Carcinosarcoma of the Prostate
Carcinosarcoma of the prostate is a biphasic tumor containing adenocarcinoma (ACA) and recognizable sarcomatous components. It is a rare neoplasm with only 12 previous reported cases. We describe three additional cases arising between 4 and 6 years after initial diagnosis of prostatic ACA. Two patients were initially treated by prostatectomy, pelvic external beam radiotherapy, and hormonal manipulation. The third patient was treated by pelvic lymphadenectomy and 125I implants. After the development of the sarcomatous component, the first two are still alive with distant metastases and residual pelvic disease at 9 and 17 months. The third patient died with disease 7 months after diagnosis. Histologically, prostatic ACA was recognized in all three cases, as well as a neoplastic mesenchymal component that appeared later. Foci of osteosarcomatous, chondrosarcomatous, and myosarcomatous differentiation were recognized in two of the three cases. Based on the chronologic and the histologic evolution of the neoplasm, we favor sarcomatoid transformation of the ACA as the most likely histogenesis. It appears that radiotherapy and hormonal therapy may be important in the development of at least some of these tumors. [1]
Thyroid carcinosarcoma
A thyroid carcinosarcoma composed of follicular carcinoma intermixed with osteosarcoma and chondrosarcoma was studied. Results of immunoperoxidase staining for thyroglobulin were positive in the areas of follicular carcinoma and negative in the sarcomatous component. Likewise, the carcinomatous areas showed thyroid epithelial characteristics by ultrastructure, while the sarcomatous areas showed typical mesenchymal differentiation. This is an extremely rare neoplasm, with only 16 cases reported in the literature. It occurs predominantly in elderly women, is thought to arise through a process of neoplastic metaplasia, and has a uniformly dismal prognosis. Immunoperoxidase and ultrastructural studies, the first reported in such lesions, proved helpful in ascertaining the sarcomatous nature of the anaplastic, mesenchymal component of this unusual and aggressive neoplasm. [2]
Uterine Carcinosarcoma
Carcinosarcoma is a rare but highly aggressive uterine malignancy. Pathologically, carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. A comprehensive approach for management is recommended with complete surgical staging to assess tumor dissemination followed by multimodal therapy with combinations of external beam irradiation or vaginal brachytherapy and systematic chemotherapy in patients with both early and advanced stage disease. [3]
Carcinosarcoma of Ovary, it’s Histopathological, Management and Prognostic Analysis with Review of Literature
Carcinosarcoma is a mixed malignant biphasic tumour representing a rare entity and comprises of both epithelial and mesenchymal components. Primary ovarian carcinosarcoma is a rare neoplasm with a number of cases reported in the literature in the hundreds. It accounts for less than 1% of all ovarian tumours. These tumours are usually diagnosed at older age and advanced stage. It has aggressive clinical behaviour and survival depends on stage at presentation. Radiological imagings cannot differentiate carcinosarcomas from other ovarian cancers. Diagnosis is based upon histological findings. Cytoreductive debulking surgery is a crucial part in the treatment of carcinosarcoma of ovary. The role of adjuvant chemotherapy regimen is still controversial. Combination chemotherapy with taxane and platinum based regimen or ifosfamide and platinum based regimen are considered as adjuvant treatment. Despite aggressive treatment modalities such as surgery and chemotherapy, the outcome is poor. Response to therapy and overall survival for carcinosarcoma are poor in comparison to that of epithelial ovarian malignancies. Due to rarity of the disease, such poor prognosis needs collaboration of studies with molecular analysis to obtain new therapeutic guidelines to improve survival of the patients. [4]
Sarcomatoid Carcinoma (Carcinosarcoma) of the Prostate Gland: A Review of the Literature
Background: Adenocarcinomas of the prostate gland are commonly encountered globally but other uncommon variants of carcinoma of the prostate are sporadically encountered including primary sarcomatoid carcinoma of the prostate (PSCP).
Aims: To review the literature of PSCP.
Methods: Various internet search engines were searched for literature on PSCP.
Literature Review: About 100 cases of PSCP have so far been reported. PSCP may develop de novo or may emanate following hormonal treatment or radiotherapy for adenocarcinoma of prostate; PSCP may present with LUTS, haematuria, perineal/back pain. Histology of prostate biopsy tends to show a biphasic tumour which has an adenocarcinoma component as well as a second component which is a clearly recognizable type of sarcoma component which could be angiosarcoma, chondrosarcoma, leiomyosarcoma, osteosarcoma or rhabdomyosarcoma. With regard to immunohistochemistry Immunohistochemistry, the epithelial component of sarcomatoid carcinoma of prostate stains positively for cytokeratin and PAP, and negatively for PSA; the sarcoma component stains negatively for PSA, EMA and keratin. There is no consensus opinion on treatment. TURP has been performed for lower urinary tract obstruction symptoms and urinary retention, radical prostatectomy, pelvic exenteration, and chemotherapy are some of the treatments employed. A number of cases of PSCP had presented at advanced stages of the disease. PCSP is aggressive with poor prognosis; however, early aggressive surgery in some cases had resulted in survival.
Conclusions: A multi-centre trial is required to determine the best treatment option for PSCP.
Perhaps patients with progressing prostate cancer following radiotherapy of castrate resistant prostate cancer should have repeat prostate biopsies to determine if they have developed dedifferentiation into PSCP or other variants of prostate cancer and to try cases of PSCP on chemotherapy as a trial. [5]
Reference
[1] Lauwers, G.Y., Schevchuk, M., Armenakas, N. and Reuter, V.E., 1993. Carcinosarcoma of the prostate. The American journal of surgical pathology, 17(4), pp.342-349.
[2] Donnell, C.A., Pollock, W.J. and Sybers, W.A., 1987. Thyroid carcinosarcoma. Archives of pathology & laboratory medicine, 111(12), pp.1169-1172.
[3] El-Nashar, S.A. and Mariani, A., 2011. Uterine carcinosarcoma. Clinical obstetrics and gynecology, 54(2), pp.292-304.
[4] Nayak, R. and Kumar Sahoo, T. (2015) “Carcinosarcoma of Ovary, it’s Histopathological, Management and Prognostic Analysis with Review of Literature”, Journal of Cancer and Tumor International, 3(2), pp. 1-10. doi: 10.9734/JCTI/2016/22769.
[5] Kodzo-Grey Venyo, A. (2015) “Sarcomatoid Carcinoma (Carcinosarcoma) of the Prostate Gland: A Review of the Literature”, Journal of Cancer and Tumor International, 2(3), pp. 128-143. doi: 10.9734/JCTI/2015/19516.
