatoid carcinomas) are controversial, biphasic tumors composed of both carcinomatous and sarcomatous elements. They are uncommon and occur in numerous locations. At the time of this report only 3 cases of carcinosarcoma of penis have been reported in the literature. The aim of this article is to provide a discussion of these lesions, using informations gleaned from the pertinent literature as well as the personal experience of the authors. METHODS: The formalin-fixed paraffin-embedded tissue was stained with hematoxylin and eosin, reticulum, alcian blue and Mallory's trichrome stains. Section from selected paraffin-embedded blocks, were stained with antibodies to citokeratins, EMA, vimentin, desmin, and a actin. RESULTS: In our case the carcinomatous elements were admixed with areas of "divergent differentiation": spindle-cell and giant-cell sarcomatoid component with bone and cartilage differentiation were noted. In situ carcinoma was also detected. Immunohistochemistry showed reactivity for keratin and epithelial membrane antigen (EMA). In most of pleomorphic spindle elements. Immunoreactivity for vimentin, desmin and actin were focally found. CONCLUSIONS: The carcinosarcomas may demonstrate "divergent" differentiation into bone, cartilage or myogenous tissue, so it is possible that the cell of origin could be heterogeneous. In our case myogenous differentiation was focally found. Although the clinical data, available from the only three cases of the literature, demonstrate that the behaviour of this tumors was not different from those of squamous cell carcinoma, the authors recommended a constant careful follow-up of the patients.

Journal Article↗

PubMedDate not supplied

Ultrastructural changes induced in Walker carcinosarcoma by treatment with dihematoporphyrin ester and light in animals with diabetes mellitus.

The purpose of this study was to evaluate by electron microscopy the tumoral fine structure changes induced by photodynamic therapy (PDT) in diabetic animals. Walker -256 carcinosarcoma harvested from animals with/without diabetes mellitus exposed to PDT (Photofrin II/5 mg/kg and 24 hrs later He-Ne laser irradiation/632.8 nm; 10 mW) and examined by electron microscopy showed different degrees of lesions in the nucleus and cytoplasmic fine structure. The ultrastructural changes induced by PDT in animals with diabetes mellitus bearing carcinosarcoma are characterized by: lysis of chromatin situated on the central zone of nucleus; swelling and vacuolization of mitochondria; formation of phagosome--like structures; myelin figures; degenerescence and disappearance of cytoplasmic organelles. Summing up, the data presented in this work demonstrate that the exposure to three doses of PDT produces changes in tumoral fine structure, increases survival rate and reduces incidence of carcinosarcoma in rats with diabetes mellitus.

Alloxan↗

PubMedDate not supplied

Squamocellular carcinoma and chondrosarcoma: a true pulmonary carcinosarcoma. Report of a case.

BACKGROUND: Carcinosarcoma is one of the less common tumors of the lung and is composed of a mixture of malignant epithelial and mesenchymal elements of the type ordinarily seen in malignancies of adults. The carcinomatous component is mostly epidermoid and sometimes adenomatoid or undifferentiated. The mesenchymal part is mostly a spindle cell sarcoma and sometimes a polymorphocellular sarcoma. Differentiation as osteosarcoma and chondrosarcoma is rare. CASE REPORT: This report describes the case of a patient with carcinosarcoma of the lung composed of epidermoid carcinoma and chondrosarcoma. A left hilar mass was incidentally diagnosed. The patient was submitted to surgical exploration and a left lower lobectomy with dissection of local lymph nodes was performed. At microscopy the tumor was composed of both epithelial and stromal malignant component. The epithelial component consisted of poorly-differentiated squamous cell carcinoma and the stromal component consisted of chondrosarcoma. He remains well 30 months later. CONCLUSION: The prognosis of patients with carcinosarcoma is not always unfavourable. Potentially curative surgical resections should always be attempted. Pathologists should be aware of a wrong diagnosis of undifferentiated small cell lung carcinoma which eliminates the patient from surgery.

Aged↗

PubMed2004

The effect of triethyllead on the motile activity of walker 256 carcinosarcoma cells.

The effect of triethyllead (TriEL) on the morphology and motile activity of Walker 256 carcinosarcoma cells was investigated. It was found that both 2 and 5 microM TriEL affected the cellular motility in a dose- and time-dependent manner. Initially, 2 microM TriEL caused the formation of blebs instead of lamellipodia at the front of some cells and stimulated the migration of Walker cells, but after 2 hours of 2 microM TriEL treatment, a reduction of cellular motility was observed. In the presence of 5 microM TriEL, Walker 256 carcinosarcoma cells rounded up, and their rate of movement was reduced. Moreover, the treatment of Walker carcinosarcoma cells with TriEL caused the disruption of microtubules and affected the F-actin distribution at both concentrations. At a concentration of 2 microM TriEL, the actin staining intensity was greatest in the tail of front-tail polarised blebbing cells and the actin layer was very thin at the leading edge. The control cells showed linear cortical F-actin distribution and somewhat less intense cytoplasmic staining at the same TriEL concentration. Cells treated with 5 microM TriEL showed an under-membrane pattern of actin distribution.

Actins↗