UTERINE CARCINOSARCOMAS: CLINICAL,

HISTOPATHOLOGIC, AND
IMMUNOHISTOCHEMICAL
CHARACTERISTICS

Oleh : dr. Elisa Laura O. Sitohang

Pembimbing: Dr. dr. I.G.A Sri Mahendra Dewi, Sp.PA(K)

 UTERINE CARCINOSARCOMAS:
CLINICAL, HISTOPATHOLOGIC,
AND IMMUNOHISTOCHEMICAL
CHARACTERISTICS

Oleh : dr. Elisa Laura O. Sitohang

Pembimbing: Dr. dr. I.G.A Sri Mahendra Dewi, Sp.PA(K)

UTERINE
CARCINOSARCOMAS:
CLINICAL,
HISTOPATHOLOGIC, AND
IMMUNOHISTOCHEMICAL
CHARACTERISTICS

Oleh : dr. Elisa Laura O. Sitohang

Pembimbing: Dr. dr. I.G.A Sri Mahendra Dewi, Sp.PA
Preface

Rare highly aggressive malignant Biphasic

tumors

CARCINOSARCOMAS

Prognosis depend on:

2 Histogenesis theory - Histologic type
- The “collision” or “multiclonal” hypothesis - Depth of myometrial invasion
- “monoclonal” hypothesis - LVI and Cervical involvement
MATERIA
L AND
METHOD
 PATIENT SELECTION
• Colombia University Institutional Review Board
• Th 1995 – 2011 : 62 women with uterine carcinosarcomas
• Review by 2 pathologist ( X.C & M.H)
Criteria
Formalin fixed, paraffin embedded blocked
IHK Staining: p16, PAX8, p53  nuclear staining
 Staining Index
P=0 if < 5 % of cells

P=1 if 5 – 10 % of cells
Persentage % P
Positive P=2 if 11 – 50 % of cells
staining
P=3 if > 50 % of cells

IHC
I=0 No staining

I=1 Mild intensity

I
SI = P x I
> 4 : high-expressing Intensity
I=2 Moderate intensity

≤ 4 : low-expressing staining
I=3 Strong intensity
 H E STAINING

GAMBAR. 1. Carcinosarcoma
(hematoxylin and eosin stain, 200 ):
Malignant epithelial and mesenchymal
components.
 IHC STAINING OF p16

GAMBAR. 2. Carcinosarcoma (p16 stain,

200 ):
Strongly positive cytoplasmic staining in both
epithelial and mesenchymal components.
 IHC STAINING OF p53

FIG. 3. Carcinosarcoma (p53 stain, 200 ):

Strongly positive nuclear staining in epithelial and
mesenchymal components.
 IHC STAINING OF PAX8

GAMBAR. 4. Carcinosarcoma (PAX8 stain, 200 ):

a case showing strongly positive nuclear staining in
epithelial and mesenchymal components.
 STATISTICAL METHOD
• Study Data  Staining Intensity and percent of tumor cell
• Fisher exact test  association:

DEMOGRAPHIC AND
EPITHELIAL AND
CLINICAL
STROMAL EXPRESSION
BASELINE
OF p16, p53, PAX8
CHARACTERISTICS
 STATISTICAL METHOD
• Overall survival
 calculated as the time from date surgery – date of death of any cause, or
date the patient was known to be alive
• Recurrence Free Survival :
 the date of surgery – the date of reccurence or death

• P-value ≤ 0,5 (statistical significance)

RESULTS
RESULT
RESULT
RESULT
DISCUSSION
RESULT
RESULT
DISCUSSION
• Uterine carcinosarcomas are aggressive tumors containing both malignant
epithelial and mesenchymal components
• WHO 2003  uterine carcinosarcoma composed of an admixture of malignant epithelial and stromal components,
does not take into account the histologic grade of those malignant tissue components
• WHO 2014  uterine carcinosarcomas as biphasic tumors with high grade carcinomatous and sarcomatous
elements

• WHO 2019 
The clinical course of carcinosarcomas is similar
to
that of high-grade endometrioid
adenocarcinomas and
uterine serous carcinomas, but they seem to
occur in
older women. In our study, median age at
diagnosis was
67 yr.
CONCLUSIONS
CONCLUSION

Immunohistochemical staining for p16, p53, and PAX8 may be helpful in

establishing a diagnosis of carcinosarcoma, both primary and metastatic.

Poorly differentiated carcinomas were more likely to show

p16 stromal positivity.

The patient’s age and FIGO stage were associated with overall survival an
recurrence-free survival.

Expression of p16, p53, and PAX8 in the both epithelial and stromal components of these
tumors lends support to the monoclonal theory of uterine carcinosarcoma tumorigenesis.
THANK
YOU