Serous effusion cytology in gynecologic malignant mixed müllerian tumors

Effusion cytology of metastatic carcinosarcoma

Objectives

Carcinosarcomas (CSs) are rare gynecological neoplasms seen in elderly females. These are composed of malignant epithelial and mesenchymal components, which appear as adenocarcinoma and high-grade sarcoma. Effusions are encountered uncommonly in CS.

Material and Methods

The study focuses on the cytomorphology of 10 cases of metastatic CS in effusions. In 6 years, there were 10 (0.45%) cases of metastatic CS in effusion samples out of 2240 malignant effusion samples. The samples were processed by SurePath™ and centrifuge technique. Both May-Grünwald-Giemsa and Papanicolaou stained smears were evaluated for cytomorphological features, and the findings were correlated with subsequent histopathology.

Results

The cells were predominantly arranged in ball-like clusters and discretely. The cells had abundant vacuolated cytoplasm and enlarged pleomorphic nuclei. Occasional cases showed scattered spindle cells. The cases were diagnosed as metastatic adenocarcinoma (7/10) and positive for malignant cells (3/10). None of the cases was diagnosed as CS. The primary of these cases was in the uterus (7/10) and ovary (3/10).

Conclusion

The cytological evaluation of such effusion samples rarely demonstrates the classical biphasic pattern of these tumors. Mostly, the carcinomatous component is evident, and the sarcomatous element is inapparent and readily missed.

Cytologic presentation and clinicopathologic correlation of Mullerian carcinosarcoma on serous fluid samples

INTRODUCTION

Limited data are present to study the cytologic findings of Mullerian carcinosarcoma (MCS) in serous fluid samples and clinicopathologic features that are associated with cytology yield.

MATERIALS AND METHODS

We studied 30 MCS patients diagnosed on surgical resection samples, and reviewed their cytomorphology and immunophenotypes on concurrent serous fluid cytology samples. Clinicopathologic features were also compared between cases with positive or negative cytology.

RESULTS

Fourteen out of 30 patients showed positive cytology, including 12 patients with only carcinomatous components and 2 with sarcomatous cells. Cytomorphology of MCS was mostly consistent with adenocarcinoma, with psammoma bodies occasionally present. The 2 cases with sarcomatous cells showed spindle cells without signs of heterologous differentiation. PAX8 was positive in 10 of 11 cases, and WT1 was positive in 8 of 11 cases including the case with negative PAX8. In 1 case, PAX8 and WT1 were only positive in the sarcomatous but not in carcinomatous cells. MOC31 showed consistent positivity in carcinomatous cells, which appeared to be more sensitive than B72.3 (positive in 72.7%). In addition, sarcomatous cells showed CD10 positivity in 1 case. Clinically, patients who developed body cavity effusions or with higher stage diseases were more likely to have positive cytology.

CONCLUSIONS

Cytologic diagnosis of MCS in the serous fluid is challenging due to the rare presence of sarcomatous component. Staining both PAX8 and WT1 is recommended to confirm their Mullerian origin, although both markers may be positive only in sarcomatous cells. Cytology yield of MCS is highly associated with the disease stage.

Effusion cytodiagnosis of carcinosarcoma derived from the female genital tract: immunohistochemical features of MMP-7 and Ki-67 and immunofluorescence double staining analyses of eight cases

OBJECTIVE

Expression of Matrix metalloproteinase 7 (MMP-7) and Ki-67 by carcinoma components (CCs) and sarcoma components (SCs) in carcinosarcoma of the female reproductive organs has been investigated by conventional methods, but analysis with immunohistochemical staining of multiple antigens has not been reported. We report the profiles of expression of MMP-7 and Ki-67 in carcinosarcoma determined with immunohistochemical staining techniques.

METHODS

We used antibodies against epithelial antigen (EA), epithelial membrane antigen (EMA), and vimentin for immunofluorescence double staining of ascitic fluid in eight cases of carcinosarcoma of female reproductive organs. We also used immunohistochemical triple staining to compare MMP-7 and Ki-67 expression between CCs and SCs in the primary site of carcinosarcoma.

RESULTS

Immunofluorescence analysis revealed that all neoplastic cells in the ascitic fluid were positive for EA or EMA, indicating that these cells were CCs. Immunohistochemical analyses of the primary organ of carcinosarcoma revealed that MMP-7 was expressed on CCs in four of eight cases of carcinosarcoma, whereas MMP-7 was not expressed on SCs. The average Ki-67 labeling index (LI) in CCs and SCs was 51.8% and 28.6%, respectively. The difference in Ki-67 LI between CCs and SCs was statistically significant (t test for paired samples, P = 0.0173).

CONCLUSIONS

This is the first study to examine carcinosarcoma of the female reproductive organ by immunohistochemical staining for multiple antigens, which allows analysis of mixed tumor elements. In addition, we found that expression of MMP-7 and the average Ki-67 LI differ between CCs and SCs in carcinosarcoma. The predominance of CCs as the malignant cells in the ascitic fluid may be due to cytological differences between CCs and SCs of carcinosarcoma.