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Koyanagi T, To Y, Ando M, Matsuoka S, Nakamura S, Goto M, Kondo H, Eguchi F, Tsujioka H. Primary peritoneal carcinosarcoma arising from the Douglas pouch: A case report. Mol Clin Oncol 2018; 9:485-488. [PMID: 30345041 PMCID: PMC6174426 DOI: 10.3892/mco.2018.1711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2018] [Accepted: 08/17/2018] [Indexed: 11/09/2022] Open
Abstract
Primary peritoneal carcinosarcoma is extremely rare and only few cases have been reported in the literature to date. We herein present a case of carcinosarcoma of the Douglas pouch in a 73-year-old Japanese woman. The patient complained of fever and lower abdominal pain, and a large pelvic mass (>10 cm in diameter) was detected, with rectal invasion. Laparotomy was performed and revealed a left ovarian abscess and a Douglas pouch mass; however, there was no obvious tumor involvement of the bilateral ovaries or uterus. The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and tumor debulking, with a reduction rate of ~30%. Sigmoid colostomy was also performed due to the deep and wide rectal invasion. Histologically, the tumor was composed of a mixture of ovarian high-grade serous carcinoma and spindle-cell sarcoma mimicking leiomyosarcoma. Immunohistochemically, the serous carcinoma component was positive for cytokeratin (CK)7, Wilms' tumor-1 and p53 (null type), while CDX-2 and CK20 were negative. The spindle-cell sarcoma component was positive for vimentin and α-smooth muscle actin. The present case was diagnosed as carcinosarcoma of the homologous type derived from the peritoneum in the Douglas pouch. The patient received several courses of combination chemotherapy with paclitaxel, carboplatin and bevacizumab, and achieved complete remission. The principal treatment for such cases is surgery, and several chemotherapeutic regimens, including paclitaxel and carboplatin, or cisplatin and ifosfamide, have been reported. The accumulation of more clinical cases is crucial for understanding the clinicopathological characteristics of these rare tumors and establishing effective therapeutic strategies.
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Affiliation(s)
- Takahiro Koyanagi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan.,Department of Obstetrics and Gynecology, School of Medicine, Jichi Medical University, Shimotsuke, Tochigi 329-0498, Japan
| | - Yoko To
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Miho Ando
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sakiko Matsuoka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Sumie Nakamura
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Maki Goto
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Haruhiko Kondo
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Fuyuki Eguchi
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
| | - Hiroshi Tsujioka
- Department of Obstetrics and Gynecology, ASO Iizuka Hospital, Iizuka, Fukuoka 820-8505, Japan
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Semczuk A, Ignatov A, Obrzut B, Reventos J, Rechberger T. Role of p53 Pathway Alterations in Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumors). Oncology 2014; 87:193-204. [DOI: 10.1159/000363574] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 05/07/2014] [Indexed: 01/10/2023]
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Terada T. Carcinosarcoma in the pouch of douglas. Arch Gynecol Obstet 2009; 281:345-8. [PMID: 19484471 DOI: 10.1007/s00404-009-1132-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2008] [Accepted: 05/12/2009] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Only one case of carcinosarcoma in the pouch of douglas has been reported in the English literature. CASE The author herein reports a case of carcinosarcoma of the pouch of douglas. A rapidly growing tumor (10 cm in diameter) was found in the pelvic cavity of a 51-year-old woman, and an operation was performed for the clinical diagnosis of left ovarian malignancy. However, it was found that the tumor was located in the pouch of douglas, free of ovarian involvement. Because the tumor was impossible to resect totally, an incisional biopsy was performed. Histologically, the tumor showed a mixture of squamous cell carcinoma, atypical epithelial cells occasionally forming tubules, myxomatous spindle cell sarcoma, and chondrosarcoma. The tumor showed abundant vessels, hemorrhage and necrosis. Immunohistochemically, the squamous cell carcinoma and atypical epithelium components were positive for cytokeratins, CEA, CA125, and p53 protein. The spindle cell sarcoma and chondrosarcoma components were positive for vimentin and p53 protein. The overall Ki-67 labeling was 30%. The author diagnosed the present case as carcinosarcoma of heterologous type. CONCLUSION The present case shows that carcinosarcoma can occur in the pouch of douglas. It may arise from misplaced Mullerian duct remnants in the pouch of douglas.
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Affiliation(s)
- Tadashi Terada
- Department of Pathology, Shizuoka City Shimizu Hospital, Miyakami 1231 Shimizu-Ku, Shizuoka, 424-8636, Japan.
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