Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma

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Ovarian carcinosarcomas presented as larger masses with more frequent stained-glass appearance, hemorrhage, and necrosis compared to high-grade serous carcinomas.

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This retrospective study compared MRI and clinical characteristics of 12 patients with ovarian carcinosarcoma (CS) versus 30 with high-grade serous carcinoma (HGSC), assessing tumor size and morphology, the nature of cystic/solid components, and features such as hemorrhage and necrosis, alongside age/menopausal status, histologic subtype, tumor markers, stage, and presence of endometriosis. CSs were significantly larger, and MRI more often showed a “stained-glass” appearance, hemorrhage, and necrosis compared with HGSC; endometriosis was also more frequently present in CS. CA-125 levels were significantly lower in CS than in HGSC, while stage distribution did not differ significantly. A key limitation is the small, single-institution sample size and retrospective design, which the authors acknowledge through their methodology. Relevance to endometriosis: the paper specifically reports that endometriosis was significantly more common in ovarian carcinosarcoma than in high-grade serous carcinoma, though the study’s main focus is MRI/clinical differentiation between ovarian cancer subtypes.

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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. Similar content being viewed by others

References

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About this article Cite this article Saida, T., Mori, K., Tanaka, Y.O. et al. Carcinosarcoma of the ovary: MR and clinical findings compared with high-grade serous carcinoma. Jpn J Radiol 39, 357–366 (2021). https://doi.org/10.1007/s11604-020-01072-7 Received: Accepted: Published: Version of record: Issue date: DOI: https://doi.org/10.1007/s11604-020-01072-7

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MeSH descriptors

Carcinosarcoma Carcinosarcoma Cystadenocarcinoma, Serous Cystadenocarcinoma, Serous Magnetic Resonance Imaging Ovarian Neoplasms Ovarian Neoplasms Adult Aged Biomarkers, Tumor Carcinosarcoma Case-Control Studies Cystadenocarcinoma, Serous Female Hemorrhage Hemorrhage Hemorrhage Humans Middle Aged Necrosis

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