Imaging in gynecological disease: clinical and ultrasound characteristics of ovarian carcinosarcomas.

Objectives To describe the clinical and ultrasound characteristics of ovarian carcinosarcoma. Methods This is a retrospective multicenter study. From the International Ovarian Tumor Analysis (IOTA) database we identified 24 patients with a histological diagnosis of ovarian carcinosarcoma who had undergone preoperative ultrasound examination between 2010 and 2019. Another 67 patients were identified from the databases of the participating centers. The masses were described using the terms and definitions of the IOTA group. Additionally, two authors (FC, AB) reviewed all available images to try to identify typical ultrasound features using pattern recognition. Results Median age at diagnosis was 66 (range, 33-91) years, and 84/91 (92.3%) patients were postmenopausal. Most patients (67/91, 73.6%) were symptomatic, the most common complaint being pain (51/91, 56%). Most tumors (67/91, 73.6%) were FIGO Stage III or IV. Bilateral lesions were observed on ultrasound in 46/91 (50.5 %) patients. Ascites was present in 38/91 (41.7%) patients. The median largest tumor diameter was 100 (range, 18-260) mm. All ovarian carcinosarcomas contained solid components, and most were described as solid (66/91, 72.5%) or multilocular-solid (22/91, 24.2%). The median diameter of the largest solid component was 77.5 mm (range, 11-238). Moderate or rich vascularization was found in 78/91 (85.7%) cases. Retrospective analysis of ultrasound images using pattern recognition revealed that the solid components were inhomogeneous with irregular margins in all cases. Forty-seven of 73 (64.4%) masses appeared as solid tumors with cystic areas. "Cooked aspect" of solid tissue was recognized in 28/73 (38.3%) tumors. No pathognomonic ultrasound sign of ovarian carcinosarcoma was found. Conclusions Ovarian carcinosarcomas are usually diagnosed in postmenopausal women and at an advanced stage. The most common ultrasound appearance is that of a large solid tumor with irregular margins and inhomogeneous echogenicity of the solid tissue with cystic areas. The second most common pattern is a large multilocular-solid mass with inhomogeneous echogenicity of the solid tissue. This article is protected by copyright. All rights reserved.