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PubMed1986

Development of experimental models for meningeal neoplasia using intrathecal injection of 9L gliosarcoma and Walker 256 carcinosarcoma in the rat.

Two models for meningeal neoplasia have been developed in rats using intrathecal injection of 9L gliosarcoma and Walker 256 carcinosarcoma cells. Tumor cells were injected in unanesthetized animals through an indwelling catheter inserted at the cisterna magna to the level of the lumbar enlargement of the spinal cord. Survival of rats was dependent on the number of tumor cells injected. Spread of tumor was quantified by histology using a grading scale, and functional and behavioral changes were measured. Rats injected with 10(6) 9L gliosarcoma cells showed progressive weight loss, flaccid paralysis, and neurogenic bladder dysfunction and had a median survival of 11 days. The tumor frequently grew as a mass compressing the spinal cord. The 9L gliosarcoma tumor cells markedly invaded the Virchow-Robin spaces but exhibited only minimal invasion of the central nervous system parenchyma. The tumor reached the brain by day 10. Rats injected with 2 X 10(5) Walker 256 carcinosarcoma cells showed progressive weight loss and weakness and had a median survival of 6 days. The tumor grew within the leptomeninges in a discontinuous multifocal fashion and reached the brain by day 4. There was extensive invasion of the central nervous system parenchyma by Walker 256 tumor cells along the Virchow-Robin spaces resulting in hemorrhage and necrosis of grey and white matter. Hot plate and tail flick response times were significantly delayed only in the days immediately preceding death of animals with either 9L or Walker 256 tumor and were not good indicators of tumor progression. Loss of motor coordination and failure of the stepping and placing reflex on the other hand showed good correlation with spread of tumor measured histologically. Control animals injected with 0.9% NaCl or with lethally irradiated tumor cells showed no significant weight loss or functional or behavioral changes. The intrathecal 9L gliosarcoma and Walker 256 carcinosarcoma models show different characteristics of human meningeal carcinomatosis and will be used for studies of experimental chemotherapy with intrathecally administered antitumor drugs.

Animals↗

PubMed1998

Monoclonal origin of an esophageal carcinosarcoma producing granulocyte-colony stimulating factor: a case report.

BACKGROUND: Carcinosarcomas are comprised of carcinomatous and sarcomatous elements, and their histogenesis remains unclear. The authors examined the serum concentrations of hematopoietic growth factors and performed immunohistochemical studies on an esophageal carcinosarcoma from a patient with marked granulocytosis to determine its histopathogenesis and clonality. METHODS: The authors examined the case of a 63-year-old man with a polypoid tumor of the esophagus associated with marked leukocytosis (131 x 10(9) per liter). Immunohistochemical staining of the esophageal tumor was performed using monoclonal antibodies against granulocyte-colony stimulating factor (G-CSF), keratin, epithelial membrane antigen (EMA), and vimentin. RESULTS: The patient's leukocyte count was increased (124 x 10(9) per liter) on admission. Because mature granulocytes predominantly were increased despite the absence of apparent infection, the patient's serum G-CSF concentration was examined and found to be 286.0 pg/mL and to increase with time. After thoracic esophagectomy was performed, granulocyte count and serum G-CSF concentration rapidly normalized. G-CSF concentration was 50-fold higher in the tumor tissue extract than in the extract from normal esophageal tissue. Microscopic examination of the resected specimens revealed that the tumor was comprised of squamous cell carcinoma (SCC) and spindle-shaped sarcomatous elements, and transitional features were observed within these two components. Immunohistochemical examination disclosed cells that were positive for keratin and EMA in the carcinomatous element and vimentin positive cells in the sarcomatous element. However, both types of tumor cells were positive for G-CSF. CONCLUSIONS: The presence of G-CSF in both SCC cells and spindle-shaped sarcomatous cells indicated that these two components originated from a single clone.

Carcinosarcoma↗

PubMed1976

Pseudosarcoma and carcinosarcoma of the esophagus.

Two cases of polypoid carcinoma with pseudosarcoma and one of so-called carcinosarcoma of the esophagus are presented. The clinical and morphologic characteristics of these tumors are described and the literature is reviewed. It is postulated that pseudosarcomas and so-called carcinosarcomas belong essentially to the same pathologic entity because of their similar morphologic and biologic aspects. The histogenesis of the sarcoma-like elements of these tumors support the theory of epithelial origin on the basis of the sarcoma-like transformation of squamous cell carcinoma and of the presence of epithelial elements in the "sarcomatous" areas.

Aged↗

PubMed1986

Carcinosarcoma of the colon. Report of a unique case with light and immunohistochemical studies.

A unique case of carcinosarcoma of the colon is reported. The tumor invaded the bowel wall deeply, metastasized widely, resisted multi-agent chemotherapy, and caused the patient's death 4 years later. The tumor was composed of adenosquamous carcinoma admixed with sarcoma showing osseous, cartilaginous, and nonspecific spindle-cell differentiation. Although carcinoembryonic antigen appeared limited to carcinoma cells, cytokeratin immunoreactivity was observed in both carcinoma and sarcoma cells. Like carcinosarcomas at other body sites, the finding of cytokeratin in sarcoma cells supports partial epithelial differentiation in this component, likely retained from carcinoma precursor cells.

Aged↗

PubMed1988

Fine-needle aspiration cytology of pulmonary carcinosarcoma with immunocytochemical and ultrastructural observations.

The cytologic, immunocytochemical, and ultrastructural features of a pulmonary carcinosarcoma diagnosed by fine-needle aspiration biopsy are presented. Both malignant epithelial groups and bizarre spindle-shaped cells arranged in loose groups, microtissue fragments and in a dissociate fashion showed dual immunoperoxidase staining with cytokeratins and vimentin. Although the immunocytochemical staining pattern is typical of this neoplasm, it does not allow differentiation in all cases from the more common primary large-cell undifferentiated carcinoma, which can also show dual staining for cytokeratin and vimentin. However, the presence of poorly differentiated epithelial groupings associated with a malignant mesenchymal component set in a myxoid stroma should suggest the correct diagnosis. Cytologically, differentiating carcinosarcoma, a poorly differentiated malignancy showing dual staining for cytokeratin and vimentin, from a large-cell carcinoma is important, since the former may pursue a more indolent clinical course.

Biopsy, Needle↗

PubMed1992

Cervicovaginal cytology in carcinosarcoma [malignant mixed mullerian (mesodermal) tumor] of the uterus.

We examined the cervicovaginal cytology (PAP) findings in a series of 21 endometrial and 2 cervical carcinosarcomas (CS) [malignant mixed mullerian (mesodermal) tumors] (MMMT). Initial cytology diagnosis was positive for cancer in 14 of 23 cases (sensitivity of 61%); however, CS was correctly identified only 2 times. The remaining 12 cancer diagnoses were carcinomas: 10 adenocarcinomas (4 endometrial, 1 cervical, and 5 adenocarcinomas not otherwise specified), 1 squamous carcinoma, and 1 poorly differentiated carcinoma. Seventeen smears were available for review, all 8 false negative, one unsatisfactory, and 8 of 14 true positive smears. One false negative smear showed rare clusters diagnostic of adenocarcinoma. The remaining 7 false negative smears showed 3 high grade squamous dysplasias (two with additional findings: one showed atypical spindle cells and the other showed endometrial stromal cells), 2 extensive repair changes, and 2 negatives. The unsatisfactory smear showed atypical spindle cells. Review of the 8 true positive smears confirmed malignant spindle cells in the two cases originally identified as CS by cytology and in 3 other cases originally identified as adenocarcinoma. Of 9 smears positive for cancer available for review, 4 showed only carcinoma cells. PAP positive for cancer was associated with high stage at presentation (P less than .025) and recurrent disease (P less than .001) (even among stage I or II patients, P less than .025). PAP positive for cancer showed no association with depth of myometrial invasion, size, grade, or histologic type of carcinosarcoma. The results of this study demonstrate the importance of consultative cytology reporting in which recommendations for appropriate biopsy are included in the report.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗

PubMed1978

Carcinosarcomas and mixed mesodermal tumors of the ovary: a clinicopathologic study of six cases.

A clinicopathologic study of three ovarian carcinosarcomas and three mixed mesodermal tumors of the ovary is presented. None of the patients survived for more than 1 year, irrespective of chemotherapeutic treatment or the extent of surgery. No prognostic differences were noted between the histologic patterns of varying tumor sizes of carcinosarcomas and mixed mesodermal tumors. The association of these two entities with other neoplasms of Müllerian nature suggests a multicentric tumor response of Müllerian tract derivatives. The necessity of adequate sampling, both for correct diagnosis and to exclude the possibility of teratoma (which behaves in a more benign fashion), is emphasized.

Aged↗

PubMed1997

Cervical carcinosarcoma occurring after subtotal hysterectomy, a case report.

Subtotal hysterectomy has been advocated in recent years as an alternative to total abdominal hysterectomy. In leaving behind the uterine cervix, this remnant can be at risk for dysplastic and neoplastic changes. The development of cancer of the cervix after subtotal hysterectomy is considered low and is usually of an epithelial origin. Carcinosarcomas of the uterine corpus are infrequent aggressive tumors with a very poor prognosis. This malignancy of the cervix has been rarely reported. We present a case of cervical carcinosarcoma occurring in the remaining lower uterine segment and cervix following subtotal hysterectomy for pelvic pain.

Carcinosarcoma↗

PubMed1998

The impact of adjuvant radiotherapy on carcinosarcoma of the uterus.

BACKGROUND: The role of adjuvant radiotherapy in the setting of uterine carcinosarcoma has not been clearly established. METHODS: A retrospective review of 60 patients receiving definitive therapy for carcinosarcoma of the uterus was undertaken at a single institution. Twenty-nine of 60 patients were treated with adjuvant radiotherapy. RESULTS: The addition of radiotherapy significantly reduced the local recurrence rate from 55% (17 patients) to 3% (1 patient). Adjuvant radiotherapy reduced the risk of distant failure and death in patients with disease confined to the uterus but did not impact distant recurrence or survival in stage III patients. Increasing stage and depth of myometrial tumor invasion were negatively associated with overall survival and disease-free survival but had no impact on local recurrence rates. The nuclear grade of the epithelial component was predictive of local recurrence (P = 0.0592), but epithelial architectural grade, grade of stromal component, and stromal versus epithelial predominance did not provide prognostic information. The relative risk of local recurrence of unirradiated patients versus irradiated patients was 17.54 (P = 0.0055) after adjusting for nuclear grade of the epithelial component. CONCLUSIONS: Local failure represents a significant site of failure in the absence of adjuvant radiotherapy. The improvement in local failure rates with the addition of radiotherapy translates into an improvement in distant failure rates and survival only for patients with stage I/II disease. Epithelial nuclear grade, in addition to depth of myometrial invasion and stage, provides important prognostic information. Epithelial architectural grade, stromal grade, type of stromal component (homologous versus heterologous), and predominance of either stromal or epithelial component were not found to be significant prognostic factors.

Aged↗

PubMed2000

A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group Study.

OBJECTIVE: The aims of this study were to substantiate the previously reported activity of ifosfamide in patients with advanced, persistent, or recurrent carcinosarcoma (mixed mesodermal sarcoma) of the uterus, and to determine whether the addition of cisplatin results in an improved response or survival. Secondarily, we sought to determine the toxicity of ifosfamide-cisplatin in this patient population. METHODS: Patients were randomized to receive ifosfamide (1.5 g/m(2)/day) times 5 days every 3 weeks for eight courses with mesna uroprotection, with or without cisplatin (20 mg/m(2)/day) times 5 days. No patient had received previous chemotherapy. RESULTS: Of 224 patients entered on this study, 30 were ineligible for a variety of reasons, leaving 194 evaluable patients. Early in the study, the dose of the combination regimen was reduced by 20% (1 day) because of toxicity. The investigational arms were balanced for age, grade, and Gynecologic Oncology Group performance status. Percentages of adverse effects reported in 191 patients receiving chemotherapy included (ifosfamide/cisplatin-ifosfamide) grade 3 or 4 granulocytopenia (36/60), grade 3 or 4 anemia (8/17), grade 3 or 4 central nervous system toxicity (19/14), and grade 3 or 4 peripheral neuropathy (1/12). Treatment may have contributed to the deaths of 6 patients treated with full doses of ifosfamide and cisplatin for 5 days. The proportion of patients responding to ifosfamide alone versus ifosfamide-cisplatin therapy was (0.36 versus 0.54) overall, 0.47 versus 0.61 for pelvic, 0.21 versus 0.54 for lung, and 0.33 versus 0.40 for "other" metastatic sites of measurable disease. The relative odds ratio of response adjusted for measurable sites of disease was 1.82 (P = 0.03, one-tailed test; 95% lower confidence limit, 1.06). Progression-free survival (PFS) and survival data suggest that the combination offers a slight prolongation of PFS (relative risk, 0.73; 95% upper confidence limit, 0.94; P = 0.02, one-tailed test), but no significant survival benefit (relative risk, 0.80, 95% upper confidence limit, 1.03; P = 0.071, one-tailed test). CONCLUSION: The addition of cisplatin to ifosfamide appears to offer a small improvement in progression-free survival over ifosfamide alone in the management of advanced carcinosarcoma of the uterus; the added toxicity may not justify the use of this combination.

Adult↗

PubMed1996

Carcinosarcoma of the urinary bladder.

A case of carcinosarcoma of the urinary bladder is reported. Transurethral resection was performed. Histologically the tumorous mass was composed of osteosarcoma, squamous cell carcinoma and transitional cell carcinoma. The histological findings, immunohistochemical features and clinical manifestations of bladder carcinosarcoma are discussed in relation to the literature.

Aged↗

PubMed2005

[Carcinosarcoma of the breast: a tumour with controversial histogenesis].

Carcinosarcoma of the breast is a rare, biphasic, tumour with epithelium and mesenchymal components. Its histogenesis is controversial and, hence, has received various different nomenclatures. At present, all studies indicate that it is a variety of methaplasic tumour and suggest multi-potential myoepithelial cell origin. Clinically, it presents as a tumour of variable size and its diagnosis has been by immunohistochemistry studies, or by electron microscopy. We present, here, a patient with mammary carcinosarcoma a difficult diagnosis. Treatment for the patient was a modified radical mastectomy, and adjuvant therapy.

Antineoplastic Combined Chemotherapy Protocols↗

PubMed2000

Rapid-growing carcinosarcoma of the esophagus arising from intraepithelial squamous cell carcinoma: report of a case.

A case of carcinosarcoma arising from the intraepithelial spreading area of esophageal squamous cell carcinoma (SCC) is reported herein. A 64-year-old man was referred to our hospital for investigation of a sore throat and dysphagia. An endoscopic examination revealed a 2. 5-cm polypoid mass in the mid-esophagus. Esophagograms taken 1 month prior to consultation by our hospital and just before surgery revealed marked change within a period of less than 2 months from a 2-cm sessile elevated mass to a 4-cm polypoid mass with a lobular appearance. The resected specimen contained two lesions in the esophagus. The larger one measured 4.0 x 2.0 x 2.0 cm and had a pedunculated polypoid shape, while the smaller one, measuring 1 cm in diameter, was a plateau-type elevated lesion located 3 cm distal from the larger mass. Histologically, the distal smaller lesion was diagnosed as primary SCC associated with a high frequency of intraepithelial spread, while the larger polypoid mass was composed of spindle-shaped sarcomatous cells, arising from the intraepithelial spread of SCC. To our knowledge, this is the only reported case of esophageal carcinosarcoma arising from an area of intraepithelial spread of SCC that showed such surprisingly rapid growth.

Carcinoma in Situ↗

PubMed1998

[Primary paraurethral malignant mixed tumor (carcinosarcoma) of the vagina. A case report].

In total malignant mixed tumors (carcinosarcomas) represent a very rare gynecological neoplasm. In accordance with the embryological genesis primary localizations are with descending probability the uterus, the ovarians and finally the tubes. We report on a 55 year old female patient, with a paraurethral mass, which was primarily diagnosed in 1994. Histopathological evaluation of a transvaginal biopsy did not demonstrate evidence of malignancy at that time. After painful enlargement the paraurethral mass was resected surgically and histopathological evaluation revealed a primary paraurethral malignant mixed tumor (carcinosarcoma). Postoperatively, the patient underwent percutaneous (46.4 Gy) and intracavitary (2 x 6 Gy) radiation. Twelve months postoperatively there is no evidence of disease.

Brachytherapy↗

PubMed2006

Ureteral mullerian carcinosarcoma (mixed mullerian tumor) associated with endometriosis occurring in a patient with a concentrated soy isoflavones supplementation.

Malignant transformation and particularly malignant mixed mullerian tumor arising in extragenital endometriosis is extremely rare and occurs in the majority of cases after estrogen replacement therapy. We present a case of a 75-year-old woman who developed a ureteral malignant mullerian carcinosarcoma in a context of florid endometriosis. The patient had a history of total hysterectomy with bilateral salpingo-oophorectomy 30 years earlier for extensive endometriosis. Since 5 years, the patient has been on phytoestrogen supplementation consisting of 72 mg/day of superconcentrated soy isoflavones. This is the first case of ureteral mullerian carcinosarcoma arising in endometriosis foci after extensive phytoestrogen supplementation. Our data suggest that phytoestrogens at least in concentrated form may play a role not only in maintenance of endometriosis but also in its malignant transformation. Given the extraordinary popularity and availability of these dietary supplements, several studies are indispensable regarding their safety particularly in women with extensive endometriosis.

Aged↗

PubMed2002

A gastric carcinosarcoma with neuroendocrine cell differentiation and undifferentiated spindle-shaped sarcoma component possibly progressing from the conventional tubular adenocarcinoma; an immunohistochemical and ultrastructural study.

A 56-year-old Japanese man underwent total gastrectomy with lymph-node dissection for a gastric tumor. In the oral rim of the excised large ulcerated tumor, a small nodular mass demonstrated a unique histology of a carcinosarcoma composed of more than three distinctive components. A major part of the large ulcerated tumor tissue consisted of conventional tubular adenocarcinoma, with the coincidental focal distribution of solid cell nests of poorly differentiated or neuroendocrine cell (small cell) carcinoma. Sarcoma cells were another of the constituents of the small nodular tumor with atypical spindle-shaped cells. All the excised lymph-node metastasis demonstrated the histology of tubular adenocarcinoma. In the sarcoma cells, many of the lineage-specific immunohistochemical markers were negative. Only vimentin was positive. Electron microscopy revealed that the neuroendocrine cell carcinoma contained cells with abundant small aggregations of neurosecretory-type granules in their cellular cytoplasm. Primitive cellular junctions and incomplete basal lamina were seen in the sarcoma cells. No transitional or hybrid-type cells were seen between carcinoma and sarcoma cells. The interfaces between the cancer cell nests and the proliferation of sarcoma cells are clearly discerned. It was speculated that the unique histology of carcinosarcoma might have progressed from the conventional type of pre-existing advanced tubular adenocarcinoma.

Adenocarcinoma↗

PubMed1991

Carcinosarcoma of the lung with hypertrophic pulmonary osteoarthropathy.

Carcinosarcoma of the lung is a rare malignancy. Endobronchial and parenchymal variants are classically described. Clinicopathological features are often related to anatomical location, as is the case for most lung neoplasms. This case report details the surgical management of a carcinosarcoma in a patient seen with pulmonary osteoarthropathy.

Carcinosarcoma↗

PubMed1993

Carcinosarcoma (malignant mixed müllerian (mesodermal) tumor) of the female genital tract: immunohistochemical and ultrastructural analysis of 28 cases.

In an attempt to clarify the histogenesis of carcinosarcoma (malignant mixed müllerian tumor) of the female genital tract, 20 uterine and eight ovarian tumors were studied by light microscopy, transmission electron microscopy, and immunohistochemistry. Cytokeratins (MAK-6 and AE1:AE3) and epithelial membrane antigen were detected in the epithelial component of all tumors and in the stromal component of 15 cases (55%). Vimentin was detected in the stromal component of all cases and was focally positive in the epithelial component of 18 cases (69%). Tumors showing rhabdomyosarcomatous or chondrosarcomatous differentiation were positive for myoglobin and S-100 protein, respectively. At the ultrastructural level epithelial cells were observed in tight clusters (usually surrounded by a basal lamina), in loose aggregates, and singly (sometimes spindle shaped), and were surrounded by cells displaying variable differentiation. The closest examples of "hybrid" epithelial/stromal cells were those with a prominent rough endoplasmic reticulum, cytoplasmic projections, poorly formed intercellular junctions, and an incomplete basal lamina. The observations support the view that carcinosarcomas of the female genital tract could represent examples of biphasic (metaplastic) carcinomas.

Aged↗