Uterine carcinosarcoma is a malignant mixed Mullerian tumour, composed of epithelial and stromal components. Most uterine carcinosarcomas are monoclonal tumours, but a small proportion of them is a collision of carcinoma and sarcoma.
This research is based on the investigation of formalin‐fixed, paraffin‐embedded tissue blocks from 13 women undergoing primary surgical treatment between 1961–2010, that were retrieved from the archival collections of the pathoanatomical department of the Institute of Oncology named after N.N. Petrov. Mutations of TP53, PTEN and K-RAS genes were analyzed to determine clonality of uterine carcinosarcoma. DNAs were extracted by proteinase K digestion («Fisher» US) by the method of Herrington, C.S. & McGee, J.O. Mutations of TP53, PTEN and K-RAS were defined by single-strand conformation polymorphism with the next sequence. The found mutations in the TP53 (exons 5-9), PTEN (exons 5, 8), K-RAS (exon 1) genes were compared in epithelial and stromal components of 13 uterine carcinosarcomas. The tumours were classified as monoclonal in the presence of identical mutations in epithelial and stromal components, in the presence of different mutations - as biclonal. Of 13 cases 7 (53.8%) were monoclonal, 6 (46.2%) – biclonal.
We evaluated clinical and histopathologic features of monoclonal and biclonal uterine carcinosarcomas. Monoclonal tumours showed worse prospects than the biclonal ones: 1-yr overall survival - 20% vs 37% (p = 0.0078). In all cases (100%) of monoclonal tumors the average length of full remission was three times shorter than in cases of biclonal tumours.Table: 15P
Comparison of monoclonal and biclonal carcinosarcomas
|Clinical and morphological features of uterine carcinosarcoma||Monoclonal tumours||Biclonal tumours||p ≦|
|Tumours invades the serosa of the corpus uteri, %||100 %||50 %||p < 0.0001|
|Lymphovascular invasion||80%||0||p < 0.0001|
|Average size of the tumour (cm3)||1305.8||131.5||p < 0.05|
|Length of full remission||7.75||24.6||p < 0.05|
Clonality of the uterine carcinosarcomas may be a clinical marker as it determines the prospects of the disease, influencing the overall survival rate. Biclonal carcinosarcomas have a lesser potential for malignant development and are characterized by stronger survival capacity compared with the monoclonal tumours.
Clinical trial identification
Legal entity responsible for the study
Department of Oncology of the Russian Medical Academy of Continuous Vocational Training.
Has not received any funding.
All authors have declared no conflicts of interest.