Paratubal mass carcinosarcoma: A case report of a rare malignancy in a rare location / Philippine Journal of Obstetrics and Gynecology

@#Carcinosarcoma, formerly known as malignant mixed Mullerian tumors (MMMTs) are highly aggressive tumors that include both malignant epithelial and mesenchymal or stromal elements. The most common site of carcinosarcomas in a female reproductive organ is the endometrium with an incidence of 2/100,000 females, whereas carcinosarcomas arising from the paratubal mass are extremely rare malignancies accounting for fewer than 0.1% of MMMTs. Carcinosarcomas of the Fallopian tube usually occur in the fifth to sixth decades in postmenopausal women with the most common presenting symptom of abdominal pain, followed by vaginal bleeding and abdominal distention. There have been limited published cases worldwide, that is, it has been a thing of interest to be analyzed in today’s era. A rare case of paratubal carcinosarcoma is highlighted in this paper as it discourses its clinicopathological characteristics and assesses the prognostic factors associated with treatment outcome and survival.

A report of two cases of dedifferentiated endometrioid carcinoma: A newly described underrecognized tumor of poor prognosis

Dedifferentiated endometrioid carcinoma or dedifferentiated endometrioid adenocarcinoma (DEAC) is defined by the presence of undifferentiated carcinoma with endometrioid carcinoma. Undifferentiated component can be misinterpreted as solid component of high-grade endometrioid carcinoma or sarcomatous component of malignant mixed mullerian tumor. We present two cases of DEAC. Two postmenopausal women underwent hysterectomy for vaginal bleeding. Microscopically, sections from the endometrial tumors showed a biphasic growth consisting of an undifferentiated component and a glandular component with sharp transition between the two components. The undifferentiated component showed focal positivity for cytokeratin and vimentin, while glandular component was diffusely positive for cytokeratin and negative for vimentin expression.

Uterine inversion associated with malignancy – A challenge in surgical management: A case report / Philippine Journal of Obstetrics and Gynecology

@#Uterine inversion is a rare clinical problem. Most cases of uterine inversions are puerperal inversions wherein it is encountered as an obstetric emergency, and sometimes a diagnostic challenge in gynecology. Uterine inversions associated with malignancies such as endometrial carcinoma and sarcoma are even rare. We report 2 cases of this rare condition. A 55 year old diagnosed with endometrial carcinoma and a 60-year-old woman diagnosed with sarcoma (malignant mixed mullerian tumor) presented with mass protruding from the vaginal introitus. The diagnosis of complete uterine inversion was confirmed in both cases during laparotomy. Total abdominal and vaginal hysterectomy and bilateral salpingo-oophorectomy, bilateral pelvic lymph node dissection, paraaortic lymph node sampling was done. It required a challenging surgical procedure to remove the tumor along with the review of literature especially of its association with malignancies.

Malignant mixed mullerian tumor: A case series / Philippine Journal of Obstetrics and Gynecology

@#Uterine carcinosarcoma, also known as malignant mixed mullerian tumor (MMMT) is a rare and aggressive malignancy. It is the only type of uterine carcinoma with both an epithielial-derived carcinoma and a mesodermal-derived sarcoma. Classically, they have been considered as a soft tissue sarcoma, however, recent studies ascertain the pathogenesis of carcinosarcomas as to that of a metaplastic transformation of a carcinoma to give rise to a sarcomatous component. With the paradigm shift on the pathogenesis of disease, treatments have been aligned to follow protocols used in aggressive uterine carcinomas and are in further evaluation for its applicability to the aforementioned carcinosarcoma. This paper presents three cases of MMMT diagnosed in a Private Tertiary Hospital from October 2015 to February 2017. Among the three cases, two cases underwent endometrial sampling with results suggestive of MMMT and one case with an intraoperative frozen section done revealing carcinosarcoma. All cases underwent extrafascial hysterectomy with bilateral salpingo-oophorectomy (EHBSO) and bilateral lymph node dissection (BLND). Post-operatively, two of the cases underwent adjuvant chemotherapy and are currently alive. The one case that did not receive adjuvant chemotherapy succumbed to the disease eight months after diagnosis. With the high propensity of MMMT to metastasis, relapse and recurrence, it is then imperative that all cases are properly managed.

Synchronous occurrence of primary malignant mixed mullerian tumor in ovary and uterus

Malignant mixed mullerian tumor (MMMT) arising from female internal genitalia is rare with the uterine corpus being the most prevalently affected site. It is even more rare when it occurs on both uterus and ovary at the same time. We describe a case of synchronized occurrence of MMMT on ovary and uterine adenosarcoma with review of literature.

Malignant Mixed Mullerian Tumor with Small Bowel Metastasis: A Case Report

Malignant mixed Mullerian tumors (MMMT) are rare aggressive tumors that typically arise fromthe female genital tract. This malignancy has an extremely poor prognosis due to its rapid growthand the high associated incidence of both local recurrence and distant metastases. Althoughintraperitoneal metastasis from MMMT is relatively common, no reports exist regarding theradiologic findings of intestinal metastasis from MMMT. Here, we report a case of MMMT withsecondary small bowel metastasis and the associated radiologic findings.

One Case of Malignant Mixed Mullerian Tumor Developed in a Postmenopausal Woman under Hormone Therapy / 가정의학회지

Hormone therapy for peri- and postmenopausal women is widely used for relieving vasomotor symptoms or preventing osteoporosis. Even though exogenous hormone is the most common cause of vaginal bleeding in postmenopausal women under hormone therapy, in clinical practice, physicians must never exclude the possibility of endometrial disorders, such as endometrial hyperplasia or cancer. Taking thorough medical history and performing physical and pelvic examinations are essential for the evaluation of abnormal uterine bleeding in menopausal hormone therapy. Transvaginal ultrasonography, endometrial aspiration biopsy, dilatation and curettage, and hysteroscopy are the options which physicians may use. This case is about a woman with continuous combined hormone therapy for 5 years who had experienced rather sudden onset of vaginal spotting lasting for several months and was finally diagnosed as having malignant mixed Mullerian tumor. Our purpose is to inquire into the proper approaching steps for vaginal bleeding in menopausal hormone therapy.

A case of malignant Mixed Mullerian Tumor (MMMT) of the uterine cervix / 대한산부인과학회지

Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm with two components of carcinoma and sarcoma. The most common site of occurrence in female genital tract is the uterine corpus. MMMT of the cervix is extremely rare. MMMT of uterine corpus is highly malignant and the prognosis is poor. Surgery is treatment of choice of uterine cerivx MMMT. The clinicopathologic characteristics of tumor and treatment are uncertain because of lack of clinical data. We experienced one case of malignant mixed mullerian tumor of uterine cervix and report our experience with a brief review of literature.

A case of primary peritoneal origin malignant mixed mullerian tumor / 대한산부인과학회지

Malignant mixed mullerian tumor (MMMT) is rare and has pathologically carcinoma and sarcoma components. Among them, primary peritoneal MMMTs are extremely rare, and their proper treatment and prognosis are not well-known. We experienced a case of primary peritoneal origin MMMT, so we report it with a brief review of the literatures.

Uterine sarcomas in Siriraj Hospital (1991-2005).

Objective: To study the incidence, clinical characteristics, treatments and outcomes in patients with uterine sarcomas at Siriraj Hospital. Methods: A medical record search of patients treated at Siriraj Hospital from January 1991 to December 2005 was performed for clinical characteristics and treatments. Survival curves were generated using Kaplan-Meier method. Results: Sixty uterine sarcomas were diagnosed during a 15-year period. The mean age was 49.3 years (range 27-74; SD 10.6). Abnormal bleeding was the most common presenting symptom (40%). Only 11.7% of the cases could be diagnosed preoperatively. Of 60 patients, 37 (61.6%) had leiomyosarcoma (LMS), 9 (15%) had malignant mixed mullerian tumor (MMMT), and 14 (23.3%) had endometrial stromal sarcoma (ESS). The distribution by FIGO staging was as follows: stage I: 47.5%, stage II: 15%, stage III: 17.5%, and stage IV: 20%. The treatment was mainly hysterectomy with adjuvant chemotherapy. The median follow-up time was 25 months. The five-year survival rate was 55.4%. Conclusion: The incidence of uterine sarcoma at Siriraj Hospital was 4.4% of uterine malignancies. The most common histologic type was leiomyosarcoma (61.6%). The common presenting symptoms were uterine bleeding and pelvic mass. In most cases, the treatment modality was surgery combined with chemotherapy. The overall 5-year survival rate of the studied group was 55.4%.

One case of primary malignant mixed Mullerian tumor of the pelvic peritoneum / 부인종양

Malignant mixed mullerian tumor (MMMT) is a tumor in which carcinoma (an epithelial malignancy) is mixed with sarcoma (a nonepithelial malignancy). Extrauterine MMMTs are extremely rare, and only 32 cases are reported according to the literature. We experienced a case of primary peritoneal MMMT and repot with a brief review of literature.

Malignant Mixed Mullerian Tumor of the Uterus: Retrospective Study of 26 cases / 대한산부인과학회지

OBJECTIVE: To review the clinicopathological characteristics and prognosis of patients with malignant mixed Mullerian tumor (MMMT) of the uterus. METHODS: Retrospective clinical study was done on 26 patients diagnosed with the MMMT of the uterus at our hospital from Janurary, 1994 to December, 2004. Demographic data, pathologic findings, stages, treatment, prognosis and survival time were reviewed. RESULTS: The median age of patients was 59 years. Most of the patients (76.9%) were in the postmenopausal state. The most common symptom was vaginal bleeding (65.4%). There were 17 patients (65.4%) with stage I, 3 patients (11.6%) with stage II, 4 patients (15.4%) with stage III, 2 patients (7.6%) with stage IV disease in this study. Of the hysterectomy specimens, 4 (15.4%) of them were heterologous tumors, 22 (84.6%) of them were homologous tumors. Overall 5 year survival rate of all stages was 60% and the patients with advanced stages (III, IV) showed poorer prognosis than the patients with early stages (I, II) (P=0.001). Myometrial invasion depth was also significant prognostic factor (P<0.001). CONCLUSION: The MMMT of the uterus is a highly malignant tumor and the significant prognostic factor is the FIGO stage and myometrial invasion depth.

A case of Malignant Mixed Mullerian Tumor of the ovary / 대한산부인과학회지

Malignant mixed Mullerian tumor of the ovary is extremely rare. This is heterologous neoplasms which apparently arise from undifferentiated mullerian stroma and is composed of mixture of malignant epithelial and stromal elements. We report a case of malignant mixed mullerian tumor of the ovary with brief literature review.

Two Cases of Primary Malignant Mixed Mullerian Tumor of the ovary / 대한산부인과학회지

Malignant mixed mullerian tumor of the ovary are very aggressive tumors that were usually diagnosed at an older age. They are usually at an advanced stage at the time of diagnosis, and survival after diagnosis varies by stage of disease and histological type. Despite aggressive treatment that includes surgery and chemotherapy, women with these tumors have a significantly increased risk of death giving them a very poor prognosis. The poor prognosis associated with this rare disease represents a need to new therapeutic regimens to improve patients' survival. We experienced two cases of primary malignant mixed mullerian tumor of the ovary.

Two Cases of Primary Malignant Mixed Mullerian Tumor of the ovary / 대한산부인과학회지

Malignant mixed mullerian tumor of the ovary are very aggressive tumors that were usually diagnosed at an older age. They are usually at an advanced stage at the time of diagnosis, and survival after diagnosis varies by stage of disease and histological type. Despite aggressive treatment that includes surgery and chemotherapy, women with these tumors have a significantly increased risk of death giving them a very poor prognosis. The poor prognosis associated with this rare disease represents a need to new therapeutic regimens to improve patients' survival. We experienced two cases of primary malignant mixed mullerian tumor of the ovary.

Clinical analysis of 19 cases of uterine sarcoma / 대한산부인과학회지

OBJECTIVE: The aim is to evaluate the clinical findings of uterine sarcoma we had experienced. METHODS: This study was retrospectively reviewed 19 patients with uterine sarcoma who were managed at Wonju Christian Hospital between September 1982 and May 2003. We analyzed clinical features, type of surgery, adjuvant therapy, three year-survival rate, prognostic factors of uterine sarcoma, and the effects of postoperative chemotherapy and radiotherapy on death. RESULTS: Our study included four histologic types: 8 patients with leiomyosarcoma (42.1%), 5 patients with endometrial stromal sarcoma (26.3%), 4 patients with malignant mixed Mullerian tumor (21.0%), 1 patient with angiosarcoma (5.3%) and 1 patient with both leiomyosarcoma and endometrial stromal sarcoma (5.3%) (Table 1). The cases were classified according to the FIGO staging system. 13 patients (63.2%) had stage I, 2 patients (10.5%) stage II, 2 patients (10.5%) stage III, 3 patients (15.8%) stage IV (Table 1). The three-year survival rate of uterine sarcoma was 53.8%, the most common symptom was abnormal vaginal bleeding. CONCLUSION: Uerine sarcomas are aggressive tumors with poor prognosis, except when the diagnosis is low grade endometrial stromal sarcoma. The effects of postoperative chemotherapy and radiotherapy on death were not statistically significant. This is a retrospective review with small numbers and short periods. Prospective multicentric trials including a statistically evaluable number of patients are necessary.

A Case of Malignant Mixed Mullerian Tumor after radiation therapy for Cervical cancer / 대한산부인과학회지

Malignant mixed mullerian tumors (MMMT) are uncommon neoplasms of the female genital tract that histologically consist of malignant epithelial components and stromal components. Most MMMTs are found in postmenopausal women. The clinical course is very poor due to frequent metastasis and recurrence. Among the carcinogenic epidemiologic predisposing factors, the relationship of previous pelvic irradiation to subsequent development of a malignant mixed mullerian tumor has been reported in recent years. We are reporting a case of MMMT of the uterus which occured in a woman who received radiation therapy for cervical cancer 11 years before the present date.

Clinical profiles of 10 cases of ovarian malignant mixed mullerian tumor / 대한산부인과학회잡지

Malignant mixed mullerian tumors (MMMT) of the ovary are rare, constituting less than 1% of all primary ovarian tumors. Histologically, tumors include malignant epithelial and sarcomatous elements. MMMT of the ovary is a highly aggressive and rapidly progressive tumor with a poor long-term prognosis. The survival rate is very low inspite of surgery, chemotherapy and radiotherapy. The prognostic factors and optimal treatments for this tumor are still controversial because of its rarity. We experienced ten cases of malignant mixed mullerian tumors of the ovary and report our experiences with a brief review of literature.

A Case of Malignant Mixed Mullerian Tumor of the Fallopian Tube / 대한산부인과학회잡지

Malignant mixed mullerain tumors (MMMT) are rare neoplasms of the female genital tract that histolotically consist of malignant epithelial and stromal components, arising in the endometirum, followed in decreasing order by the vagina, cervix, and ovary. Tubal origin is extremely rare and accounts for less than 4% of all MMMTs. Most of the patients present with nonspecific abdominal pain or abnormal vaginal bleeding. Nonspecific findings on imaging studies also make exact preoperative diagnosis very difficult, mostly mistaken as ovarian malignancies. The primary goal of treatment is removal of tumor mass by cytoreductive surgery. Postoperatively, chemotherapy or radiotherapy is added, but prognosis is very poor. The best form of postoperative adjuvant therapy is not yet established due to the rarity of this disease entity. We report a case of a malignant mixed mullerian tumor of the fallopian tube that we have experienced recently with a brief review of the literature.

Ovarian Malignant Mixed Mullerian Tumor Managed with Neoadjuvant Chemotherapy and Cytoreductive Surgery / 대한산부인과학회잡지

Malignant mixed Mullerian tumor(MMMT) of the ovary is very uncommon neoplasm consisting of both a sarcomatous and carcinomatous component. These tumors usually present in an advanced stage and are characterized by rapid growth and poor survival and appropriate treatment remained controversial. The patients with advanced stage ovarian cancer could only benefit from an optimal surgical debulking. However, the optimal cytoreductive surgery may often be difficult to achieve due to the initial extent of the disease. Thus primary surgery for this subset of patients may be questionable. So, we tried neoadjuvant Taxol and/or cis-platinum combined chemotherapy as primary treatment. At the end of neoadjuvant chemotherapy, the patient showed markedly decrease of serum CA 125 level(from 210 U/ml to 59 U/ml) and optimal cytoreductive surgery was performed. After surgery, adjuvant chemotherapy was administered and the serum CA 125 level decreased to the normal range. This case shows our experience of neoadjuvant chemotherapy followed by cytoreductive surgery and adjuvant chemotherapy in patient with primarily unresectable ovarian malignant mixed Mullerian tumor(MMMT).