Costa M J, Khan R, Judd R
Department of Anatomic Pathology, Grady Memorial Hospital, Atlanta, GA 30335-3801.
Arch Pathol Lab Med. 1991 Jun;115(6):583-90.
We examined the histologic, immunohistochemical, and clinical features of a series of 23 endometrial, five cervical, and one ovarian carcinosarcomas (malignant mixed müllerian [mesodermal] tumors) and nine associated distant peritoneal metastases. The primary tumors all showed epithelial differentiation (cytokeratin and/or epithelial membrane antigen expression) of the carcinomatous component, while sarcomatous areas showed epithelial differentiation in all but one case. The metastases showed uniform staining for cytokeratin (eight of eight cases) and epithelial membrane antigen (eight of eight cases), including the spindle cell component that was present in four of nine cases. Desmin significantly changed the interpretation of rhabdomyosarcoma differentiation by refuting putative rhabdomyoblasts in two cases and identifying rhabdomyoblasts in two other cases where they were unrecognized on hematoxylineosin staining. S100 protein was positive in all five cases with chondrosarcoma differentiation. Muscle-specific actin and vimentin were positive in the sarcomatous component of all cases and in the carcinomatous component of seven and 10 cases, respectively. After immunostaining, heterologous elements were present in 18 of 29 cases (11 cases of rhabdomyosarcoma, three cases of chondrosarcoma, three cases of mixed rhabdomyosarcoma and chondrosarcoma, and one case of liposarcoma). Only six of 27 patients with follow-up were disease free for 12 months or longer (associated with stage I or II disease, smaller size, no lymphatic invasion in the resection specimen, and no invasion of the outer two thirds of myometrium). Presence and type of heterologous elements, grade of sarcomatous or carcinomatous components, histologic type of carcinomatous component, gross appearance, presence of necrosis, or use of chemotherapy or radiotherapy did not affect outcome. Carcinosarcomas are clinically aggressive distinctive mixed epithelial-stromal neoplasms with histologic and immunohistochemical features that overlap with metaplastic carcinoma in many cases.
我们研究了23例子宫内膜癌肉瘤、5例宫颈癌肉瘤和1例卵巢癌肉瘤（恶性混合苗勒管[中胚层]肿瘤）以及9例相关远处腹膜转移瘤的组织学、免疫组化和临床特征。所有原发性肿瘤的癌性成分均显示上皮分化（细胞角蛋白和/或上皮膜抗原表达），而肉瘤区域除1例病例外均显示上皮分化。转移瘤的细胞角蛋白（8例中的8例）和上皮膜抗原（8例中的8例）染色均呈一致性，包括9例中的4例存在的梭形细胞成分。结蛋白显著改变了横纹肌肉瘤分化的判断，在2例病例中排除了假定的横纹肌母细胞，而在另外2例苏木精-伊红染色未识别出横纹肌母细胞的病例中识别出了横纹肌母细胞。S100蛋白在所有5例具有软骨肉瘤分化的病例中均呈阳性。肌肉特异性肌动蛋白和波形蛋白分别在所有病例的肉瘤成分以及7例和10例病例的癌性成分中呈阳性。免疫染色后，29例病例中的18例（11例横纹肌肉瘤、3例软骨肉瘤、3例横纹肌肉瘤和软骨肉瘤混合病例以及1例脂肪肉瘤）存在异源性成分。27例接受随访的患者中只有6例无病生存12个月或更长时间（与Ⅰ期或Ⅱ期疾病、肿瘤较小、切除标本无淋巴侵犯以及子宫肌层外三分之二未受侵犯相关）。异源性成分的存在和类型、肉瘤或癌性成分的分级、癌性成分的组织学类型、大体外观、坏死的存在或化疗或放疗的使用均不影响预后。癌肉瘤是临床上具有侵袭性的独特混合上皮-间质肿瘤，其组织学和免疫组化特征在许多情况下与化生癌重叠。
