Rodríguez Sánchez-Reyman J, Luque-González P, Gutiérrez-Domingo Á, Rodríguez-Jiménez I, Pantoja-Garrido M

Language: Spanish
References: 20
Page: 884-890
PDF size: 297.76 Kb.

ABSTRACT

Background: Ovarian carcinosarcoma, or mixed Müllerian tumor, is a rare neoplasm that represents about 1 to 4% of epithelial ovarian carcinomas. Its histology combines sarcomatous and carcinomatous components.
Clinical case: 55-year-old female patient with a diagnosis of ovarian carcinosarcoma. She consulted due to irregular uterine bleeding and abdominal pain. Transvaginal ultrasound showed a solid and heterogeneous adnexal formation measuring 11.95 x 10.6 cm, with Doppler uptake. The study was expanded with an abdominopelvic and chest computed axial tomography (CT) scan in which a tumor was observed on the left side measuring 18 x 13 cm. Tumor markers were reported elevated: CEA 10.60, CA 125 91.3 and CA19.9 153 U/mL, with HE-4 protein 86.8 pmol/L, slightly decreased. Exploratory laparotomy was completed with R0 surgery. Chemotherapy with paclitaxelcarboplatin was indicated. The definitive histological study reported the existence of a solid-cystic tumor, compatible with a carcinosarcoma in the left ovary, with extensive peritoneal dissemination. Three months after surgery, the patient continued without signs of recurrence.
Conclusions: Carcinosarcoma is a rare but very aggressive gynecologic tumor; because of its exceptional finding no treatment criteria are yet available. It is crucial to encourage future research on prognostic factors and biomarkers and to develop treatments targeted to the molecular characteristics of each patient.

REFERENCES

1. Wang WP, Li N, Zhang YY, Gao YT, et al. Prognostic significance of lymph node metastasis and lymphadenectomy in early-stage ovarian carcinosarcoma. Cancer Manag Res 2018; 10: 1959-68. doi: 10.2147/CMAR.S166524.

2. Zhao S, Bellone S, Lopez S, Thakral D, et al. Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition. Proc Natl Acad Sci U S A 2016; 113 (43): 12238-43. doi: 10.1073/pnas.1614120113

3. Guy JB, Trone JC, Castillo F, Forest F, et al. Carcinosarcomas in female genital tracts: general review. Bull Cancer 2014; 101 (7-8): 760-4. doi: 10.1684/bdc.2014.1937

4. Nizam A, Bustamante B, Shan W, Shih KK, et al. Overall Survival and Adjuvant Therapy in Women with Ovarian Carcinosarcoma: A Single-Institution Experience. Diagnostics (Basel) 2019; 9 (4): 200. doi: 10.3390/diagnostics9040200.

5. Montalvo-Esquivel G, Chanona-Vilchis JG, Herrera-Gómez A, Meneses-García AA, et al. Primary ovarian carcinosarcoma. Report of eight cases. Ginecol Obstet Mex 2014; 82 (7): 483-9. PMID: 25102674.

6. Daimon A, Fujiwara S, Tanaka Y, Tanaka T, et al. A rare case of ovarian carcinosarcoma with squamous cell carcinoma. Ovarian Res 2019; 12 (1): 32. doi: 10.1186/s13048-019- 0507-3.

7. Zhu A, Li JD, Feng YL, Xu MM, et al. Clinical analysis of 12 cases of ovarian carcinosarcoma. Nan Fang Yi Ke Da Xue Xue Bao 2011; 31 (3): 518-21. PMID: 21421496

8. Kim HJ, Lee HM, Kim MK, Lee YK, et al. Prognostic assessment of sarcomatous histologic subtypes of ovarian carcinosarcoma. Obstet Gynecol Sci 2017; 60 (4): 350- 56. doi: 10.5468/ogs.2017.60.4.350

9. Gotoh O, Sugiyama Y, Takazawa Y, Kato K, et al. Clinically relevant molecular subtypes and genomic alteration-independent differentiation in gynecologic carcinosarcoma. Nat Commun 2019; 10: 4965. doi: 10.1038/s41467-019- 12985-x

10. Rewsuwan S, Satabongkoch N, Suprasert P, Khunamornpong S. Ovarian carcinosarcoma and its association with mature cystic teratoma and primary tubal carcinoma. Case Rep Pathol 2016; 2016: 2605045. doi: 10.1155/2016/2605045

11. Han C, Altwerger G, Menderes G, Haines K, et al. Novel targeted therapies in ovarian and uterine carcinosarcomas. Discov Med 2018; 25 (140): 309-19. PMID: 30021104

12. Kostov S, Kornovski Y, Ivanova Y, Dzhenkov D, et al. Ovarian carcinosarcoma with retroperitoneal para-aortic lymph node dissemination followed by an unusual postoperative complication: a case report with a brief literature review. Diagnostics (Basel) 2020; 10 (12): 1073. doi: 10.3390/ diagnostics10121073

13. Pankaj S, Nazneen S, Kumari A, Kumari S, et al. A rare tumor of the ovary: carcinosarcoma report and review of literature. J Obstet Gynaecol India 2016; 66 (Suppl 2): 648-50. doi: 10.1007/s13224-015-0788-4

14. Xu Q, Zhang X, Zou Y. Primitive ovarian carcinosarcoma: a clinical and radiological analysis of five cases. J Ovarian Res 2020; 13 (1): 129. doi: 10.1186/s13048-020-00728-2

15. Koirala P, Moon AS, Chuang L. Clinical utility of preoperative assessment in ovarian cancer cytoreduction. Diagnostics (Basel) 2020; 10 (8): 568. doi: 10.3390/diagnostics10080568

16. García Prado J, González Hernando C, Varillas Delgado D, Saiz Martínez R, et al. Diffusion-weighted magnetic resonance imaging in peritoneal carcinomatosis from suspected ovarian cancer: diagnostic performance in correlation with surgical findings. Eur J Radiol 2019; 121: 108696. doi: 10.1016/j.ejrad.2019.108696

17. Peres LC, Cushing-Haugen KL, Köbel M, Harris HR, et al. Invasive epithelial ovarian cancer survival by histotype and disease stage. J Natl Cancer Inst 2019; 111 (1): 60-68. doi: 10.1093/jnci/djy071

18. González Martín A, Oda AM, Embleton AC, Pfisterer J, et al. Exploratory outcome analyses according to stage and/or residual disease in the ICON7 trial of carboplatin and paclitaxel with or without bevacizumab for newly diagnosed ovarian cancer. Gynecol Oncol 2019; 152 (1): 53-60. doi: 10.1016/j.ygyno.2018.08.036

19. Telli ML, Timms KM, Reid J, Hennessy B, et al. Homologous Recombination Deficiency (HRD) score predicts response to platinum-containing neoadjuvant chemotherapy in patients with triple-negative breast cancer. Clin Cancer Res 2016; 22 (15): 3764-73. doi: 10.1158/1078-0432.CCR-15-2477

20. Liu FW, Tewari KS. New targeted agents in gynecologic cancers: synthetic lethality, homologous recombination deficiency, and PARP inhibitors. Curr Treat Options Oncol 2016; 17 (3): 12. doi: 10.1007/s11864-015-0378-9