Sarcomatoid carcinoma of the cervix

Objectives. To characterize clinical and pathologic characteristics of sarcomatoid carcinoma of the cervix. Methods. We retrospectively reviewed the charts of women with sarcomatoid carcinoma of the cervix identified by query of the Snomed pathologic diagnostic retrieval system and by direct physician query. Data were extracted from available charts, and pathology review was performed on all cases. SPSS was used for statistical analysis. Results. Nine of 12 identified patients had complete clinical information and pathologic material available. The mean age at diagnosis was 48 (range, 29-76) years. Stage at diagnosis was I (4 patients), II (2 patients), and IV (3 patients). Patients younger than 40 years of age presented with stage I disease. All patients had visible tumor; 8 of 9 had vaginal bleeding or discharge at presentation. Microscopic evaluation revealed areas of spindle-cell sarcomatous tumor confluent with areas of poorly differentiated squamous cell carcinoma. Immunohistochemistry demonstrated coexpression of cytokeratin and vimentin in tumor cells. Tumors with a prominent spindle-cell component also expressed smooth muscle actin. Initial treatment varied, but all patients had a complete response to initial treatment. Five patients recurred with a median disease-free interval of 4.9 (range, 2-9.5) months, and none responded to second-line therapy. Four patients remained disease-free at 5, 18, 30, and 40 months, respectively, after completing initial therapy. Conclusions. Sarcomatoid carcinoma of the cervix is an aggressive neoplasm. Primary treatment offers the best chance for cure in women with early-stage disease. Patients with advanced disease at presentation or recurrence succumb to their disease.