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An Abnormal Cervicovaginal Cytology Smear in Uterine Carcinosarcoma Is an Adverse Prognostic Sign
Analysis of 25 Cases

Matthew J. Snyder MD, Stanley J. Robboy MD, Robin T. Vollmer MD, Leslie G. Dodd MD
DOI: http://dx.doi.org/10.1309/KUA1FQ3BQRC8YG4V 434-439 First published online: 1 September 2004

Abstract

Carcinosarcoma of the uterus has been poorly characterized on cervicovaginal (Pap) smears, and we examine whether they effectively screen for carcinosarcoma and whether an abnormal Pap smear result has any clinical importance. Twenty-five patients with histologically confirmed carcinosarcoma had a conventional Pap smear shortly before diagnosis. Eleven smears (44%) originally were read as abnormal (malignant or atypical), and 4 additional cases were read as abnormal on retrospective review (15/25 [60%]). All malignant elements were epithelial, and 2 cases (8%) had atypical spindle cells, but no diagnostic sarcoma. Cervical involvement was the only histologic parameter correlating with an abnormal Pap smear result (P = .04). Univariate analysis found stage III or IV disease was an adverse prognostic sign compared with stage I or II disease (mean survival, 8 vs 36 months, respectively; P = .001), and multivariate analysis indicated that an abnormal Pap smear result correlated with worse survival ( P= .023). The conventional Pap smear is insensitive (60%) for detecting carcinosarcoma, but when the result is abnormal, the Pap is an important stage-independent adverse prognosticator.

Key Words:
  • Carcinosarcoma
  • Uterus
  • Malignant mixed mesodermal tumor
  • Malignant mixed müllerian tumor
  • MMMT
  • Papanicolaou smear
  • Cytology
  • Prognosis