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Primary sarcoma of the ovary: Clinicopathological characteristics, prognostic

factors and evaluation of therapy

Article in Chinese Medical Journal · May 2011

DOI: 10.3760/cma.j.issn.0366-6999.2011.09.008 · Source: PubMed

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1316 Chin Med J 2011;124(9):1316-1321

Original article
Primary sarcoma of the ovary: clinicopathological characteristics,
prognostic factors and evaluation of therapy
DAI Yi, SHEN Keng, LANG Jing-he, HUANG Hui-fang, PAN Ling-ya, WU Ming, YANG Jia-xin and
ZHONG Ding-rong

Keywords: ovary; sarcoma; chemotherapy

Background The primary ovarian sarcoma is a very rare malignancy. The objective of this study was to further
investigate the clinicopathologic features and outcome in patients with primary sarcoma of the ovary.
Methods Between 1988 and 2007, 24 patients with primary ovarian sarcoma who underwent treatment at Peking
Union Medical Hospital were reviewed retrospectively. Response to treatment, progression and overall survival were
analyzed.
Results Patients with ovarian sarcoma had a mean age of (54.3±10.3) years, and 16 of them were postmenopausal.
The most common symptom was abdominal pain, present in 14 patients. Of the 24 patients, 16 patients were
pathologically diagnosed as carcinosarcoma (known as malignant mixed mesodermal tumor (MMMT)), 2 as ovarian
leiomyosarcoma (LS) and 6 patients as ovarian endometrial stromal sarcoma (ESS). The patients in optimal debulking
group had a median survival period of 28 months and 1-year survival rate of 71%. The patients in suboptimal debulking
group had a significantly lower median survival of 6 months (P=0.02) and 1-year survival rate of 29%. Among the patients,
23 patients received chemotherapy and most of regimens were based on platinum, 3 patients received chemoradiation.
The mean number of courses of combined chemotherapy was 6.6±5.0, and the response was unsatisfactory. The median
survival for the entire group was 18.7 months. The one-year survival rate was 58%, and two-year survival rate only 29%.
Conclusions Ovarian primary sarcoma has a poor overall prognosis. Optimal debulking surgery appears to be of
prognostic significance. There is a clear need for further study to explore the role and the regimen of platinum-based
chemotherapy in primary ovarian sarcoma.
Chin Med J 2011;124(9):1316-1321

T he primary ovarian sarcoma is a very rare malignancy.

Infrequent occurrence and indistinctive symptoms
make preoperative diagnosis of this tumor difficult. In the
were excluded. All of pathologic diagnoses were
reviewed by a gynecologic pathologist.

pelvis, sarcoma typically develops in the uterus and Baseline variables were recorded retrospectively,
ovarian primary sarcoma are reported to represent <2% of including age, CA125 level, tumor stage and histological
ovarian malignancies.1 There are few studies involving type (Table 1). In all cases, a histological diagnosis of
large numbers of patients published. Most studies focus ovarian sarcoma was confirmed by a gynecologic
on carcinosarcoma, others are case reports of rare pathologist reviewing section. Using the International
sarcoma, such as ovarian leiomyosarcoma. Patients with Federation of Gynecology and Obstetrics (FIGO)
carcinosarcoma often quickly develop a recurrence and classification, disease was staged by surgical findings and
have a poor prognosis. Although platinum-based chemo- pathological confirmation. All surgeries and the
therapy is commonly utilized in the setting of advanced chemotherapy were performed by specialists in
disease, to our knowledge, its role in the adjuvant setting gynecologic oncology. Chemotherapy was administered
has not been clarified in the context of randomized
DOI: 10.3760/cma.j.issn.0366-6999.2011.09.008
controlled trials. We reported 24 patients with primary Department of Obstetrics and Gynecology (Dai Y, Shen K, Lang
ovarian sarcoma treated in Peking Union Medical College JH, Huang HF, Pan LY, Wu M and Yang JX), Department of
(PUMC) Hospital in this study focusing on the diagnosis, Pathology (Zhong DR), Peking Union Medical College Hospital,
management and outcome of this rare disease. Peking Union Medical College & Chinese Academy of Medical
Sciences, Beijing 100730, China
Correspondence to: SHEN Keng, Department of Obstetrics and
METHODS Gynecology, Peking Union Medical College Hospital, Peking
Union Medical College & Chinese Academy of Medical Sciences,
Between 1988 and December 2007, a total of 1798 Beijing 100730, China (Tel: 86-10- 65296238. Fax: 86-10-65212507.
patients with ovarian carcinoma and 24 (1.33%) patients Email: [email protected])
with the diagnosis of primary ovarian sarcoma were This study was supported by grants from the National Natural
Science Foundation for Young Scholars of China (No. 30801233)
pathologically identified and treated in the Department of and Sicence & Technology Young Scholars Plan of Beijing
Obstetrics and Gynecology, PUMC Hospital. The patients Municipal Scicence & Technology Commission (No. 2008A048).
whose endometrium and uterine muscle had neoplasm All the authors declare that there are no conflicts of interest.
Chinese Medical Journal 2011;124(9):1316-1321 1317

Table 1. Characteristics of patients with primary ovarian sarcoma age of patients was (54.3±10.3) years (35 to 71 years).
Variables Carcinosarcoma LS ESS The mean gravida was 3.4±1.6 (1 to 8) and mean para
Patients (n) 16 2 6
was 2.1±1.6 (0 to 8). Sixteen patients (16/24) were
Mean age (years, mean±SD) 54.9±8.6 42.5±6.4 48.7±11.1
FIGO (n)
postmenopausal. Two women had a history of
Stage I 1 – 1 hysterectomy for a benign disorder. The most common
Stage II – – – symptom was abdominal pain presented in 13 patients.
Stage III 13 2 4 The other symptoms were ascites in 9 patients, abdominal
Stage IV 2 – 1 distention in 8 patients, weight loss in 5 patients, fever in
CA125 (U/ml) 696.54±314.06 39.4 39.21±20.90
Optimally debulked (n) 12 1 4
2 patients, and postmenorrhael vaginal bleeding only in 1
Suboptimally debulked (n) 4 1 2 patient. The patients with carcinosarcoma had the mean
LS: leiomyosarcoma. ESS: endometrial stromal sarcoma including one case of CA125 level of (696.54±314.06) U/ml, much higher than
nondifferenfial sarcoma. the patients with leiomyosarcoma and endometrial
stromal sarcoma group (39.4 U/ml, (39.21±20.90) U/ml,
Table 2. Chemotherapy regimen received in three histological respectively, P =0.02).
group patients (n)
Chemotherapy regimen MMMT LS ESS
Total number of patients 16 2 6
Surgical treatment
Cisplatinum/carboplatinum+taxol 4 1 Overall, 24 patients underwent 18 primary cytoreductive
Cisplatinum+cyclophosphamide 4 surgeries, 10 re-cytoreductive surgeries, 1 laporoscopic
Cisplatin+epirubicin+ifosfamide 2 3 biopsy, and 1 staging surgery. Seven patients (7/24) had
Cisplatin+VP-16/vincristine+bleomycin 2 2
residual tumor smaller than 1 cm, 10 (10/24) patients’
Cisplatin+adriamycin+cyclophosphamide 2 2
Gamzer+ifosfamide 1
residual tumor smaller than 2 cm but larger than 1 cm,
Progesterone+radiotherapy 2 and 7 patients (7/24) had unsatisfactory debulking
Taxol+cisplatin+pharmorubicin 1 surgery with residue greater than 2 cm.
Taxol+cisplatin+dacarbazine 1
MMMT: ovarian malignant mesodermal mixed tumor. LS: ovarian Operative finding
leiomyosarcoma. ESS: ovarian endometrial stromal sarcoma.
The tumor was unilateral in 19 (19/24) cases (12 in left, 7
in right) and bilateral in 5 cases (P=0.02). The diameter
to 23 of 24 patients with ovarian sarcoma (Table 2). The
of tumor was (12.27±6.69) cm. Gross descriptions of the
radiotherapy was performed under the supervision of
primary tumors were available in 18 cases. The tumor
radiologists and gynecologic oncologists.
was predominantly solid in 6 cases, entirely solid in 10,
For patients with measurable disease, response to and predominantly cystic in 2 cases with hemorrhagic
chemotherapy was evaluated by computed tomography fluid like chocolate cyst. In 18 cases of primary debulking
(CT) according to WHO response criteria.2 A complete surgery and 1 case of staging surgery, according the
response (CR) was defined as the complete disappearance operative records, greater omentum metastasis was found
of all clinically detectable disease for at least 4 weeks. A in 14 (14/19) cases, diaphragms metastases in 7 (7/19)
partial response (PR) was defined as a >50% decrease in cases, appendix metastasis in 7 (7/19) cases, colon
the sum of the products of the largest perpendicular metastasis in 5 (5/19), rectum metastasis in 5 (5/19),
dimensions of all measurable lesions for at least 4 weeks mesenterium metastasis in 4 cases (4/19), pelvic lymph
without an increase in the size of any known lesion or the node metastasis in 5 (5/19) cases, supraclavicular lymph
appearance of a new lesion. No change was defined as a nodes metastasis in 1 case (1/19), and liver parenchyma
<50% decrease and <25% increase in the sum of metastasis in 1 (1/19) case. There were 6 cases where the
measurable or evaluable lesions for at least 6 weeks. uterus was involved: 5 cases just in serous membrane, 1
Progressive disease was defined as the appearance of new case reaching subserous muscle infiltrated directly by
lesions or a >25% increase in the sum of measurable or ovarian tumor.
evaluable lesions.
Of the 24 patients, 2 patients had stage Ic disease, 18
For patients without measurable disease on CT scan, patients had stage IIIc disease, 1 patient had stage IIIb
response to chemotherapy was calculated according to disease, 3 patients had stage IV disease according to the
CA125 response using the criteria of Rustin et al.3,4 FIGO classification (Table 1).

Patient survival was calculated by the Kaplan-Meier Pathology

method. The significance of the survival rate in each Of the 24 patients, 16 patients were pathologically
group was tested with the log-rank test. Statistical diagnosed as carcinosarcoma (known as malignant mixed
significance was set at P <0.05. mesodermal tumor (MMMT)), 2 as ovarian leiomyo-
sarcoma (LS) and 6 as ovarian endometrial stromal
RESULTS sarcoma (ESS) (Figures 1–5).

Patient chracteristics Chemotherapy

Patient characteristics are shown in Table 1. The mean One patient had advanced progressive disease, and died
1318 Chin Med J 2011;124(9):1316-1321

Figure 1. The HE staining of lesions showing the nest of carcinoma around by fusiforming sarcoma cells (original magnification ×100).
Figure 2. Carcinoma cells were positive in AE1AE3 immunohistochemical staining (original magnification ×200).
Figure 3. The HE staining of lesions showing the chondrosarcoma in carcinoma tissue (original magnification ×100).
Figure 4. Immunohistochemical staining of lesions with Vimentin, the sarcoma cell was positive in staining, the carcinoma cells was
negative (original magnification ×200).
Figure 5. The HE staining of ovarian endometrial stromal sarcoma (original magnification×200).

shortly after diagnosis without chemical therapy. Gamzer + IFO, Taxol + cisplatin + pharmorubicin, Taxol
Twenty-three patients received chemical therapy and 3 + cisplatin + dacarbazine, respectively, none of whom had
patients received radical and chemical therapy. The mean good reponse to therapy. The one ESS patient staging Ic
number of courses of combined chemical therapy was received Xeloda and progesterone 250 mg per day after
6.6±5.0 (Table 2). Some of patients received more than 2 optimal bulking surgery for 6 months. She has been
regimens chemotherapy through the whole treatment. We non-progressive survival for 41 months by now.
list the regimens of the different hisotologic patients in
Table 2. Radiotherapy
Among 6 ESS patients, 2 received progesterone at 250
Four patients received Taxol and cisplatin/carboplatin mg/d and radiotherapy simultaneously after optimal
(TP/TC) combination as the first line chemotherapy, and debulking surgery, one has been followed for 40 months,
mean number of courses was 6.4±4.7 (range from 2 to 14 the other for 32 months, without the sign of relapse. One
courses). Among them, 1 patient’s disease progressed MMMT patients also underwent the pelvic radiotherapy
during therapy, the others’ relapsed, the average time of after the suboptimal surgery and non-response for TP
relapse was (3.8±1.9) months after chemical therapy. One regimen, and disease made progress rapidly and she died
patient received the 7 courses Taxol and cisplatin shortly in 3 months after operation.
combination after tumor relapsed, but the disease
progressed. The cisplatin and cyclophosphamide Prognosis
combination were performed in 4 MMMT patients as the The median follow-up was (18.7±17.4) (from 1 to 74)
first line therapy and the mean number of courses was months. The median survival for the entire group was
5.0±2.2. They also appeared to respond poorly, one 18.7 months. The one year survival rate of entire group
progressed during therapy and three relapsed (3.0±1.4) was 58% (14/24), and 2-year survival rate only 29%
months later. The same unsatisfactory responses also (7/24), 5-year survival rate only 4% (1/24). But there was
were observed in the cisplatin + epirubicin + isosfamide difference between each subgroup based on pathology.
(PEI) regimen, 2 patients received as the first line The one-year survival rate was 50% (8/16) in MMMT
chemotherapy (4 and 9 course respectively) and 3 patients patients, 100% (6/6) in endometrial stromal sarcoma
received as the second line (mean (5.0±1.0) course). One patients, and 0% (0/2) in leiomyosarcoma patients
of the 5 patients had no response for the treatment, 1 (P=0.02). The median survival time for MMMT, LS, ESS
patient were worse during therapy, the others all relapsed patients was 12, 4 and 74 months respectively (P=0.00),
4 months after chemotherapy. Two MMMT and 1 ESS and the mean survival time for each subgroup was
patients received cisplatin, adriamycin and (13.4±11.5) months, (5.0±1.4) months and (37.3±20.5)
cyclophosphamide (PAC) regimen as priory months respectively, P=0.00 (Table 3).
chemotherapy and one ESS patient as secondary. Only Table 3. Estimated survival rate of patients based on pathology
the ESS patient had good response to medication, Variables MMMT ESS LS P values
relapsing 1 year after treatment, the others progressed Survial rate (n/N)
during therapy. Two MMMT and two LS patients 1-year 8/16 6/6 0/2 0.02
received 3 to 6 courses of cisplatin, VP-16/vincristine and 2-year 3/16 4/6 0/2 >0.05
3-year 1/16 3/6* 0/2
bleomycin combination (PEB/PVB) therapy as the 5-year 0/16 1/6 0/2 >0.05
first-line treatment. Only one stage I MMMT patients had Mean ST (months) 13.4±11.5 37.3±20.5 5.0±1.4 0.00
good response, 2 patients progressed, and one relapsed 5 Median ST (months) 12 4 74 0.00
months after chemotherapy. Only 3 patients received *
Two patients are still under follow-up. ST: survival time.
Chinese Medical Journal 2011;124(9):1316-1321 1319

The presence of residual disease was associated with a incidence of hemorrhagic ascites (n=6) which was
decreased overall survival. The 17 patients in optimal observed in 60% of the patients with ascites (n=10).
debulking group had a median survival period of 28 CA125 was not as sensitive as that in epithelial ovarian
months, comparing the significantly lower median cancer. Only in patients with carcinosarcoma, the CA125
survival of 6 months (P=0.00) in the suboptimal level was much higher. Lack of specific symptom and
debulking group. At 1 year, 71% (12/17) of patients with marker, makes the primary ovarian sarcoma more
residual lesions less than 2 cm were alive, only 29% (2/7) difficult in early diagnosis.
patients in suboptimal group was alive. Kaplan-Meier
estimated survival of total 24 patients also showed the There was a similar stage distribution in the three type of
significantly difference between two group patients primary ovarian sarcoma, with the majority of patients
(Figure 6). having advanced diseases (stage III/IV) at the time of
presentation. The tumor is often unilateral, solid, and the
greater omentum is the most common matastasis location.
Because of the uncommonly widespread of metastasis,
surgical debulking becomes difficult.

In our results, the entire group median survival was only

18.7 months. Ovarian sarcoma has a poor overall
prognosis in the literatures, median survival was from 8
to 26 months.10-15 An aggressive surgical and
chemotherapy has been questioned in this population of
patients. The role of cytoreduction in epithelial ovarian
carcinoma is well established; however, in primary
sarcomas, its benefit still is controversial. Barakat et al12
reported the size of residual disease after tumor debulking
Figure 6. Kaplan-Meier estimated survival for patients with did not significantly impact survival. However, Muntz et
primary ovarian sarcoma in optimal debulked (<2 cm) (green
al13 reported a 14% 2-year survival in suboptimal
line) and suboptimal debulked (≥2 cm) (red line). RT: residual
tumor. P=0.00. advanced stage patients compared with 52% 2-year
survival in patients achieving optimal cytoreduction. The
DISCUSSION same outcome of surgery was also reported by Sood et
al.14 The median survival for optimal cytoreduction was
Primary ovarian sarcomas are very rare tumors, reported 25 months compared with 8 months in patients with
to represent <2% of ovarian malignancies.1,5 Because of suboptimal cytoreduction. Cicin et al10 reported, the
its rarity, the articles about the primary ovarian sarcoma overall median survival of the ovarian carcinosarcoma
often were case reports,6,7 not including the large sample. patients, which underwent initial debulking surgery was
In these reports, the carcinosarcoma was the most 26 months. Residual disease was associated with a
common histological type. In our study, primary ovarian decreased overall survival. Our series demonstrated that
sarcoma represented 1.33% of the total number of ovarian the median survival time in optimal debulking group was
malignancies. Among the primary ovarian sarcomas, significantly longer than suboptimal debulking group (28
carcinosarcomas are predominantly histological type. The vs. 6 months, P=0.00). At 1 year, 71% of patients with
pathogenesis of ovarian sarcoma has not been clear. Lavie residual less than 2 cm were alive, but the rate in
et al8 reported 2 cases of ovarian carcinosarcomas suboptimal group was only 29%. Considering the
associated with prolonged use of tamoxifeno. Boruban et disappointing results of chemotherapy, we still believe
al9 reported a case of ovarian endometriosis associated that optimal cytoreduction surgery is the most important
with carcinoma and sarcoma. But in our study, we did not factor in prognosis.
find some definitely high risk factor of these patients.
There is no well established consensus regarding whether
Our data showed the carcinosarcoma tends to affect a patients with carcinosarcoma should receive
more elderly population than does leiomyosarcoma and chemotherapy and which regimen should be regarded as
endometrial stromal sarcoma, with the mean age of optimal. There has been a variety of different
patients with carcinosarcoma being significantly older chemotherapy regimens used in the current series, which
than that of patients with the other two diseases. As with can be divided into two categories: platinum-based and
epithelial ovarian cancer, there is no typical symptom nonplatinum-based. Harris et al16 reported 40 primary
helpful in differential diagnosis. In our study, the most ovarian carcinosarcoma patients, the response rate in
common clinical presentation is abdominal pain (72.2%). patients received platinum-based chemotherapy was 40%
The other symptoms were ascites, abdominal distention, with an overall median survival of 8.7 months. Brown et
weight loss, fever and postmenorrhael vaginal bleeding. al17 also reported a significantly inferior reponse rate of
In the retrospective analysis of Cicin et al,10 the most carcinosarcoma to platinum-based chemotherapy
striking clinicopathological finding was the high compared with serous adenocarcinoma (25% vs. 60%;
1320 Chin Med J 2011;124(9):1316-1321

P=0.02). Prendeville et al18 reported 15 patients received that patients with ovarian sarcomas should be treated by
chemotherapy predominantly based on cyclophosphamide optimal cytoreduction. The use of chemotherapy has yet
with minority of patients receiving platinum. Their to be identified fully. Therefore there is a clear need for
response rate still was 47% with median survival of 14 further study to explore the role of chemotherapy in
months. The Gynecologic Oncology Group (GOG) primary ovarian sarcoma.
initiated a concerted effort to study cytotoxic therapy for
these patients.19 From 1977 to 1996, 136 eligible patients REFERENCES
with ovarian carcinosarcoma received cisplatin (50
mg/m2) every 3 weeks until disease progression or 1. Bicher A, Levenback C, Silva EG, Burk TW, Morris M,
unacceptable toxicity, which was the largest prospective Gershenson DM. Ovarian malignant mullerian tumors treated
study focus on the platinum-based chemotherapy. Among with platinum-based chemotherapy. Obstet Gynecol 1995: 85:
44 patients evaluated for response, only 2% complete 735-739.
response and 18% partial response resulted. Median 2. World Health Organization. Handbook for reporting results of
progression-free survival in 130 patients was 5.2 months, cancer treatment. Geneva: World Health Organization. 1979.
and median survival was 11.7 months. Signorelli et al20 3. Rustin G, Nelstrop A, Bentzen S, Bond S, McClean P.
evaluated the combination of anthracycline, alkylating Selection of active drugs for ovarian cancer based of CA125
agent, and cisplatin in carcinosarcoma patients. The and standard response rates in phase II trials. J Clin Oncol
regimen showed a good response but also a high toxicity. 2000; 18: 1733-1739.
Among 22 women considered evaluable for response, 10 4. Rustin GJ, Nelstrop AE, McLean P, Brady MF, McGuire WP,
(46%) achieved a complete response and 3 (13%) Hoskins WJ, et al. Defining response of ovarian carcinoma to
achieved a partial response (global response rate, 59%). initial chemotherapy according to serum CA125. J Clin
Overall progression-free survival was 11.8 months (range, Oncol 1996; 14: 1545-1551.
0.9–96 months). In Cicin’s report,10 there was a trend for 5. Kondi-Pafit A, Grapsa D, Hasiakos D, Gennatas K, Fotiou S.
increased median survival in the patients who were Carcinosarcoma of the uterus and ovary: a clinicopathologic
treated with carboplatin/paclitaxel combination (P=0.066). and immunohistochemical study of 11 cases. Eur J Gynaecol
When the patients treated with ifosfamide and Oncol 2009; 30: 93-97.
carboplatin/paclitaxel combinations, survival was 6. Cambruzzi E, Pegas KL, Milani DM, Cruz RP, Guerra EH,
statistically improved compared to the other regimens Ferrari MB. Angiosarcoma arising in an ovarian fibroma: a
(36.0 vs. 9.7 months, P=0.04). Chemotherapy regimens case report. Pathol Res Int 2010; 2010: 842592.
containing doxorubicin or cyclophosphamide were not 7. Brustmann H, Geiss IM, Hinterholzer S. Undifferentiated
encouraging. The platinum-based chemotherapy endometrial sarcoma of the ovary: a case report with review
containing either paclitaxel or ifosfamide (P=0.024) of recent literature and discussion of lacking specificity of
remained predictive of outcome in the multivariate CD10 immunoreactivity. Pathol Res Int 2010; 2010: 608519.
analysis. 8. Lavie O, Longacre T, Segev Y, Husain A. Ovarian
carcinosarcoma associated with prolonged use of tamoxifen:
In our study, the platinum-based chemotherapy did not case reports. Int J Gynecol Cancer 2009; 19: 1521-1523.
show the optimal results. Although median survival is as 9. Boruban MC, Jaishuen A, Sirisabya N, Li Y, Zhang HG,
long as 18.7 months in the entire group, most of our Deavers MT, et al. Ovarian endometriosis associated with
patients relapsed after chemotherapy within 6 months. So carcinoma and sarcoma. Eur J Gynecol Oncol 2008; 29:
more randomized control clinic study is needed to clarify 393-396.
the role of cisplastinum in ovarian sarcoma. 10. Cicin I, Saip P, Rralp Y, Selam M, Topuz S, Ozluk Y, et al.
Ovarian carcinosarcoma: clinicopathological prognostic
As to primary ovarian leiomyosarcoma, there also is no factors and evaluation of chemotherapy regimens containing
conclusive evidence that adjavant chemotherapy or platinum. Gynecol Oncol 2008; 108: 136-140.
radiation offers any survival advantage. In our series, the 11. Rutledge TL, Gold MA, McMeekin DS, Huh WK, Powell
ovarian leiomyosarcoma patients’ disease all aggravated MA, Lewin SN, et al. Carcinosarcoma of the ovary — a case
during chemotherapy. Monk et al21 believed that surgery series. Gynecol Oncol 2006; 100: 128-132.
remained the mainstay of treatment and any adjuvant 12. Barakat RR, Rubin SC, Wong G, Saigo PE, Markman M,
therapies are of unproven benefit. The same problem is Hoskins WJ. Mixed mesodermal tumor of the ovary:
ovarian endometrial stromal sarcoma facing. In our study, ananlysis of prognosis factors in 31 cases. Obstet Gynecol
the two patients in radiotherapy and progesterone show 1990; 80: 660-664.
good response. It still needs more case and longer 13. Muntz HG, Jones MA, Goff BA, Fuller Jr AF, Nikrui N, Rice
follow-up to verify. LW. Malignant mixed mullerian tumors of the ovary:
experience with surgical cytoreduction and combination
In conclusion, the primary ovarian sarcoma is very chemotherapy. Cancer 1995; 76: 1209-1213.
uncommon malignancy. And it presents a more 14. Sood AK, Sorosky JI, Gelder MS, Buller RE, Anderson B,
aggressive clinical course and a worse survival than Wilkinson EJ, et al. Primary ovarian sarcoma — analysis of
epithelial ovarian cancer. Optimal debulking surgery prognosis variables and the role of surgical cytoreduction.
appears to be of prognostic significance and we advise Cancer 1998; 82: 1731-1737.
Chinese Medical Journal 2011;124(9):1316-1321 1321

15. Cantrell LA, Van Le L. Carcinosarcoma of the ovary a review. Homesley HD; Gynecology Oncology Group. Cisplatin as
Obstet Gynecol Surv 2009; 64: 673-680. initial chemotherapy in ovarian carcinosarcomas: a
16. Harris M, Delap L, Sengupta P, Wilkinson PM, Welch RS, Gynecologic Oncology Group study. Gynecol Oncol 2004; 93:
Swindell R, et al. Carcinosarcoma of the ovary. Br J Cancer 336-339.
2003; 88: 654-657. 20. Signorelli M, Chiappa V, Minig L, Fruscio R, Perego P,
17. Brown E, Stewart M, Rye T, Al-Nafussi A, Williams AR, Caspani G, et al. Platinum, anthracycline, and alkylating
Bradburn M, et al. Carcinosarcoma of the ovary: 19 years of agent-based chemotherapy for ovarian carcinosarcoma. Int J
prospective data from a single center. Cancer 2004; 100: Gynecol Cancer 2009; 19: 1142-1146.
2148-2153. 21. Monk BJ, Nieberg R, Berek JS. Primary leiomyosarcoma of
18. Prendeville J, Murphy D, Rennison J, Buckley H, Crowther the ovary in a perimenarchal female. Gynecol Oncol 1993; 48:
D. Carcinosarcoma of the ovary treated over a 10-year period 389-393.
at the Christie hospital. Int J Gynecol Cancer 1994; 4:
200-205. (Received September 14, 2010)
19. Tate Thigpen J, Blessing JA, DeGeest K, Look KY, Edited by GUO Li-shao

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