Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma
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ORIGINAL ARTICLE
Carcinosarcoma of the ovary: MR and clinical findings compared with high‑grade serous carcinoma Tsukasa Saida1 · Kensaku Mori1 · Yumiko Oishi Tanaka2 · Masafumi Sakai1 · Taishi Amano1 · Shunsuke Kikuchi1 · Souta Masuoka1 · Miki Yoshida1 · Tomohiko Masumoto1 · Toyomi Satoh3 · Manabu Minami1 Received: 20 August 2020 / Accepted: 4 November 2020 © Japan Radiological Society 2020
Abstract Purpose To clarify imaging and clinical characteristics of ovarian carcinosarcoma (CS) compared with high-grade serous carcinoma (HGSC). Methods We retrospectively reviewed MR imagings of 12 patients with CS and 30 patients with HGSC and evaluated tumor size, shape, appearance, nature of cystic and solid components, hemorrhage, and necrosis. Age, premenopausal or postmenopausal, histologic subtype, presence of endometriosis, tumor markers, and stage were also evaluated. These parameters were compared using the Mann–Whitney U test and the chi-square test/Fisher’s exact test. Results The mean size of CSs was 13.6 cm, and significantly larger than that of HGSCs (mean 9.0 cm, p = 0.022). The stained-glass appearance (67% vs. 23%, p = 0.013), hemorrhage (100% vs. 50%, p = 0.003), necrosis (75.0% vs. 13%, p = 0.000), and endometriosis (33% vs. 7%, p = 0.012) were significantly more common in CSs. The postmenopausal ratio of CSs was 100% and significantly higher than that of HGSCs (70.0%, p = 0.041). Among the tumor makers, only CA-125 was significantly lower in CSs than in HGSCs (mean 715.1 U/ml vs. 1677.1 U/ml, p = 0.009). The stage distribution was similar and was not significantly different. Conclusion CSs formed larger masses, and the stained-glass appearance, hemorrhage, and necrosis were more frequently observed in CSs. Keywords Malignant mixed epithelial and mesenchymal tumor · Carcinoma · Cancer · Ovarian sarcoma · Magnetic resonance imaging
Introduction Carcinosarcoma (CS) is a rare ovarian tumor reported to represent 2% of ovarian malignancies [1]. CS is a biphasic neoplasm composed of high-grade malignant epithelial and mesenchymal elements, synonymous with malignant mixed * Tsukasa Saida [email protected] 1
Department of Radiology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
2
Department of Diagnostic Imaging, The Cancer Institute Hospital Japanese Foundation for Cancer Research, 3‑8‑31, Ariake, Koto, Tokyo 135‑8550, Japan
3
Department of Obstetrics and Gynecology, Faculty of Medicine, University of Tsukuba, 1‑1‑1 Tennodai, Tsukuba, Ibaraki 305‑8575, Japan
mesodermal tumor, and malignant mixed Müllerian tumor. These tumors are subclassified as “heterologous” (tissue not native to the ovary) or “homologous” (tissue native to the ovary) according to the presence or absence of a stromal component containing mesenchymal tissue not normally found in the ovary [2]. The pattern of spread is similar to epithelial ovarian carcinoma, especially high-grade serous carcinoma (HGSC), with early serosal and peritoneal dissemination. Due to
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