454 Obstetrics and Gynecology Board Review •••
❍ Initial metastases from carcinosarcomas are usually of epithelial or stromal origin?
Epithelial.
❍ How is the prognosis for patients with carcinosarcomas affected by the presence or absence of heterologous
elements?
Recent studies have shown no prognostic difference.
❍ The triad of pelvic pain, postmenopausal bleeding, and what physical finding is highly suggestive of a
carcinosarcoma?
Tissue protruding through the cervical os.
❍ Surgical staging will upstage what percentage of patients with carcinosarcoma clinically confined to the
uterus?
25% to 50%. Risk of extrauterine disease is related to depth of myometrial invasion, lymphvascular space
involvement, and cervical extension.
❍ What is the 5-year survival rate for each type of uterine sarcoma?
Carcinosarcoma (MMMT) → 35%.
Leiomyosarcoma → 25%.
ESS → 60%.
❍ Which chemotherapeutic agents have demonstrated activity against carcinosarcomas?
Combination therapy with either paclitaxel and ifosfamide or paclitaxel and carboplatin are the current regimens
of choice for treating carcinosarcoma.
❍ Which chemotherapeutic agent is recommended for leiomyosarcoma?
Doxorubicin currently is considered first line therapy. However, treatment with the combination of gemcitabine
and docetaxel currently has the highest proven response rate (36%).
❍ What is the frequency of pelvic lymph node metastases in uterine carcinosarcomas and leiomyosarcoma?
15% for uterine carcinosarcoma and 3% for leiomyosarcoma.
❍ What is STUMP (smooth muscle tumor of uncertain malignant potential)?
Tumors that show some worrisome histologic features, such as necrosis or nuclear atypia, but cannot be diagnosed
reliably as benign or malignant based on generally applied criteria fall into this category.
❍ At which stage is leiomyosarcoma most frequently diagnosed at?
Stage 1 68% of the cases.
❍ Describe the differences between endometrial stromal nodule and ESS.
Nodules are benign, characterized by a well-delineated margin, and composed of neoplastic cells that resemble
proliferative-phase endometrial stromal cells. Grossly, the tumor is a solitary, round or oval, fleshy nodule
measuring a few centimeters. Histologically, they are distinguished from ESS by a lack of myometrial infiltration.