Carcinosarcoma of the fallopian tube with disappearance of carcinoma cells by neoadjuvant chemotherapy: case study

The authors report a case of carcinosarcoma (CS) of the fimbria of the fallopian tube in which carcinoma cells disappeared with neoadjuvant chemotherapy (NAC). A 74-year-old woman visited the present hospital with a large pelvic mass and pleural effusion. A magnetic resonance image of the tumor was highly suggestive of ovarian carcinoma. Due to the presence of both serous adenocarcinoma cells in pleural effusion and pulmonary thrombosis, the patient was given NAC consisting of carboplatin plus paclitaxel (TC) and anti-coagulant therapy with warfarin potassium. With six courses of NAC, the pleural effusion and pulmonary thrombosis disappeared, and the tumor decreased 36.2% in greatest diameter. Maximum debulking surgery was then performed. The tumor was found to be located in the fimbria of the right fallopian tube. Hysterectomy and bilateral salpingo-oophorectomy were performed, and histologic examination revealed chondrosarcoma with the presence of necrotic epithelial cells. The necrotic areas were interspersed with papillary structures, and immunohistochemical study showed positivity for CK7 and negativity for CK20, p53, and estrogen receptor (ER), indicating serous adenocarcinoma. Thus, heterologous CS with disappearance of viable carcinoma cells by NAC was diagnosed. The patient was given adjuvant chemotherapy consisting of three courses of TC, and there has been no evidence of disease for 20 months. The authors’ experience in this case of gynecologic CS indicates that a serous adenocarcinomatous component of tubal CS can be well cured by TC-based NAC.

Carcinosarcoma; Fallopian tube; Neoadjuvant chemotherapy.

[1] Fujii H., Yoshida M., Gong Z.X., Matsumoto T., Hamano Y., Fuku-naga M., et al.: “Frequent genetic heterogeneity in the clonal evolu-tion of gynecological carcinosarcinoma and its influence on phenotypic diversity”. Cancer Res., 2000, 60, 114.

[2] Le T., Shahriari P., Hopkins L., Faught W., Fung K., Fung M., et al.: “Prognostic significance of tumor necrosis in ovarian cancer patients treated with neoadjuvant chemotherapy and interval debulking sur-gery”. Int. J. Gynecol. Cancer, 2006, 16, 986.

[3] Kuhn W., Rutke S., Späthe K., Schmalfeldt B., Florack G., von Hun-delshausen B., et al.: “Neoadjuvant chemotherapy followed by tumor debulking prolongs survival for patients with poor prognosis in In-ternational Federation of Gynecology and Obstetrics Stage IIIC ovar-ian carcinoma”. Cancer, 2001, 92, 2585.

[4] Vergote I., De Wever I., Tjalma W., Van Gramberen M., Decloedt J., van Dam P., et al.: “Neoadjuvant chemotherapy or primary debulk-ing surgery in advanced ovarian carcinoma: a retrospective analysis of 285 patients”. Gynecol. Oncol., 1998, 71, 431.

[5] Rauh-Hain J.A., Growdon W.B., Rodriguez N., Goodman A.K., Boruta D.M. 2nd, Schorge J.O., et al.: “Carcinosarcoma of the ovary: a case-control study”. Gynecol. Oncol., 2011, 121, 477.

[6] Tate Thigpen J., Blessing J.A., DeGeest K., Look K.Y., Homesley H.D.; Gynecologic Oncology Group: “Cisplatin as initial chemother-apy in ovarian carcinosarcomas: a Gynecologic Oncology Group study”. Gynecol. Oncol., 2004, 93, 336.

[7] Cicin I., Saip P., Eralp Y., Selam M., Topuz S., Ozluk Y., et al.: “Ovarian carcinosarcomas: clinicopathological prognostic factors and evaluation of chemotherapy regimens containing platinum”. Gy-necol. Oncol., 2008, 108, 136.

[8] Duska L.R., Garret A., Eltabbakh G.H., Oliva E., Penson R., Fuller A. F., et al.: “Paclitaxel and platinum chemotherapy for malignant mixed mullerian tumors of the ovary”. Gynecol. Oncol., 2002, 85, 459.

[9] Leiser A.L., Chi D.S., Ishill N.M., Tew W.P.: “Carcinosarcoma of the ovary treated with platinum and taxane: The Memorial Sloan-Kettering Cancer experience”. Gynecol. Oncol., 2007, 105, 657.

[10] Harris M.A., Delap L.M., Sengupta P.S., Wilkinson P.M., Welch R. S., Swindell R., et al.: “Carcinosarcoma of the ovary”. Br. J. Can-cer, 2003, 88, 654.