Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Abdominal Radiology
Published in: Abdominal Radiology 8/2019

01-08-2019 | Endometrial Cancer | Review

Uterine carcinosarcoma: a primer for radiologists

Authors: Pavitra Ravishankar, Daniel A. Smith, Stefanie Avril, Elias Kikano, Nikhil H. Ramaiya

Published in: Abdominal Radiology | Issue 8/2019

Login to get access

Abstract

Objective

To provide a modern overview for radiologists of the unique radiological, pathological, and clinical features of uterine carcinosarcoma (UCS).

Results

UCS is a unique gynecological malignancy that continues to present diagnostic and therapeutic challenges to the field of oncology. The classification and clinical understanding of this malignancy have evolved in recent years, yielding a modern conceptualization of a neoplastic entity that has been well studied but incompletely understood. As UCS causes a significant proportion of deaths secondary to uterine cancer, developing a familiarity with the imaging and clinical features of this entity is critical. In addition to summarizing the modern understanding of this tumor variant, an overview of the common imaging features of UCS will be presented. The role of radiological staging, imaging findings on presentation and follow-up imaging, and modern treatment paradigms will be discussed. Lastly, the current treatment paradigms and surveillance recommendations for UCS will be summarized.

Conclusion

Knowledge of the modern understanding of uterine carcinosarcoma, including its relevant imaging and clinical features, is critical for radiologists.
Literature
1.
2.
Singh R. Review literature on uterine carcinosarcoma. J Cancer Res Ther. 2014;10(3):461–8.PubMed
3.
Schiavone MB, Zivanovic O, Zhou Q, Leitao MMJ, Levine DA, Soslow RA, et al. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2016 Jan;23(1):196–202.CrossRefPubMed
4.
Cherniack AD, Shen H, Walter V, Stewart C, Murray BA, Bowlby R, et al. Integrated Molecular Characterization of Uterine Carcinosarcoma. Cancer Cell. 2017 Mar;31(3):411–23.CrossRefPubMedPubMedCentral
5.
Ashley CW, Da Cruz Paula A, Kumar R, Mandelker D, Pei X, Riaz N, et al. Analysis of mutational signatures in primary and metastatic endometrial cancer reveals distinct patterns of DNA repair defects and shifts during tumor progression. Gynecol Oncol. 2018;(xxxx):1–9.
6.
McConechy MK, Hoang LN, Chui MH, Senz J, Yang W, Rozenberg N, et al. In-depth molecular profiling of the biphasic components of uterine carcinosarcomas. J Pathol Clin Res. 2015 Jul;1(3):173–85.CrossRefPubMedPubMedCentral
7.
Arend R, Doneza JA, Wright JD. Uterine carcinosarcoma. Curr Opin Oncol. 2011 Sep;23(5):531–6.PubMed
8.
Harano K, Hirakawa A, Yunokawa M, Nakamura T, Satoh T, Nishikawa T, et al. Prognostic factors in patients with uterine carcinosarcoma: a multi-institutional retrospective study from the Japanese Gynecologic Oncology Group. Int J Clin Oncol. 2016;21(1):168–76.CrossRefPubMed
9.
Kurnit KC, Previs RA, Soliman PT, Westin SN, Klopp AH, Fellman BM, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol. 2018;152(1).
10.
Inoue A, Yamaguchi K, Kurata Y, Murakami R, Abiko K, Hamanishi J, et al. Unenhanced region on magnetic resonance imaging represents tumor progression in uterine carcinosarcoma. J Gynecol Oncol. 2017;28(5):1–10.CrossRef
11.
Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, et al. Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition. Proc Natl Acad Sci U S A. 2016 Oct;113(43):12238–43.CrossRefPubMedPubMedCentral
12.
Dickson EL, Vogel RI, Gehrig PA, Pierce S, Havrilesky L, Secord AA, et al. A multi-institutional study of outcomes in stage I-III uterine carcinosarcoma. Gynecol Oncol. 2015 Nov;139(2):275–82.CrossRefPubMedPubMedCentral
13.
Tirumani SH, Ojili V, Shanbhogue AKP, Fasih N, Ryan JG, Reinhold C. Current concepts in the imaging of uterine sarcoma. Abdom Imaging. 2013;38(2):397–411.CrossRefPubMed
14.
Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: A SEER analysis. Gynecol Oncol. 2008;111(1):82–8.CrossRefPubMed
15.
Kanthan R, Senger J-L. Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumours): A Review with Special Emphasis on the Controversies in Management. Obstet Gynecol Int. 2011;2011:1–13.CrossRef
16.
Pradhan TS, Stevens EE, Ablavsky M, Salame G, Lee YC, Abulafia O. FIGO staging for carcinosarcoma: Can the revised staging system predict overall survival? Gynecol Oncol. 2011;123(2):221–4.CrossRefPubMed
17.
Takahashi M, Kozawa E, Tanisaka M, Hasegawa K, Yasuda M, Sakai F. Utility of histogram analysis of apparent diffusion coefficient maps obtained using 3.0T MRI for distinguishing uterine carcinosarcoma from endometrial carcinoma. J Magn Reson Imaging. 2016;43(6):1301–7.
18.
Koh W-J, Abu-Rustum NR, Bean S, Bradley K, Campos SM, Cho KR, et al. Uterine Neoplasms, Version 1.2018, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw. 2018 Feb;16(2):170–99.
19.
Ho K-C, Lai C-H, Wu T-I, Ng K-K, Yen T-C, Lin G, et al. 18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma. Eur J Nucl Med Mol Imaging. 2008 Mar;35(3):484–92.CrossRefPubMed
20.
Freeman SJ, Aly AM, Kataoka MY, Addley HC, Reinhold C, Sala E. The Revised FIGO Staging System for Uterine Malignancies: Implications for MR Imaging. RadioGraphics. 2012;32(6):1805–27.CrossRefPubMed
21.
Akin EA, Kuhl ES, Zeman RK. The role of FDG-PET/CT in gynecologic imaging: an updated guide to interpretation and challenges. Abdom Radiol. 2018;43(9):2474–86.CrossRef
22.
Lee HJ, Park JY, Lee JJ, Kim MH, Kim DY, Suh DS, et al. Comparison of MRI and18F-FDG PET/CT in the preoperative evaluation of uterine carcinosarcoma. Gynecol Oncol. 2016;140(3):409–14.CrossRefPubMed
23.
Lewin SN. Revised FIGO staging system for endometrial cancer. Clin Obstet Gynecol. 2011 Jun;54(2):215–8.CrossRefPubMed
24.
Teo SY, Babagbemi KT, Peters HE, Mortele KJ. Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI. AJR Am J Roentgenol. 2008 Jul;191(1):278–83.CrossRefPubMed
25.
Kamishima Y, Takeuchi M, Kawai T, Kawaguchi T, Yamaguchi K, Takahashi N, et al. A predictive diagnostic model using multiparametric MRI for differentiating uterine carcinosarcoma from carcinoma of the uterine corpus. Jpn J Radiol. 2017;35(8):472–83.CrossRefPubMed
26.
27.
28.
29.
Zwahlen DR, Schick U, Bolukbasi Y, Thariat J, Abdah-Bortnyak R, Kuten A, et al. Outcome and Predictive Factors in Uterine Carcinosarcoma Using Postoperative Radiotherapy: A Rare Cancer Network Study. Rare Tumors [Internet]. 2016 Jun 29;8(2):6052. Available from: https://​www.​ncbi.​nlm.​nih.​gov/​pubmed/​27441069
30.
Shah SH, Jagannathan JP, Krajewski K, O’Regan KN, George S, Ramaiya NH. Uterine sarcomas: Then and now. Am J Roentgenol. 2012;199(1):213–23.CrossRef
31.
Healy V, O’Halloran P, O’Brien S, Beausang A, Caird J. CNS metastasis secondary to malignant-mixed Müllerian tumor: case report and review of therapeutics. CNS Oncol. 2017/10/09. 2017 Oct;6(4):315–23.
32.
Cantrell LA, Havrilesky L, Moore DT, O’Malley D, Liotta M, Secord AA, et al. A multi-institutional cohort study of adjuvant therapy in stage I-II uterine carcinosarcoma. Gynecol Oncol. 2012;127(1):22–6.CrossRefPubMed
33.
Cha J, Kim YS, Park W, Kim HJ, Kim JY, Kim JH, et al. Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: A multicenter retrospective study (KROG 13-08). J Gynecol Oncol. 2016;27(6):1–12.CrossRef
34.
Kumar Dandamudi R, Aslam S, Walji N, El-Modir A, Fernando I. Chemotherapy for uterine carcinosarcoma with carboplatin, ifosfamide and mesna. Anticancer Res. 2015;35(9):4841–8.
35.
Brackmann M, Stasenko M, Uppal S, Erba J, Reynolds RK, McLean K. Comparison of first-line chemotherapy regimens for ovarian carcinosarcoma: A single institution case series and review of the literature. BMC Cancer. 2018;18(1):1–7.CrossRef
36.
Homesley HD, Filiaci V, Gibbons SK, Long HJ, Cella D, Spirtos NM, et al. A randomized phase III trial in advanced endometrial carcinoma of surgery and volume directed radiation followed by cisplatin and doxorubicin with or without paclitaxel: A Gynecologic Oncology Group study. Gynecol Oncol. 2009 Mar;112(3):543–52.CrossRefPubMed
37.
Sutton G, Brunetto VL, Kilgore L, Soper JT, McGehee R, Olt G, et al. A phase III trial of ifosfamide with or without cisplatin in carcinosarcoma of the uterus: A Gynecologic Oncology Group Study. Gynecol Oncol. 2000 Nov;79(2):147–53.CrossRefPubMed
38.
Lacour RA, Euscher E, Atkinson EN, Sun CC, Ramirez PT, Coleman RL, et al. A phase II trial of paclitaxel and carboplatin in women with advanced or recurrent uterine carcinosarcoma. Int J Gynecol Cancer. 2011 Apr;21(3):517–22.CrossRefPubMed
39.
Lorusso D, Martinelli F, Mancini M, Sarno I, Ditto A, Raspagliesi F. Carboplatin-Paclitaxel versus Cisplatin-Ifosfamide in the treatment of uterine carcinosarcoma: a retrospective cohort study. Int J Gynecol Cancer. 2014 Sep;24(7):1256–61.CrossRefPubMed
40.
Powell MA, Filiaci VL, Rose PG, Mannel RS, Hanjani P, Degeest K, et al. Phase II evaluation of paclitaxel and carboplatin in the treatment of carcinosarcoma of the uterus: a Gynecologic Oncology Group study. J Clin Oncol. 2010 Jun;28(16):2727–31.CrossRefPubMedPubMedCentral
41.
Matsuo K, Ross MS, Yunokawa M, Johnson MS, Machida H, Omatsu K, et al. Salvage chemotherapy with taxane and platinum for women with recurrent uterine carcinosarcoma. Gynecol Oncol. 2017;147(3):565–71.CrossRefPubMed
42.
Vitale SG, Laganà AS, Capriglione S, Angioli R, La Rosa VL, Lopez S, et al. Target therapies for uterine carcinosarcomas: Current evidence and future perspectives. Int J Mol Sci. 2017;18(5):1–16.CrossRef
43.
Makker V, Recio FO, Ma L, Matulonis UA, Lauchle JO, Parmar H, et al. A multicenter, single-arm, open-label, phase 2 study of apitolisib (GDC-0980) for the treatment of recurrent or persistent endometrial carcinoma (MAGGIE study). Cancer. 2016 Nov;122(22):3519–28.CrossRefPubMedPubMedCentral
44.
Einstein MH, Klobocista M, Hou JY, Lee S, Mutyala S, Mehta K, et al. Phase II trial of adjuvant pelvic radiation “sandwiched” between ifosfamide or ifosfamide plus cisplatin in women with uterine carcinosarcoma. Gynecol Oncol. 2012 Jan;124(1):26–30.CrossRefPubMed
45.
Sozen H, Çiftçi R, Vatansever D, Topuz S, Iyibozkurt AC, Bozbey HU, et al. Combination of adjuvant chemotherapy and radiotherapy is associated with improved survival at early stage type II endometrial cancer and carcinosarcoma. Aust New Zeal J Obstet Gynaecol. 2016;56(2):199–206.CrossRef
46.
GGonzalez Bosquet J, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol. 2010;116(3):419–23.CrossRefPubMed
47.
Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ. Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer. 2000 Jun;88(12):2782–6.CrossRefPubMed
48.
Matsuo K, Ross MS, Yunokawa M, Johnson MS, Machida H, Omatsu K, et al. Clinical utility of CA-125 in the management of uterine carcinosarcoma. Vol. 29, Journal of Gynecologic Oncology. Korea (South); 2018. p. e88.
Metadata
Title
Uterine carcinosarcoma: a primer for radiologists
Authors
Pavitra Ravishankar
Daniel A. Smith
Stefanie Avril
Elias Kikano
Nikhil H. Ramaiya
Publication date
01-08-2019
Publisher
Springer US
Published in
Abdominal Radiology / Issue 8/2019
Print ISSN: 2366-004X
Electronic ISSN: 2366-0058
DOI
https://doi.org/10.1007/s00261-019-02038-8

Other articles of this Issue 8/2019

Abdominal Radiology 8/2019 Go to the issue

Interventional Radiology

Diffusion-weighted imaging of hepatocellular carcinoma before and after transarterial chemoembolization: role in survival prediction and response evaluation

Hepatobiliary

Assessment of liver fibrosis with gadoxetic acid-enhanced MRI: comparisons with transient elastography, ElastPQ, and serologic fibrosis markers

Interventional Radiology

The occlusion balloon reduction technique for de novo placement and salvage of malpositioned enteric tubes

Interventional Radiology

Microwave ablation assisted by three-dimensional visualization system as local therapy for relapsed hepatoblastoma: a small pilot study

Kidneys, Ureters, Bladder, Retroperitoneum

Clinical significance of incidentally discovered renal cysts in pediatric patients

Classics in Abdominal Radiology

The “striated” testis

ACC 2024 Congress Coverage

Heart Failure Video

Year in Review: Heart failure and cardiomyopathies

Watch now

Watch this official video from ACC.24 to hear Dr. Biykem Bozkurt discuss last year's major advances in heart failure and cardiomyopathies.

Semaglutide benefits people with type 2 diabetes and obesity-related heart failure

16-04-2024 Type 2 Diabetes News

Incentivised to exercise

11-04-2024 Lifestyle Modifications News

New intervention for STEMI-related cardiogenic shock

10-04-2024 Myocardial Infarction News

» View more highlights on the ACC 2024 congress hub page

Image Credits