Uterine Carcinosarcomas (Malignant Mixed Müllerian Tumours): A Review with Special Emphasis on the Controversies in Management

Table 2

Controversies in uterine carcinosarcoma.

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(i) Origins: sarcomatous versus carcinomatous monoclonal versus biclonal versus polyclonal.

(ii) Demographics: more common in Afro-American versus Caucasian women.

(iii) Aetiology: radiation inducible tumour versus metaplastic versus dedifferentiation versus common stem cell.

(iv) Pathogenesis: collision theory versus combination theory versus conversion theory.

(v) Risk factors: beneficial effect of oral contraceptives versus detrimental effect of exogenous estrogens.

(vi) Presentation: symptomatic (pyometra/vaginal bleeding/abdominal pain) versus asymptomatic.

(vii) Microscopic: biphasic components—separated versus merged.

(viii) MRI description: endophytic with architectural obliteration versus exophytic with no invasiveness.

(ix) Sonography: diagnostic use—yes versus no technique—transabdominal versus transvaginal.

(x) Surgery: lymphadenectomy versus nolymph-node dissection.

(xi) Adjuvant therapy: radiotherapy versus chemotherapy versus molecular targeted versus multimodality therapy.

(xii) Radiotherapy: locoregional control versus improved overall survival limited pelvic radiation versus whole abdominal radiation.

(xiii) Chemotherapy: single-agent versus combination versus targeted antineoplastic therapy.

(xiv) Prognostic features: ?significance of tumour size, patient age, and histology of sarcomatous element.

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