Carcinosarcoma of Uterus: a Review
Corresponding Author(s) : Dr. Deepti Sharma
drdeeptisharma16@gmail.com
International Journal of Allied Medical Sciences and Clinical Research,
Vol. 4 No. 3 (2016): 2016 Volume 4- Issue -3
Abstract
Carcinosarcoma of the uterus is an aggressive, rare biphasic neoplasm composed of malignant epithelial and mesenchymal elements believed to arise from a monoclonal origin. The principal treatment in early/locally-advanced carcinosarcoma is surgery. Because of its aggressiveness, it generally presents distant metastases at diagnosis. Adjuvant radiotherapy and chemotherapy have uncertain effect. Chemotherapy alone or associated with radiotherapy seems to improve disease free survival (DFS) and overall survival (OS) in stage III and IV UCS. No advantages in OS and DFS have been shown with radiotherapy alone. The present review summarizes and analyzes the most important features about this type of gynaecological cancer.
Keywords
Carcinosarcoma of uterus
MMMT uterus
Radiation therapy
Monoclonal
1.
Dr. Deepti Sharma. Carcinosarcoma of Uterus: a Review. Int. J. of Allied Med. Sci. and Clin. Res. [Internet]. 2020 Aug. 6 [cited 2026 Apr. 19];4(3):429-35. Available from: https://ijamscr.com/ijamscr/article/view/291
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References
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Olah KS, Dunn JA, Gee H. Leiomyosarcoma have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors the result of a retrospective study of 423 cases of uterine sarcoma. Br J Obstet Gynecol 99, 1992, 590?4.
[2]. Silverberg SG, Major FJ, Blessing JA, Fetter B, Askin FB, Liao SY, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 9, 1990, 1?19.
[3]. Prendiville J, Murphy D, Rennison J, Buckley H, Crowther D. Carcinosarcoma of the ovary treated over a 10 year period at the Christie hospital. Int J Gynecol Cancer 4, 1994, 200?5.
[4]. Clement PB, Zubovits JT, Young RH, Scully RE. Malignant mixed tumours of the uterine cervix: A report of 9 cases of a neoplasm with morphology often different from its counterpart in the corpus. Int J Gynecol Pathol 17, 1998, 211?22.
[5]. Garamvoelgyi E, Guillou L, Gethard S, Salmeron M, Seematter RJ, Hadjee MH, et al. Primary malignant mixed Mullerian tumour (metaplastic carcinoma) of the female peritoneum. A clinical, pathological, and immunological study of three cases and a review of the literature. Cancer 74, 1994, 854?63.
[6]. Gadduci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: A debated critical challenge. Crit Rev Oncol Hematol 65, 2008, 129?42.
[7]. Kernochan LE and Garcia RL. Carcinosarcomas (malignant mixed mullerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. Journal of the National Comprehensive Cancer Network 7(5), 2009, 550–557.
[8]. U. Kuyumcuo?glu and A. Kale. Homologous type of malignant mixed Mullerian tumor of the uterus presenting as a cervical mass. Journal of the Chinese Medical Association 72(10), 2009, 533–535.
[9]. Kloos I, Delaloge S, Pautier P, Di Palma M, Goupil A, Duvillard P, et al. Tamoxifen related uterine carcinosarcomas occur under/after prolonged treatment: Report of five cases and review of literature. Int J Gynecol Cancer 12, 2002, 496?500.
[10]. Doss LL, Llorens AS, and Henriquez EM. Carcinosarcoma of the uterus: a 40-year experience from the state of Missouri. Gynecologic Oncology 18(1), 1984, 43–53.
[11]. N’Kanza AL, Jobanputra S, Farmer P, Lovecchio J, Yelon JA, and Rudloff U. Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus. Archives of Gynecology and Obstetrics 273(1), 2005, 63–68.
[12]. Kumar V, Abbas A, Aster J, Fausto N. Robbins Pathologic Basis of Disease. 7th ed. Philadelphia: W.B. Saunders company; 2005, 1088.
[13]. L. Brown. Pathology of uterine malignancies. Clinical Oncology 20(6), 2008, 433–447.
[14]. Ahuja A, Safaya R, Prakash G, Kumar L, and Shukla NK. Primary mixed mullerian tumor of the vagina—a case report with review of the literature. Pathology Research and Practice 207(4), 2011, 253.
[15]. El-Nashar SA and Mariani A. Uterine carcinosarcoma. Clinical Obstetrics and Gynecology 54(2), 2011, 292–304.
[16]. Iwasa Y, Haga H, Konishi I, Kobashi Y, Higuchi K, Katsuyama E, et al. Prognostic factors in uterine carcinosarcoma. A clincopathological study of 25 patients. Cancer 82, 1998, 512?9.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
434
[17]. Kuyumcuoglu U, Kale A. Homologous type malignant mixed Mullerian tumour of the uterus presenting as cervical mass. J Chin Med Assoc 72, 2009, 533?5.
[18]. Bitterman P, Chun B, Kurman RJ. The significance of epithelial differentiation in mixed mesodermal tumours of the uterus. A clinicopathologic and immunohistochemical study. Am J Surg Pathol 14, 1990, 317?28.
[19]. Major FJ, Blessing JA, Silverberg SG, Marrow CP, Creasman WT, Currie JL, et al. Prognostic factor in early stage uterine sarcoma. A Gynaecologic Oncology Group study. Cancer 71, 1993, 1702?9.
[20]. Larson B, Silfversward C, Nilsson B, Petterson F. Mixed mullerian tumours of the uterus - prognostic factors: A clinical and histopathologic study of 147 cases. Radiother Oncol 17, 1990, 123?32. [21]. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma. Gynecol Oncol. 109, 2008, 255–62.
[22]. Shapeero LG and Hricak H. Mixed mullerian sarcoma of the uterus: MR imaging findings. American Journal of Roentgenology 15(2), 1989, 317–319. [23]. Bharwani N, Newland A, Tunariu N et-al. MRI appearances of uterine malignant mixed müllerian tumors. AJR Am J Roentgenol. 195(5), 2010, 1268-75. [24]. Takeuchi M, Matsuzaki K, Harada M. Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy. Acta Radiologica. 2016, 18:0284185115626475. [25]. Eary JF, O'Sullivan F, Powitan Y, Chandhury KR, Vernon C, Bruckner JD, et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: A retrospective analysis. Eur J Nucl Med Mol Imaging. 29, 2002, 1149–54 [26]. Ho KC, Lai CH, Wu TI, Ng KK, Yen TC, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 35, 2008, 484–92.
[27]. Callister M, Ramondetta LM, Jhingran A, Burke TW, and EifelPJ. Malignant mixed mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. International Journal of Radiation Oncology Biology Physics. 58(3), 2004, 786–796. [28]. Bosquet JS, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecologic Oncology. 116(3), 2010, 419-423.
[29]. Menczer J, Levy T, Piura B, Chetrit A, Altaraj M, Meirovitz M, et al. A comparison between different postoperative treatment modalities of uterine carcinosarcoma. Gynecol Oncol 97, 2005, 166?70.
[30]. Garg G, Kruger M, Christensen C, Deppe G, and Toy EP. Stage III uterine carcinosarcoma: 2009 international federation of gynecology and obstetrics staging system and prognostic determinants,” International Journal of Gynecological Cancer. In press.
[31]. Nemani D, Mitra N, Guo M, and Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecologic Oncology 111(1), 2008, 82–88.
[32]. Vorgias G and Fotiou S. The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Archives of Gynecology and Obstetrics 282(6), 2010, 659–664.
[33]. Sartori E, Bazzurini L, Gaducci A, Landoni F, Lissoni A, Maggino T, et al. Carcinosarcoma of the uterus a clinicopathologic multicenter CTF study. Gynecol Oncol 67, 1997, 70?5. [34]. Smith DC, Macdonald OK, Gaffney DK. The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiotherapy and Oncology. 88(2), 2008, 227-32. [35]. Wright JD, Seshan VE, Shah M, Schiff PB, Burke WM, Cohen CJ, Herzog TJ. The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma. American journal of obstetrics and gynecology. 199(5), 2008, 536. [36]. Hoskins PJ, Le N, Ellard S, Lee U, Martin LA, Swenerton KD, Tinker AV. Carboplatin plus paclitaxel for advanced or recurrent uterine malignant mixed mullerian tumors. The British Columbia Cancer Agency experience. Gynecologic oncology. 108(1), 2008, 58-62.
[37]. Wolfson AH, Brady MF, Rocereto T et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatinifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol 107, 2007, 177–185.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
435
[38]. Thigpen JT, Blessing JA, Beecham J et al. Phase II trial of cisplatin as firstline chemotherapy in patients with advanced or recurrent uterine sarcomas: a Gynecologic Oncology Group study. J Clin Oncol 9, 1991, 1962–1966.
[39]. Gershenson DM, Kavanagh JJ, Copeland LJ et al. Cisplatin therapy for disseminated mixed mesodermal sarcoma of the uterus. J Clin Oncol 5, 1987, 618–621.
[40]. Sutton GP, Blessing JA, Rosenshein N et al. Phase II trial of ifosfamide and mesna in mixed mesodermal tumors of the uterus: a Gynecologic Oncology Group study. Am J Obstet Gynecol 161, 1989, 309–312.
[41]. Thigpen J, Blessing JA, Orr J et al. Phase II trial of cisplatin in the treatment of patients with advanced or recurrent mixed mesodermal sarcomas of the uterus: a Gynecologic Oncology Group study. Cancer Treat Rep 70, 1986, 271–274.
[42]. Sutton GP, Blessing JA, Homesley HD et al. A phase II trial of ifosfamide and mesna in patients with advanced or recurrent mixed mesodermal tumors of the ovary previously treated with platinum-based chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol 53, 1994, 24–26.
[43]. Curtin JP, Blessing JA, Soper JT et al. Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol 83, 2001, 268–270.
[44]. Miller DS, Blessing JA, Schilder J et al. Phase II evaluation of topotecan in carcinosarcoma of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 98, 2005, 217–221.
[45]. Sutton G, Brunetto VL, Kilgore L et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecol Oncol 79, 2000, 147–153.
[46]. Homesley HD, Filiaci V, Markman M et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 25, 2007, 526–531.
[47]. Emoto M, Ishiguro M, Iwasaki H, Kikuchi M, Kawarabayashi T. Effect of angiogenesis inhibitor (TNP?470) on the growth, blood flow, and microvessel density in xenografts of human uterine carcinosarcoma in nude mice. Gynecol Oncol 89, 2003, 88?94. [48]. Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, Brown J, Gano JB, Burke TW, Ramondetta LM. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International Journal of Gynecological Cancer. 21(3), 2011, 517-22. [49]. George E, Lillemoe TJ, Twiggs LB, Perrone T. Malignant mixed müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 14(1), 1995, 39-44. [50]. Ronnett BM, Zaino RJ, Ellenson LH, Kurman RJ. Endometrial carcinoma. Kurman RJ. Blaustein’s Pathology of the Female Genital Tract. 5. New York City: Springer-Verlag; 2002, 538-541. [51]. Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 112(1), 2008, 64-70.
References
Olah KS, Dunn JA, Gee H. Leiomyosarcoma have a poorer prognosis than mixed mesodermal tumours when adjusting for known prognostic factors the result of a retrospective study of 423 cases of uterine sarcoma. Br J Obstet Gynecol 99, 1992, 590?4.
[2]. Silverberg SG, Major FJ, Blessing JA, Fetter B, Askin FB, Liao SY, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 9, 1990, 1?19.
[3]. Prendiville J, Murphy D, Rennison J, Buckley H, Crowther D. Carcinosarcoma of the ovary treated over a 10 year period at the Christie hospital. Int J Gynecol Cancer 4, 1994, 200?5.
[4]. Clement PB, Zubovits JT, Young RH, Scully RE. Malignant mixed tumours of the uterine cervix: A report of 9 cases of a neoplasm with morphology often different from its counterpart in the corpus. Int J Gynecol Pathol 17, 1998, 211?22.
[5]. Garamvoelgyi E, Guillou L, Gethard S, Salmeron M, Seematter RJ, Hadjee MH, et al. Primary malignant mixed Mullerian tumour (metaplastic carcinoma) of the female peritoneum. A clinical, pathological, and immunological study of three cases and a review of the literature. Cancer 74, 1994, 854?63.
[6]. Gadduci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: A debated critical challenge. Crit Rev Oncol Hematol 65, 2008, 129?42.
[7]. Kernochan LE and Garcia RL. Carcinosarcomas (malignant mixed mullerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. Journal of the National Comprehensive Cancer Network 7(5), 2009, 550–557.
[8]. U. Kuyumcuo?glu and A. Kale. Homologous type of malignant mixed Mullerian tumor of the uterus presenting as a cervical mass. Journal of the Chinese Medical Association 72(10), 2009, 533–535.
[9]. Kloos I, Delaloge S, Pautier P, Di Palma M, Goupil A, Duvillard P, et al. Tamoxifen related uterine carcinosarcomas occur under/after prolonged treatment: Report of five cases and review of literature. Int J Gynecol Cancer 12, 2002, 496?500.
[10]. Doss LL, Llorens AS, and Henriquez EM. Carcinosarcoma of the uterus: a 40-year experience from the state of Missouri. Gynecologic Oncology 18(1), 1984, 43–53.
[11]. N’Kanza AL, Jobanputra S, Farmer P, Lovecchio J, Yelon JA, and Rudloff U. Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus. Archives of Gynecology and Obstetrics 273(1), 2005, 63–68.
[12]. Kumar V, Abbas A, Aster J, Fausto N. Robbins Pathologic Basis of Disease. 7th ed. Philadelphia: W.B. Saunders company; 2005, 1088.
[13]. L. Brown. Pathology of uterine malignancies. Clinical Oncology 20(6), 2008, 433–447.
[14]. Ahuja A, Safaya R, Prakash G, Kumar L, and Shukla NK. Primary mixed mullerian tumor of the vagina—a case report with review of the literature. Pathology Research and Practice 207(4), 2011, 253.
[15]. El-Nashar SA and Mariani A. Uterine carcinosarcoma. Clinical Obstetrics and Gynecology 54(2), 2011, 292–304.
[16]. Iwasa Y, Haga H, Konishi I, Kobashi Y, Higuchi K, Katsuyama E, et al. Prognostic factors in uterine carcinosarcoma. A clincopathological study of 25 patients. Cancer 82, 1998, 512?9.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
434
[17]. Kuyumcuoglu U, Kale A. Homologous type malignant mixed Mullerian tumour of the uterus presenting as cervical mass. J Chin Med Assoc 72, 2009, 533?5.
[18]. Bitterman P, Chun B, Kurman RJ. The significance of epithelial differentiation in mixed mesodermal tumours of the uterus. A clinicopathologic and immunohistochemical study. Am J Surg Pathol 14, 1990, 317?28.
[19]. Major FJ, Blessing JA, Silverberg SG, Marrow CP, Creasman WT, Currie JL, et al. Prognostic factor in early stage uterine sarcoma. A Gynaecologic Oncology Group study. Cancer 71, 1993, 1702?9.
[20]. Larson B, Silfversward C, Nilsson B, Petterson F. Mixed mullerian tumours of the uterus - prognostic factors: A clinical and histopathologic study of 147 cases. Radiother Oncol 17, 1990, 123?32. [21]. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma. Gynecol Oncol. 109, 2008, 255–62.
[22]. Shapeero LG and Hricak H. Mixed mullerian sarcoma of the uterus: MR imaging findings. American Journal of Roentgenology 15(2), 1989, 317–319. [23]. Bharwani N, Newland A, Tunariu N et-al. MRI appearances of uterine malignant mixed müllerian tumors. AJR Am J Roentgenol. 195(5), 2010, 1268-75. [24]. Takeuchi M, Matsuzaki K, Harada M. Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy. Acta Radiologica. 2016, 18:0284185115626475. [25]. Eary JF, O'Sullivan F, Powitan Y, Chandhury KR, Vernon C, Bruckner JD, et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: A retrospective analysis. Eur J Nucl Med Mol Imaging. 29, 2002, 1149–54 [26]. Ho KC, Lai CH, Wu TI, Ng KK, Yen TC, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 35, 2008, 484–92.
[27]. Callister M, Ramondetta LM, Jhingran A, Burke TW, and EifelPJ. Malignant mixed mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. International Journal of Radiation Oncology Biology Physics. 58(3), 2004, 786–796. [28]. Bosquet JS, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecologic Oncology. 116(3), 2010, 419-423.
[29]. Menczer J, Levy T, Piura B, Chetrit A, Altaraj M, Meirovitz M, et al. A comparison between different postoperative treatment modalities of uterine carcinosarcoma. Gynecol Oncol 97, 2005, 166?70.
[30]. Garg G, Kruger M, Christensen C, Deppe G, and Toy EP. Stage III uterine carcinosarcoma: 2009 international federation of gynecology and obstetrics staging system and prognostic determinants,” International Journal of Gynecological Cancer. In press.
[31]. Nemani D, Mitra N, Guo M, and Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecologic Oncology 111(1), 2008, 82–88.
[32]. Vorgias G and Fotiou S. The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Archives of Gynecology and Obstetrics 282(6), 2010, 659–664.
[33]. Sartori E, Bazzurini L, Gaducci A, Landoni F, Lissoni A, Maggino T, et al. Carcinosarcoma of the uterus a clinicopathologic multicenter CTF study. Gynecol Oncol 67, 1997, 70?5. [34]. Smith DC, Macdonald OK, Gaffney DK. The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiotherapy and Oncology. 88(2), 2008, 227-32. [35]. Wright JD, Seshan VE, Shah M, Schiff PB, Burke WM, Cohen CJ, Herzog TJ. The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma. American journal of obstetrics and gynecology. 199(5), 2008, 536. [36]. Hoskins PJ, Le N, Ellard S, Lee U, Martin LA, Swenerton KD, Tinker AV. Carboplatin plus paclitaxel for advanced or recurrent uterine malignant mixed mullerian tumors. The British Columbia Cancer Agency experience. Gynecologic oncology. 108(1), 2008, 58-62.
[37]. Wolfson AH, Brady MF, Rocereto T et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatinifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol 107, 2007, 177–185.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
435
[38]. Thigpen JT, Blessing JA, Beecham J et al. Phase II trial of cisplatin as firstline chemotherapy in patients with advanced or recurrent uterine sarcomas: a Gynecologic Oncology Group study. J Clin Oncol 9, 1991, 1962–1966.
[39]. Gershenson DM, Kavanagh JJ, Copeland LJ et al. Cisplatin therapy for disseminated mixed mesodermal sarcoma of the uterus. J Clin Oncol 5, 1987, 618–621.
[40]. Sutton GP, Blessing JA, Rosenshein N et al. Phase II trial of ifosfamide and mesna in mixed mesodermal tumors of the uterus: a Gynecologic Oncology Group study. Am J Obstet Gynecol 161, 1989, 309–312.
[41]. Thigpen J, Blessing JA, Orr J et al. Phase II trial of cisplatin in the treatment of patients with advanced or recurrent mixed mesodermal sarcomas of the uterus: a Gynecologic Oncology Group study. Cancer Treat Rep 70, 1986, 271–274.
[42]. Sutton GP, Blessing JA, Homesley HD et al. A phase II trial of ifosfamide and mesna in patients with advanced or recurrent mixed mesodermal tumors of the ovary previously treated with platinum-based chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol 53, 1994, 24–26.
[43]. Curtin JP, Blessing JA, Soper JT et al. Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol 83, 2001, 268–270.
[44]. Miller DS, Blessing JA, Schilder J et al. Phase II evaluation of topotecan in carcinosarcoma of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 98, 2005, 217–221.
[45]. Sutton G, Brunetto VL, Kilgore L et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecol Oncol 79, 2000, 147–153.
[46]. Homesley HD, Filiaci V, Markman M et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 25, 2007, 526–531.
[47]. Emoto M, Ishiguro M, Iwasaki H, Kikuchi M, Kawarabayashi T. Effect of angiogenesis inhibitor (TNP?470) on the growth, blood flow, and microvessel density in xenografts of human uterine carcinosarcoma in nude mice. Gynecol Oncol 89, 2003, 88?94. [48]. Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, Brown J, Gano JB, Burke TW, Ramondetta LM. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International Journal of Gynecological Cancer. 21(3), 2011, 517-22. [49]. George E, Lillemoe TJ, Twiggs LB, Perrone T. Malignant mixed müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 14(1), 1995, 39-44. [50]. Ronnett BM, Zaino RJ, Ellenson LH, Kurman RJ. Endometrial carcinoma. Kurman RJ. Blaustein’s Pathology of the Female Genital Tract. 5. New York City: Springer-Verlag; 2002, 538-541. [51]. Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 112(1), 2008, 64-70.
[2]. Silverberg SG, Major FJ, Blessing JA, Fetter B, Askin FB, Liao SY, et al. Carcinosarcoma (malignant mixed mesodermal tumor) of the uterus. A Gynecologic Oncology Group pathologic study of 203 cases. Int J Gynecol Pathol 9, 1990, 1?19.
[3]. Prendiville J, Murphy D, Rennison J, Buckley H, Crowther D. Carcinosarcoma of the ovary treated over a 10 year period at the Christie hospital. Int J Gynecol Cancer 4, 1994, 200?5.
[4]. Clement PB, Zubovits JT, Young RH, Scully RE. Malignant mixed tumours of the uterine cervix: A report of 9 cases of a neoplasm with morphology often different from its counterpart in the corpus. Int J Gynecol Pathol 17, 1998, 211?22.
[5]. Garamvoelgyi E, Guillou L, Gethard S, Salmeron M, Seematter RJ, Hadjee MH, et al. Primary malignant mixed Mullerian tumour (metaplastic carcinoma) of the female peritoneum. A clinical, pathological, and immunological study of three cases and a review of the literature. Cancer 74, 1994, 854?63.
[6]. Gadduci A, Cosio S, Romanini A, Genazzani AR. The management of patients with uterine sarcoma: A debated critical challenge. Crit Rev Oncol Hematol 65, 2008, 129?42.
[7]. Kernochan LE and Garcia RL. Carcinosarcomas (malignant mixed mullerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. Journal of the National Comprehensive Cancer Network 7(5), 2009, 550–557.
[8]. U. Kuyumcuo?glu and A. Kale. Homologous type of malignant mixed Mullerian tumor of the uterus presenting as a cervical mass. Journal of the Chinese Medical Association 72(10), 2009, 533–535.
[9]. Kloos I, Delaloge S, Pautier P, Di Palma M, Goupil A, Duvillard P, et al. Tamoxifen related uterine carcinosarcomas occur under/after prolonged treatment: Report of five cases and review of literature. Int J Gynecol Cancer 12, 2002, 496?500.
[10]. Doss LL, Llorens AS, and Henriquez EM. Carcinosarcoma of the uterus: a 40-year experience from the state of Missouri. Gynecologic Oncology 18(1), 1984, 43–53.
[11]. N’Kanza AL, Jobanputra S, Farmer P, Lovecchio J, Yelon JA, and Rudloff U. Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus. Archives of Gynecology and Obstetrics 273(1), 2005, 63–68.
[12]. Kumar V, Abbas A, Aster J, Fausto N. Robbins Pathologic Basis of Disease. 7th ed. Philadelphia: W.B. Saunders company; 2005, 1088.
[13]. L. Brown. Pathology of uterine malignancies. Clinical Oncology 20(6), 2008, 433–447.
[14]. Ahuja A, Safaya R, Prakash G, Kumar L, and Shukla NK. Primary mixed mullerian tumor of the vagina—a case report with review of the literature. Pathology Research and Practice 207(4), 2011, 253.
[15]. El-Nashar SA and Mariani A. Uterine carcinosarcoma. Clinical Obstetrics and Gynecology 54(2), 2011, 292–304.
[16]. Iwasa Y, Haga H, Konishi I, Kobashi Y, Higuchi K, Katsuyama E, et al. Prognostic factors in uterine carcinosarcoma. A clincopathological study of 25 patients. Cancer 82, 1998, 512?9.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
434
[17]. Kuyumcuoglu U, Kale A. Homologous type malignant mixed Mullerian tumour of the uterus presenting as cervical mass. J Chin Med Assoc 72, 2009, 533?5.
[18]. Bitterman P, Chun B, Kurman RJ. The significance of epithelial differentiation in mixed mesodermal tumours of the uterus. A clinicopathologic and immunohistochemical study. Am J Surg Pathol 14, 1990, 317?28.
[19]. Major FJ, Blessing JA, Silverberg SG, Marrow CP, Creasman WT, Currie JL, et al. Prognostic factor in early stage uterine sarcoma. A Gynaecologic Oncology Group study. Cancer 71, 1993, 1702?9.
[20]. Larson B, Silfversward C, Nilsson B, Petterson F. Mixed mullerian tumours of the uterus - prognostic factors: A clinical and histopathologic study of 147 cases. Radiother Oncol 17, 1990, 123?32. [21]. Park JY, Kim EN, Kim DY, Suh DS, Kim JH, Kim YM, et al. Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma. Gynecol Oncol. 109, 2008, 255–62.
[22]. Shapeero LG and Hricak H. Mixed mullerian sarcoma of the uterus: MR imaging findings. American Journal of Roentgenology 15(2), 1989, 317–319. [23]. Bharwani N, Newland A, Tunariu N et-al. MRI appearances of uterine malignant mixed müllerian tumors. AJR Am J Roentgenol. 195(5), 2010, 1268-75. [24]. Takeuchi M, Matsuzaki K, Harada M. Carcinosarcoma of the uterus: MRI findings including diffusion-weighted imaging and MR spectroscopy. Acta Radiologica. 2016, 18:0284185115626475. [25]. Eary JF, O'Sullivan F, Powitan Y, Chandhury KR, Vernon C, Bruckner JD, et al. Sarcoma tumor FDG uptake measured by PET and patient outcome: A retrospective analysis. Eur J Nucl Med Mol Imaging. 29, 2002, 1149–54 [26]. Ho KC, Lai CH, Wu TI, Ng KK, Yen TC, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 35, 2008, 484–92.
[27]. Callister M, Ramondetta LM, Jhingran A, Burke TW, and EifelPJ. Malignant mixed mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. International Journal of Radiation Oncology Biology Physics. 58(3), 2004, 786–796. [28]. Bosquet JS, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecologic Oncology. 116(3), 2010, 419-423.
[29]. Menczer J, Levy T, Piura B, Chetrit A, Altaraj M, Meirovitz M, et al. A comparison between different postoperative treatment modalities of uterine carcinosarcoma. Gynecol Oncol 97, 2005, 166?70.
[30]. Garg G, Kruger M, Christensen C, Deppe G, and Toy EP. Stage III uterine carcinosarcoma: 2009 international federation of gynecology and obstetrics staging system and prognostic determinants,” International Journal of Gynecological Cancer. In press.
[31]. Nemani D, Mitra N, Guo M, and Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: a SEER analysis. Gynecologic Oncology 111(1), 2008, 82–88.
[32]. Vorgias G and Fotiou S. The role of lymphadenectomy in uterine carcinosarcomas (malignant mixed mullerian tumours): a critical literature review. Archives of Gynecology and Obstetrics 282(6), 2010, 659–664.
[33]. Sartori E, Bazzurini L, Gaducci A, Landoni F, Lissoni A, Maggino T, et al. Carcinosarcoma of the uterus a clinicopathologic multicenter CTF study. Gynecol Oncol 67, 1997, 70?5. [34]. Smith DC, Macdonald OK, Gaffney DK. The impact of adjuvant radiation therapy on survival in women with uterine carcinosarcoma. Radiotherapy and Oncology. 88(2), 2008, 227-32. [35]. Wright JD, Seshan VE, Shah M, Schiff PB, Burke WM, Cohen CJ, Herzog TJ. The role of radiation in improving survival for early-stage carcinosarcoma and leiomyosarcoma. American journal of obstetrics and gynecology. 199(5), 2008, 536. [36]. Hoskins PJ, Le N, Ellard S, Lee U, Martin LA, Swenerton KD, Tinker AV. Carboplatin plus paclitaxel for advanced or recurrent uterine malignant mixed mullerian tumors. The British Columbia Cancer Agency experience. Gynecologic oncology. 108(1), 2008, 58-62.
[37]. Wolfson AH, Brady MF, Rocereto T et al. A gynecologic oncology group randomized phase III trial of whole abdominal irradiation (WAI) vs. cisplatinifosfamide and mesna (CIM) as post-surgical therapy in stage I-IV carcinosarcoma (CS) of the uterus. Gynecol Oncol 107, 2007, 177–185.
Deepti S et al / Int. J. of Allied Med. Sci. and Clin. Research Vol-4(3) 2016 [429-435]
435
[38]. Thigpen JT, Blessing JA, Beecham J et al. Phase II trial of cisplatin as firstline chemotherapy in patients with advanced or recurrent uterine sarcomas: a Gynecologic Oncology Group study. J Clin Oncol 9, 1991, 1962–1966.
[39]. Gershenson DM, Kavanagh JJ, Copeland LJ et al. Cisplatin therapy for disseminated mixed mesodermal sarcoma of the uterus. J Clin Oncol 5, 1987, 618–621.
[40]. Sutton GP, Blessing JA, Rosenshein N et al. Phase II trial of ifosfamide and mesna in mixed mesodermal tumors of the uterus: a Gynecologic Oncology Group study. Am J Obstet Gynecol 161, 1989, 309–312.
[41]. Thigpen J, Blessing JA, Orr J et al. Phase II trial of cisplatin in the treatment of patients with advanced or recurrent mixed mesodermal sarcomas of the uterus: a Gynecologic Oncology Group study. Cancer Treat Rep 70, 1986, 271–274.
[42]. Sutton GP, Blessing JA, Homesley HD et al. A phase II trial of ifosfamide and mesna in patients with advanced or recurrent mixed mesodermal tumors of the ovary previously treated with platinum-based chemotherapy: a Gynecologic Oncology Group study. Gynecol Oncol 53, 1994, 24–26.
[43]. Curtin JP, Blessing JA, Soper JT et al. Paclitaxel in the treatment of carcinosarcoma of the uterus: a gynecologic oncology group study. Gynecol Oncol 83, 2001, 268–270.
[44]. Miller DS, Blessing JA, Schilder J et al. Phase II evaluation of topotecan in carcinosarcoma of the uterus: a Gynecologic Oncology Group study. Gynecol Oncol 98, 2005, 217–221.
[45]. Sutton G, Brunetto VL, Kilgore L et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: a Gynecologic Oncology Group Study. Gynecol Oncol 79, 2000, 147–153.
[46]. Homesley HD, Filiaci V, Markman M et al. Phase III trial of ifosfamide with or without paclitaxel in advanced uterine carcinosarcoma: a Gynecologic Oncology Group Study. J Clin Oncol 25, 2007, 526–531.
[47]. Emoto M, Ishiguro M, Iwasaki H, Kikuchi M, Kawarabayashi T. Effect of angiogenesis inhibitor (TNP?470) on the growth, blood flow, and microvessel density in xenografts of human uterine carcinosarcoma in nude mice. Gynecol Oncol 89, 2003, 88?94. [48]. Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, Brown J, Gano JB, Burke TW, Ramondetta LM. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. International Journal of Gynecological Cancer. 21(3), 2011, 517-22. [49]. George E, Lillemoe TJ, Twiggs LB, Perrone T. Malignant mixed müllerian tumor versus high-grade endometrial carcinoma and aggressive variants of endometrial carcinoma: a comparative analysis of survival. Int J Gynecol Pathol. 14(1), 1995, 39-44. [50]. Ronnett BM, Zaino RJ, Ellenson LH, Kurman RJ. Endometrial carcinoma. Kurman RJ. Blaustein’s Pathology of the Female Genital Tract. 5. New York City: Springer-Verlag; 2002, 538-541. [51]. Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 112(1), 2008, 64-70.