CD34 Immunohistochemistry in Female Genital Tract Carcinosarcoma (Malignant Mixed Müllerian Tumors) Supports a Dominant Role of the Carcinomatous Component:

Diagnostic use of immunohistochemistry in uterine mesenchymal tumors

Immunohistochemistry may be helpful in the diagnosis of mesenchymal uterine tumors. This article reviews the immunoreactions used most frequently in the diagnosis of uterine smooth muscle tumors, endometrial stromal tumors, undifferentiated endometrial sarcomas, UTROSCTs, PEComas, adenomyomas, adenosarcomas and carcinosarcomas.

Current management of ovarian carcinosarcoma

Ovarian carcinosarcomas (OCS), also known as malignant mixed müllerian tumors, are uncommon malignancies that carry a poor prognosis. The presentation of OCS is usually indistinguishable from that of epithelial ovarian cancer. Due to its low frequency, prospective trials have been difficult to perform, but there is evidence that OCS are sensitive to platinum-based chemotherapy. Recent studies have shown encouraging results with platinum-ifosfamide and platinum-taxane schedules, which are usually considered the treatment of choice. However, poor performance status at presentation is also a common problem, so that many patients may be unsuitable for combination chemotherapy but may still benefit from single-agent platinum or ifosfamide or, occasionally, from nonplatinum schedules such as ifosfamide plus paclitaxel. Aggressive cytoreductive surgery appears to have a positive impact on outcome and should probably be offered to most patients. However, this procedure has been associated with higher rates of complication in OCS and should only be attempted by experienced (gynecological) surgeons in centers with expertise in the management of gynecological malignancies.

Diagnostic dilemma in a case of malignant mixed mullerian tumor of the cervix

Background

Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm. The commonest site of their occurrence in female genital tract is body of the uterus. MMMT of the cervix is extremely rare.

Case presentation

We report the clinical, pathological and immunohistochemical profile and diagnostic difficulties in a case of giant MMMT of the cervix in a postmenopausal woman who presented with a large cervical mass. On microscopic examination, initially tumor appeared to be endometrial stromal sarcoma, however, immunohistochemical examination revealed the biphasic nature of the tumor. The malignant epithelial component was basaloid squamous carcinoma with homologous sarcomatous component. The patient was treated with surgery. However, she experienced vaginal vault recurrence four months after the initial treatment, which was successfully treated with pelvic radiotherapy.

Conclusion

Accurate diagnosis of cervical MMMT is important for appropriate treatment of the patient.

Clinicopathological features of ovarian carcinosarcomas: a single institution experience

OBJECTIVE

The aim of this study was to elucidate the clinicopathological and immunohistochemical prognostic factors of patients with ovarian carcinosarcoma treated with radical surgery and postoperative chemotherapy.

METHODS

During a 6-year period, nine patients with ovarian carcinosarcoma were referred to our institution. Tissue blocks were reviewed and sections containing both carcinomatous and sarcomatous elements were stained for epithelial membrane antigen (EMA), vimentin, vascular endothelial growth factor (VEGF), CD45RO, c-erbB-2, p53, CD34, Ki67, S100, estrogen, and progesterone receptors. Histological and immunohistochemical findings as well as clinical characteristics were then correlated with progression-free interval and overall survival.

RESULTS

There were four homologous and five heterologous carcinosarcomas. Five patients had early stage disease. Seven of the patients were optimally debulked. All patients were treated with anthracycline-based chemotherapy following surgery. With regard to immunohistochemistry, all specimens were negative for CD34, c-erbB-2, estrogen, and progesterone receptor expression. Five tumors overexpressed p53 and four specimens demonstrated a positive staining for Ki67. Reactivity for VEGF and CD45RO was observed in four and two tumor specimens, respectively. The median overall survival was 32.9 months with no statistical difference between early and advanced stages, while median time to progression was 13.5 months. p53 overexpression demonstrated a trend for better overall survival.

CONCLUSIONS

Only p53 overexpression seems to influence overall survival although, due to the small number of patients studied, no safe conclusions can be drawn. Despite the predominance of early stage patients that favorably influenced overall survival, aggressive surgical cytoreduction followed by anthracycline-based treatment were the cornerstone in our multimodality approach.

Benign mixed tumor of the vagina: case report with expanded immunohistochemical profile

We present a case of benign mixed tumor of the vagina with its typical clinicopathologic and expanded immunohistochemical features. The strong coexpression of the mesenchymal spindle cell component with epithelial markers such as CK7, together with strong CD10, Bcl2, and estrogen and progesterone receptors favors a mullerian derived tumor. The tumor is best labeled as benign mixed mullerian tumor as originally designated.