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Background: Uterine carcinosarcoma (UCS), or malignant mixed Müllerian tumor, is a cancer that include both carcinomatous and sarcomatous components, resembling endometrial carcinoma. A 55-year-old woman was admitted to the hospital with postmenopausal vaginal bleeding. Gross examination of the specimen revealed brittle tissue in the fundus and the left wall of the endometrium. Postoperative pathology revealed a mixture of well-differentiated endometrioid adenocarcinoma and osteosarcoma. The patient was never given birth, which may be relevant to the diagnosis. Literature review suggests that being nulliparous may be a significant risk factor for developing uterine carcinosarcoma. Case description: In December 2023, a 55-year-old female patient was admitted to the hospital with postmenopausal vaginal bleeding. Hysteroscopic surgery was performed, and the postoperative pathology showed endometrial cancer accompanied by ossified tissue with necrosis. The immunohistochemical results indicated positive Estrogen receptors (ER), positive Progesterone receptors (PR), ki67 positivity at 70%, negative PTEN, mutated positive p53, focal positive Pax-8, positive SATB2, positive Cytokeratin 7 (CK7), positive EMA and positive Vimentin (Vim). The patient was diagnosed with Uterine carcinosarcoma. On December 18, 2023, the patient underwent partial vaginal resection, bilateral salpingo-oophorectomy, pelvic lymph node dissection, and a sub-extensive laparoscopic hysterectomy. Postoperatively, the patients received radiotherapy and four cycles of chemotherapy in the DC regimen. As of July 2024, laboratory and impact test results showed no tumor recurrence. The patient's disease-free survival (DFS) was seven months. Conclusion: The rate of childless in patients with uterine carcinosarcoma is at a high level. [ABSTRACT FROM AUTHOR]

BackgroundUterine carcinosarcoma (UCS), or malignant mixed Müllerian tumor, is a cancer that include both carcinomatous and sarcomatous components, resembling endometrial carcinoma. A 55-year-old woman was admitted to the hospital with postmenopausal vaginal bleeding. Gross examination of the specimen revealed brittle tissue in the fundus and the left wall of the endometrium. Postoperative pathology revealed a mixture of well-differentiated endometrioid adenocarcinoma and osteosarcoma. The patient was never given birth, which may be relevant to the diagnosis. Literature review suggests that being nulliparous may be a significant risk factor for developing uterine carcinosarcoma.Case descriptionIn December 2023, a 55-year-old female patient was admitted to the hospital with postmenopausal vaginal bleeding. Hysteroscopic surgery was performed, and the postoperative pathology showed endometrial cancer accompanied by ossified tissue with necrosis. The immunohistochemical results indicated positive Estrogen receptors (ER), positive Progesterone receptors (PR), ki67 positivity at 70%, negative PTEN, mutated positive p53, focal positive Pax-8, positive SATB2, positive Cytokeratin 7 (CK7), positive EMA and positive Vimentin (Vim). The patient was diagnosed with Uterine carcinosarcoma. On December 18, 2023, the patient underwent partial vaginal resection, bilateral salpingo-oophorectomy, pelvic lymph node dissection, and a sub-extensive laparoscopic hysterectomy. Postoperatively, the patients received radiotherapy and four cycles of chemotherapy in the DC regimen. As of July 2024, laboratory and impact test results showed no tumor recurrence. The patient’s disease-free survival (DFS) was seven months.ConclusionThe rate of childless in patients with uterine carcinosarcoma is at a high level.

Simple Summary: Carcinosarcoma is a rare and aggressive gynecologic cancer that may arise in any of the organs of the female reproductive tract. Most commonly, gynecologic carcinosarcoma is of uterine origin and was previously known as malignant mixed Mullerian tumor. Uterine carcinosarcoma accounts for less than 5% of all uterine malignancies. Because of the rarity of this diagnosis, gynecologic carcinosarcomas have been understudied. We aimed to determine the incidence, treatment course, and quantitate treatment outcomes via progression-free survival (PFS) and overall survival (OS) of gynecologic carcinosarcoma in a primarily minority patient population. We aimed to determine the incidence, treatment regimen, and treatment outcomes (including progression-free survival and overall survival) of gynecologic carcinosarcoma, a rare, aggressive, and understudied gynecologic malignancy. This retrospective review included all patients with gynecologic cancers diagnosed and treated at a single tertiary care comprehensive cancer center between January 2012 and May 2021. A total of 2116 patients were eligible for review, of which 84 cases were identified as carcinosarcoma: 66 were uterine (5.2% of uterine cancers), 17 were ovarian (3.6% of ovarian cancers), 1 was cervical (0.28% of cervical cancers), and 1 was untyped. Of the patients, 76.2% presented advanced-stage disease (stage III/IV) at the time of diagnosis. Minority patients were more likely to present with stage III/IV (p < 0.0001). The majority of patients underwent surgical resection followed by systemic chemotherapy with carboplatin and paclitaxel. The median PFS was 7.5 months. Of the patients, 55% were alive 1 year after diagnosis, and 45% were alive at 5 years. In the studied population, minorities were more likely to present with more advanced disease. The rate of gynecologic carcinosarcomas was consistent with historical reports. [ABSTRACT FROM AUTHOR]

A malignant mixed mullerian tumour (MMMT) is a rare tumour that primarily affects the uterus. MMMT of the ovary is very rare, contributing to 1% of ovarian carcinomas. It is an aggressive cancer of the ovary with characteristics of two types of cancers--carcinoma and sarcoma. A common presentation is a postmenopausal lady with a mean age of 65 years with complaints of abdominal mass, pelvic pain, and vaginal discharge. We report here a rare presentation of abnormal uterine bleeding in a peri-menopausal woman with an abdominopelvic mass, abdominal distension, post-coital bleed and abdominal pain, who underwent staging laparotomy with a preoperative diagnosis of malignant ovarian lesion and was found to have a malignant mixed Mullerian tumour of the ovary on histo-pathological examination. She is doing well at present after receiving six cycles of chemotherapy for Stage 2A disease. Diagnosis of malignant mixed mullerian ovarian tumours are difficult to confirm clinically because histopathological examination reports are required. This entity is rare and has poor prognosis. However, our patient is doing well to date. [ABSTRACT FROM AUTHOR]

Uterine carcinosarcoma is a rare, highly aggressive, rapidly progressing neoplasm associated with a poor prognosis. It comprises 1–5% of all uterine malignancies but accounts for 16.4% of all deaths caused by uterine malignancies. There is a definite paucity of data available from the Indian subcontinent. Hence, we retrospectively conducted this study to analyze the clinical and pathological characteristics and outcomes of women with uterine carcinosarcoma in the past 10 years managed at the tertiary care center. This is a retrospective study of women with histologically proven uterine carcinosarcoma treated at a tertiary cancer center in South India between August 2009 and April 2019. Inpatient and outpatient records were reviewed; clinicopathological data were collected; and follow-up and survival data were ascertained. Over a period of 10 years, 20 patients were diagnosed with uterine carcinosarcoma. The majority of patients were postmenopausal (80%). Post-menopausal bleeding was the main presenting complaint in about 80% of patients. More than two-thirds of patients presented in the early stage (stage I, 55%; stage II, 20%). All patients underwent staging laparotomy. Patients with good performance status (85%) received adjuvant concurrent chemoradiotherapy and chemotherapy. At a median follow-up of 40 months, 7 (35%) patients were alive, out of which 6 are disease-free and 1 had a recurrence. The event-free survival at a median follow-up of 40 months was 40% and the overall survival was 48.5%. The outcome did not significantly differ based on the age, tumor histology (heterologous versus homologous), stage, and depth of myometrial invasion. Uterine carcinosarcoma, though rare, needs to be recognized as a distinct entity, and treated aggressively. Surgery is the cornerstone of therapy. Adjuvant concurrent chemoradiation and chemotherapy improve local control and may delay recurrence, but have shown little survival advantage. The optimal adjuvant treatment for this uncommon disease is yet to be established, highlighting the need for larger multicentric studies on this tumor. [ABSTRACT FROM AUTHOR]

Abstract Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification.

This was a 57-year-old woman who presented with mild discomfort in the right groin. Physical examination revealed a mass in the right groin, and by ultrasound, the mass was hypoechoic and solid with some internal vascularity. The clinical differential diagnosis included lymphoma and others. The mass was excised for pathologic evaluation. Gross examination of the specimen revealed a 3 × 2.4 × 2 cm, solid and cystic mass. Microscopically, it was a biphasic tumor consisting of carcinomatous and sarcomatous components. The tumor was seen contiguous with endometriosis and atypical endometrioid hyperplasia. The histologic findings were consistent with malignant mixed Mullerian tumor (MMMT) arising from endometriosis in the right groin. The tumor involved the resection margin. Subsequent chest/abdominal/pelvic computed tomography did not reveal evidence of tumors, and diagnostic peritoneal/pelvic laparoscopy did not show diseases. Postoperatively, the patient received 6 cycles of chemotherapy consisting of carboplatin and paclitaxel, followed by radiation in the right groin. Malignant transformation from endometriosis occurs in less than 1% of endometriosis cases, and about 80% of the transformed tumors occur in the ovaries. The most commonly transformed malignant tumors are endometrioid and clear cell carcinomas, with rare adenosarcoma and endometrial stromal sarcoma reported. To our knowledge, we are reporting the first case of MMMT arising from endometriosis in the groin. [ABSTRACT FROM AUTHOR]

The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a 45-year-old female who was diagnosed with cervical mixed squamous neuroendocrine adenocarcinoma, metastasized carcinosarcoma and extramammary vulvar Paget's disease. The patient was first diagnosed with a microinvasive squamous cervical carcinoma in situ. After a few months, the amputation of a small residual tumor and histological evaluation revealed an IA1-stage poorly differentiated (G3) mixed squamous and neuroendocrine cervical adenocarcinoma. After two years, the disease had progressed and biopsies from altered sites were taken. Histological diagnosis from an ulcerated vulvar region revealed extramammary vulvar Paget's disease. A biopsy from vagina polyp revealed an earlier diagnosed mixed squamous and neuroendocrine cervical adenocarcinoma. However, histological diagnosis from an inguinal lymph node biopsy was unexpected and revealed carcinosarcoma. It indicated either the development of another primary malignancy, or an unusual spread of metastasis. Clinical presentation as well as diagnostic and treatment challenges are discussed in this case report. This case report shows that multiple primary malignancy cases are difficult to manage both for clinicians and the patient because the therapeutic options can become limited. This complex case was managed by a multidisciplinary team. [ABSTRACT FROM AUTHOR]

Carcinosarcoma is a rare tumor occurring mainly in the female genital tract. Its most important characteristic is the synchronous presence of a malignant epithelial component (carcinoma) and a malignant mesenchymal component (sarcoma). Recent studies show that most of the time the sarcomatous component originates from a metaplastic differentiation of the epithelial component. Due to its infrequency, the relationship between the different histologic presentations with possible associated risk factors, prognosis and therapeutic response is not known with certainty. In this paper we report the histopathologic features and immunohistochemical expression of a case of uterine carcinosarcoma in a 73-year-old female patient who initially presented as a cervical mass. The microscopic pattern documented was that of a low-grade epithelial tumor associated with a mesenchymal component with rhabdomyosarcomatous differentiation (positive immunohistochemistry for desmin and myogenin). Phenotypic documentation is important for future development of possible therapeutic options targeting the different histologic patterns and determining their possible association with risk factors. [ABSTRACT FROM AUTHOR]

Objective: We encountered a case of high-grade serous carcinoma (HGSC) of the ovary which recurred as carcinosarcoma of the sigmoid colon. Tumor cells of both the primary carcinoma and the secondary carcinosarcoma were negative for estrogen receptor (ER), WT-1, and PAX8. It is well known that most ovarian carcinomas arising from the Müllerian duct are immunoreactive for these biologic parameters. To our knowledge, this is the first case report that provides the results of immunohistochemical analysis of WT-1 and PAX8 for a primary carcinoma and recurrent carcinosarcoma. Case report: A 61-year-old woman had an advanced right ovarian HGSC. After a primary debulking surgery (hysterectomy, bilateral salpingo-oophorectomy and omentectomy) and adjuvant chemotherapy, complete remission was achieved. However, four and a half years later, a tumor arising beside the sigmoid colon was detected. A tumorectomy was performed through combined partial resection of the ileum and sigmoid colon. Microscopically, the tumor was diagnosed as carcinosarcoma of the sigmoid colon, which had originated from HGSC of the ovary. Interestingly, the malignant cells of the primary carcinoma and epithelial components of the recurrent carcinosarcoma were negative for ER, WT-1, and PAX8. These immunohistochemical features were unusual. Three cycles of chemotherapy with the previously used regimen and three additional cycles of doxorubicin and ifosfamide combination chemotherapy were administered. Currently, 3 years after the final chemotherapy was administered, the patient remains healthy. Conclusion: HGSC of the ovary can recur as carcinosarcoma. Tumor cells of the primary HGSC without ER, WT-1, and PAX8 expression may have dedifferentiated and recurred as carcinosarcoma.

Skin metastasis of ovarian cancer is extremely rare. We report an unusual case of ovarian carcinosarcoma with cutaneous metastasis of carcinomatous component that displayed distinct clinical manifestation. A 48-year-old woman presented to the dermatologist complaining of a new onset of erythematous, plaque-like skin rash with multiple small nodules on the left inner thigh, the area measuring 8 × 5cm. While the patient had no history of dermatologic conditions, she underwent a total hysterectomy and bilateral salpingo-oophorectomy, omentectomy, and lymph node dissection 16 months ago with a pathology confirmed stage IIIC ovarian carcinosarcoma. Of note, the carcinomatous component, mainly adenocarcinoma with hybrid features of seromucinous, endometrioid and minor high-grade serous carcinoma, involved bilateral fallopian tubes, omentum, and parametrium with extensive lymph node metastases. A skin biopsy specimen revealed an adenocarcinoma involving epidermis, dermis, and subcutaneous tissue with nodular contours, consistent with metastatic carcinomatous component of carcinosarcoma. Both carcinomatous component of primary ovarian carcinosarcoma and metastatic adenocarcinoma in the skin demonstrated Pax8, WT-1, and ER positivity and a mutation pattern of p53. The patient passed away 15 months after identification of skin metastasis. This case represents a unique example of cutaneous metastasis of ovarian carcinosarcoma with distinct clinical manifestation and detailed histopathological description. Alertness to the possibility of cutaneous metastasis, in combination with clinical history, morphological and immunohistochemical findings, is critical for a definitive classification. [ABSTRACT FROM AUTHOR]

The stage I uterine malignant mixed mullerian tumor (MMMT) shows different potential for progression. We reason that MMMTs with high-grade carcinomatous component and positivity for HB-EGF are prone to recurrence/metastasis in the early stage. A retrospective clinical and histopathologic review with immunohistochemical staining for HB-EGF, EGFR, and integrin-α5 was performed for 62 surgically staged MMMT cases. Recurrence/metastasis (RM) is 6/18 (33%) in stage I disease. Of all the clinicopathologic variables and biomarkers analyzed for stage I MMMT, serous carcinomatous component (83% [5/6] versus 17% [1/12], P = .0015) and HB-EGF expression (100% [6/6] versus 50% [6/12], P=.0339) were significantly different between groups with RM and without RM. The presence of serous carcinoma in all stages was 83% (5/6) in stage I with RM, 8% (1/12) in stage I without RM, 20% (1/5) in stage II, 36.4% (8/22) in stage III and 64.7% (11/17) in stage IV; this was paralleled by HB-EGF expression of 100% (6/6), 50% (6/12), 40% (2/5), 50% (11/22) and 71% (12/17) with a correlation coefficient r=0.9131 (P=.027). HB-EGF and integrin-α5 were highly expressed in MMMTs bearing serous carcinoma component, compared to endometrioid and unclassifiable/miscellaneous subtypes (84.6%/47.6%/33.3%, P=.025 for HB-EGF; and 61.5%/42.9%/20.0%, P=.021 for integrin-α5). The EGFR positivity was comparable among the three subtypes (48.1%, 47.6% and 26.7%, P=.326). This study indicates that serous carcinomatous component championed by expression of HB-EGF predisposes to recurrence/metastasis in stage I MMMT. This process might involve integrin-α5 and does not seem to require overexpression of EGFR. Further study is required.

The occurrence of more than one primary malignant tumor in a single patient is rare. Multiple primary malignancies can pose difficulties in differential diagnosis between primary tumors and metastasis. Here, we present a case report with multiple primary malignancies. The patient is a 45-year-old female who was diagnosed with cervical mixed squamous neuroendocrine adenocarcinoma, metastasized carcinosarcoma and extramammary vulvar Paget’s disease. The patient was first diagnosed with a microinvasive squamous cervical carcinoma in situ. After a few months, the amputation of a small residual tumor and histological evaluation revealed an IA1-stage poorly differentiated (G3) mixed squamous and neuroendocrine cervical adenocarcinoma. After two years, the disease had progressed and biopsies from altered sites were taken. Histological diagnosis from an ulcerated vulvar region revealed extramammary vulvar Paget’s disease. A biopsy from vagina polyp revealed an earlier diagnosed mixed squamous and neuroendocrine cervical adenocarcinoma. However, histological diagnosis from an inguinal lymph node biopsy was unexpected and revealed carcinosarcoma. It indicated either the development of another primary malignancy, or an unusual spread of metastasis. Clinical presentation as well as diagnostic and treatment challenges are discussed in this case report. This case report shows that multiple primary malignancy cases are difficult to manage both for clinicians and the patient because the therapeutic options can become limited. This complex case was managed by a multidisciplinary team.

Background Carcinosarcoma (malignant mixed Mullerian tumor (MMT)) is a rare tumor of the uterus, even rarer in the ovary. Presenting symptoms are indistinguishable from high-grade uterine endometrium carcinoma. Histologically, tumors are biphasic, composed of both epithelial and mesenchymal (sarcomatous) components. The diagnosis of carcinosarcoma presents a challenge due to the need to exclude commonly occurring mimickers, necessitating the application of a broad panel of immunohistochemistry markers. Material and methods This retrospective descriptive study of malignant MMT was conducted over a three-year period (August 2021 to July 2024). A total of six (three ovarian and three uterine) cases diagnosed as malignant MMT were included based on morphology and confirmation by expressing positivity of cytokeratin (CK) and vimentin. All the demographic, clinical, and radiological data, treatment protocols, and survival data were obtained from the medical record department. Dako ® (Agilent Diagnostics and Genomics Group, Santa Clara, California) antibodies were used for immunohistochemical (IHC) analysis with 1:100 dilutions. Results The mean age of presentation was 51.5 years (35-65 years). The primary tumor site was the uterus in four cases, bilateral ovaries in one case, and unilateral ovaries in one case. Metastasis was seen in two cases. Microscopically, the tumor was biphasic, displaying high-grade carcinomatous and sarcomatous components. Pan-CK was positive in the epithelial component of the tumor, while vimentin was positive in high-grade sarcomatous components. Epithelial membrane antigen (EMA) was positive in three cases, while myogenic was positive in heterologous rhabdomyosarcomatous component in one case. The mean ki-67 was approximately 52% (30%-80%). Conclusions Carcinosarcomas are highly aggressive tumors commonly occurring in elderly females. Uterine carcinosarcomas are rare, and ovarian carcinosarcomas are even rarer. Clinical and histological features resemble high-grade endometrial carcinoma, necessitating an extensive IHC panel to narrow down differentials and confirm the diagnosis. This study highlights the histological and IHC features and emphasizes that early diagnosis plays a crucial role in disease management., Competing Interests: Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work., (Copyright © 2024, Raghuvanshi et al.)

Aim: Morphologic examination of endometrial polyps and assess the occurrence of endometrial cancer. Materials & Methods: One hundred sixty cases of endometrial polyps received at the department of Pathology of a tertiary care hospital over 31 months i.e., from January 2014 and July 2016 were analysed. The clinical data was retrieved from the medical records department. Results: Out of the 160 cases of endometrial polyps, 94.4% of the endometrial polyps were non neoplastic & 5.6% were neoplastic. The mean age of presentation of non-neoplastic polyps was 45 years (21-76 years) & neoplastic polyps was 52 years (42-62 years). The mean size of non-neoplastic polyp was 2.4 cm (0.5-9 cm) & neoplastic polyp was 4.5cm (1.5-9cm). The non-neoplastic polyps were benign endometrial glandular polyp (83.7%), leiomyomatous polyp (2.2%), adenomyomatous polyp (1.1%) & stromomyoma (0.5%). The neoplastic polyps encountered were endometrial carcinoma type 1 (1.67%), endometrial carcinoma type 2 (0.5%), endometrial stromal sarcoma (1.67%), adenosarcoma (0.5%) & malignant mixed mullerian tumor (0.5%). Post-menopausal bleeding was seen in 27% of patients. Immunohistochemistry was performed in 3 of the cases. Tamoxifen induced endometrial polyp were seen in 1.67%. Conclusion: Endometrial polyps are rarely associated with malignancy, as most of them are hyperplastic glandular polyps. Multiple risk factors such as age, multiparity, tamoxifen usage show higher association with malignancy. Post-menopausal bleeding cases needs to be thoroughly evaluated for presence of endometrial malignancy. Histopathological evaluation of resected polyps proves the nature of the disease.

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.

Aim: Morphologic examination of endometrial polyps and assess the occurrence of endometrial cancer. Materials & Methods: One hundred sixty cases of endometrial polyps received at the department of Pathology of a tertiary care hospital over 31 months i.e., from January 2014 and July 2016 were analysed. The clinical data was retrieved from the medical records department. Results: Out of the 160 cases of endometrial polyps, 94.4% of the endometrial polyps were non neoplastic & 5.6% were neoplastic. The mean age of presentation of non-neoplastic polyps was 45 years (21-76 years) & neoplastic polyps was 52 years (42-62 years). The mean size of non-neoplastic polyp was 2.4 cm (0.5-9 cm) & neoplastic polyp was 4.5cm (1.5-9cm). The non-neoplastic polyps were benign endometrial glandular polyp (83.7%), leiomyomatous polyp (2.2%), adenomyomatous polyp (1.1%) & stromomyoma (0.5%). The neoplastic polyps encountered were endometrial carcinoma type 1 (1.67%), endometrial carcinoma type 2 (0.5%), endometrial stromal sarcoma (1.67%), adenosarcoma (0.5%) & malignant mixed mullerian tumor (0.5%). Post-menopausal bleeding was seen in 27% of patients. Immunohistochemistry was performed in 3 of the cases. Tamoxifen induced endometrial polyp were seen in 1.67%. Conclusion: Endometrial polyps are rarely associated with malignancy, as most of them are hyperplastic glandular polyps. Multiple risk factors such as age, multiparity, tamoxifen usage show higher association with malignancy. Post-menopausal bleeding cases needs to be thoroughly evaluated for presence of endometrial malignancy. Histopathological evaluation of resected polyps proves the nature of the disease. [ABSTRACT FROM AUTHOR]

Malignant mixed Müllerian tumor remains an important contributor to morbidity and mortality in women with uterine cancer. Surgery is the primary treatment modality, followed by chemotherapy and/or radiation for advanced disease or high-risk patients. Clinico-epidemiologic characteristics and outcomes in older versus younger women with Malignant mixed Müllerian tumor may differ. We analyzed and now report on 15 consecutive patients with uterine Malignant mixed Müllerian tumor treated at our institution from 2000 to 2018. The mean age at diagnosis was 65 years; 60% (9/15) patients were overweight/obese. Forty-six percent (7/15) had hypercholesterolemia, an association not previously linked with Malignant mixed Müllerian tumor in the literature. All patients but one had surgical excision of the tumor. A third of patients received adjuvant radiation therapy. A majority of patients received chemotherapy; the preferred regimen was carboplatin-paclitaxel. The patients older than 70 had a tendency towards a more advanced disease stage at diagnosis and a significantly shorter cancer-specific survival than their younger counterparts (6 months vs. 102 months (hazard ratio 1.32, p = 0.02)). Our study's conclusions are restricted due to its relatively small size, retrospective design, and some variation in the chemotherapy doses administered in individual patients. Larger studies are needed to confirm the significance of our findings. [ABSTRACT FROM AUTHOR]

Purpose: To determine whether staging pelvic magnetic resonance imaging (MRI) can distinguish malignant mixed Müllerian tumor (MMMT) from EC. Methods: Thirty-seven treatment-naïve patients with histologically proven uterine MMMT and 42 treatment-naïve patients with EC, treated at our institution, were included in our retrospective study. Staging pelvic MRI scans were reviewed for tumor size, prolapse through cervical os, and other features. Time-intensity curves for tumor and surrounding myometrium regions of interest were generated, and positive enhancement integral (PEI), maximum slope of increase (MSI), and signal enhancement ratio (SER) were measured. The Fisher's exact test or Wilcoxon rank-sum test was used to compare characteristics between disease groups. Multivariate and univariate logistic regression models were used to distinguish MMMT from EC. Receiver operating characteristic analysis and the area under the curve (AUC) were used to evaluate prediction ability. Results: MMMTs were larger than ECs with higher rate of tumor prolapse and more heterogeneous tumor enhancement compared to ECs. During the late phase of contrast enhancement, 100% of ECs, but only 84% of MMMTs, had lower signal intensity than the myometrium. Threshold PEI ratio ≥ 0.67 predict MMMT with 76% sensitivity, 84%, specificity and 0.83 AUC. Threshold SER ≤ 125 predict MMMT with 90% sensitivity, 50% specificity, and 0.72 AUC. Conclusion: MMMTs may show more frequent tumor prolapse, more heterogeneous enhancement, delayed iso- or hyper-enhancement, higher PEI ratios, and lower tumor SERs compared with EC. MRI can be used as a biomarker to distinguish MMMT from EC based on the enhancement pattern. [ABSTRACT FROM AUTHOR]

Carcinosarcoma is a malignant mixed Müllerian tumor with a highly malignant, biphasic tumor consisting of both epithelial and mesenchymal components. A 59-year-old nulligravida came with postmenopausal bleeding. Hysteroscopy revealed highly vascular polypoidal mass with prominent vasculature. Gross examination of specimen showed a polypoid mass, occupying whole uterine cavity and invading more than half of myometrium. Immunohistochemical analysis showed epithelial component AE1/AE3 and stromal component desi and p16. Tumor cells were negative for ER. As carcinosarcoma is a highly aggressive less common variant of endometrial cancer, early diagnosis and aggressive treatment are important to minimize morbidity and overall survival. [ABSTRACT FROM AUTHOR]

Background: Uterine sarcomas (US) constitute a rare heterogeneous group of gynecological malignancies with aggressive characteristics and poor prognosis. Identifying the histopathological factors that determine the prognosis of the tumor and efficacy of various treatment modalities provides a reliable source for efficient treatment of affected patients. This study presents our 11-year experience with US in the south of Iran. Methods: Medical records of 42 patients (2001-2012) with endometrial stromal sarcoma (ESS), leiomyosarcoma (LMS), and malignant mixed Müllerian tumor (MMMT) were investigated. Hazard ratio (HR) and 2- and 5-year survival of patients were analyzed based on the patients' age, histopathological characteristics (tumor type, stage, necrosis, and mitotic index), and treatment modalities. Results: Twenty-four patients survived with median follow-up of 42.5 months; 18 died within 17 months, and 52.4% had recurrence, of whom 12 died. Two- and five-year survival rate was 78.6% and 61.9%, respectively, longest for ESS and shortest for MMMT. Higher age, tumor stage, necrosis, and mitotic index increased the HR of mortality. Radiotherapy resulted in a better survival, compared with chemotherapy alone or combined with radiotherapy. Conclusion: Although ESS had the best prognosis, MMMT was the most aggressive tumor with the shortest survival time. Histological type of the tumor, staging, tumor necrosis, and mitotic index had prognostic roles. Adjuvant radiotherapy resulted in a better survival, compared with surgery alone in early stage. [ABSTRACT FROM AUTHOR]

Background. Ovarian carcinosarcomas are rare aggressive biphasic tumors. Evidence suggests that these tumors are monoclonal and that the sarcoma component is derived from a stem cell undergoing divergent differentiation. Currently, there remains a paucity of data regarding its origin, with few reports suggesting an association with serous tubal intraepithelial carcinoma (STIC) by immunohistochemistry and genetics. Objective. We sought to determine the relationship of carcinosarcoma to high-grade serous carcinoma and STIC by investigating for similar mutation signatures through next-generation sequencing. Methodology. A case of carcinosarcoma with associated high-grade serous carcinoma and STIC was macrodissected, and next-generation sequencing was performed on each component separately. Results. The STIC, high-grade serous carcinoma component, and chondrosarcoma component were all diffusely positive for p53 and p16 by immunohistochemistry. Next-generation sequencing demonstrated an identical TP53 gene c.376-1G>A 5' splice site pathogenic mutation in all 3 components. Conclusions. Our findings suggest that carcinosarcomas may also originate from the fallopian tube. [ABSTRACT FROM AUTHOR]

Extragenital malignant mixed Müllerian tumor (MMMT) is rare, and the retroperitoneum is one of the rarest sites. The etiology and risk factors are yet ill-understood. The authors report a case of primary retroperitoneal Müllerian carcinosarcoma in a pregnant woman. Initially, a pure cystic mass was found when she was four months' pregnant. After drainage of the cyst, the follow-up ultrasound detected rapid recovery of the cyst, the appearance ofseptation within the cyst, blood flow signal in the septation, more and thickened septation, and nodules on the septation and cystic wall with progressing pregnancy. After delivery, the follow-up imaging examination revealed a relatively dormant mass. The contrary clinical manifestations were consistent with sex hormone levels, which surged during pregnancy and dropped rapidly postpartum. Moreover, immunohistochemistry staining showed that both ER and PR were positive for the epithelial and stromal component. Given the clinical manifestations and pathology, for the first time, the authors can explicitly conclude that sex hormone played a direct and evident role in the development of extragenital malignant mixed Müllerian tumor. [ABSTRACT FROM AUTHOR]

Malignant mixed Mullerian tumor of the uterus, also called carcinosarcoma, is a very rare and aggressive type of malignancy with epithelial and mesenchymal components. Therefore, it is considered a metaplastic carcinoma. Predominantly these carcinomas are found in postmenopausal women presenting with uterine bleeding and uterine enlargement. We represent a case of a 60-year-old female with complaints of pain in the abdomen and bleeding per vaginum. Hysterectomy with bilateral salpingo-oophorectomy was performed and a diagnosis of malignant mixed Mullerian tumor of the uterus was made.

Background: In recent years, improvements in oncological care have led to an increased incidence of intradural extramedullary spinal metastases (IESMs) attributed to uterine carcinosarcoma (UCS). When such lesions occur, they typically carry a poor prognosis. Here, we have evaluated newer treatments, management strategies, and outcomes for IESM due to UCS. Case Description: A 59-year-old female with a history of recurrent UCS presented with the new onset of the left lower extremity pain, numbness, and episodic urinary incontinence. When the MR revealed an enhancing intradural extramedullary mass posterior to the L1 vertebral body, she underwent a focal decompressive laminectomy. Although she improved neurologically postoperatively, she succumbed to the leptomeningeal spread of her disease within 2 postoperative months. Conclusion: Management of IESM due to UCS requires multifaceted, individualized treatment modalities, including neurosurgery, radiation therapy, and medical oncologic management to maximize outcomes. [ABSTRACT FROM AUTHOR]

Primary development of malignant mixed Müllerian tumor (MMMT) in the fallopian tube is a very rare pathology associated with negative prognosis. The authors report a new case of Stage III B tubal carcinosarcoma with no heterologous element. After the surgical radical procedure, a combined adjuvant chemotherapy was given and, after two years of follow-up, the patient shows no evidence of disease. A literature review of articles on this topic was conducted through a Medline search for articles published in English, and 63 patients with the same pathology were found. Data on symptoms, diagnosis, histological type, treatment, and prognosis were collected and statistically analyzed. As conclusion, the initial stages have better survival, with no effect of histological subtype. Presence of ascites had a negative prognostic value. Due to the limited number of cases reported, making the statistical analysis difficult, the authors consider mandatory to report this rare entity to ease the upcoming research. [ABSTRACT FROM AUTHOR]

Carcinosarcomas are biphasic malignant tumors composed of 2 distinct neoplastic cell populations, epithelial cells and mesenchymal cells. A 13-y-old, female, mixed-breed goat was presented with a 1-wk history of anuria and lethargy. Transabdominal ultrasonography showed an irregular and heterogeneous structure in the region of the bladder and uterus and changes in the echogenicity of both kidneys. Given the poor prognosis, euthanasia was elected. Autopsy revealed a large mass within the uterine cervix and confirmed the changes in the urinary tract. Histopathology and immunohistochemistry revealed a mixed, anti-cytokeratin AE1/AE3–positive epithelial, and vimentin-positive mesenchymal neoplasm consistent with a homologous carcinosarcoma, also called malignant mixed Müllerian tumor, with areas of double-labeling. We highlight the complexity of the diagnosis of uterine neoplasms in domestic animals and in goats in particular. [ABSTRACT FROM AUTHOR]

Uterine carcinosarcomas or Malignant Mixed Müllerian Tumors are exceptionally rare and extremely aggressive tumors of the uterine corpus, accounting for less than 1% of all gynecologic malignancies and 2-5% of all uterine malignancies, being responsible for more than 15% of all uterine cancer associated deaths. In this report we present the case of a 66 years old woman with no personal history of gynecologic malignancy, addressing the Department of Obstetrics-Gynecology of the University Emergency Hospital in Bucharest Romania for postmenopausal vaginal bleeding. Ultrasonography and CT scan of the pelvis revealed an endocavitary mass limited to the uterine corpus. As a result, a radical hysterectomy with bilateral salpingo-oophorectomy was carried out under general anesthesia. Microscopic evaluation revealed an admixture of malignant epithelial and mesenchymal components with small foci of clear cell carcinoma and scattered heterologous elements. These features, as well as the gross aspect and immunohistochemical results were consistent with the diagnosis of carcinosarcoma of the uterine corpus. In conclusion, due to the severe outcome and reduced survival rate of these extremely aggressive tumors, we emphasize the importance of awareness, early detection, treatment and proper surgical staging for all females with uterine carcinosarcoma. [ABSTRACT FROM AUTHOR]

Few cases of osteosarcoma appearing in the uterus as malignant mixed Müllerian tumor have been published in the literature to the authors' knowledge. They report a 59-year-old postmenopausal female that underwent total abdominal hysterectomy and bilateral adnexectomy and bilateral pelvic cavity and abdominal periaortic lymphadenectomy because of numerous irregular mass in the uterus. The histopathological diagnosis which was confirmed by immunohistochemical study was osteosarcoma appearing in the uterus as malignant mixed Müllerian tumor. Then for cycles of chemotherapeutic regimens (paclitaxel plus carboplatin, 21 days as one cycle) was started at 16 days after surgery. This was a rare case of osteosarcoma appearing in the uterine as malignant mixed Müllerian tumor. [ABSTRACT FROM AUTHOR]

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A 57-year-old asymptomatic lady had come for a master health check-up with a report of fibroid uterus diagnosed on ultrasound at a private hospital. Intraoperatively, a large retroperitoneal tumor was found with the uterus and adnexae being normal. The mass was removed in toto, and its pathological examination revealed a malignant mixed Mullerian tumor (MMMT). Immunohistochemistry also supported the diagnosis of MMMT. The postoperative period was uneventful, and the patient was discharged with the advice of oncology referral.

Introduction Primary malignant mixed mesodermal tumor (MMMt, also called malignant mixed Mullerian tumor and designated in the WHO classification of female genital tract neoplasms as carcinosarcoma) is an infrequent tumor that develops usually in the uterus and more rarely in the ovary. Extragenital tumor, including primary peritoneal MMMt, is an extremely rare and aggressive neoplasm with only few case reported in the literature. Presentation of case We report a case of a 70-year’s old female who presented with nausea and abdominal discomfort for 6 months. Workup revealed an abdominal mass. Patient was treated with surgical removal in a general hospital. Discussion Most peritoneal carcinosarcomas originate in the pelvic peritoneum, followed by decreasing frequency in the serosal surface of the colon, retroperitoneum, anterolateral abdominal peritoneum, and omentum. Surgical excision is the most effective treatment in carcinosarcomas. A complete cytoreduction, with resection of cancer to a status of no evidence of disease by the surgeon’s unaided eye should be attempted. Conclusion Owing to the rarity of the disease, limited data regarding the management of peritoneal MMMT exists. Recommendations for the treatment of MMMT are based on individual cases only. In our case, the patient is alive with a follow-up of 15 months and she did not receive any cycle of chemotherapy. [ABSTRACT FROM AUTHOR]

Objective: The mechanisms underlying the histogenesis and aggressiveness of uterine carcinosarcoma (UCS) are poorly understood; however, previous studies implicate epithelial-mesenchymal transition (EMT). Fascin is a proinvasive, actin-bundling protein and an important component of EMT. It is associated with poor outcomes in human carcinoma, especially in estrogen receptor (ER)-negative tumors arising in organs normally expressing ER. We sought to evaluate fascin expression in UCS and its relationship to ER status, clinicopathologic indicators of tumor aggressiveness, and survival outcomes. Method: Forty-four surgically staged cases of UCS were immunohistochemically evaluated for fascin and estrogen receptor-> expression and correlated with clinicopathologic parameters derived from electronic medical records and pathology reports. Results: Fascin was only expressed in malignant epithelium and mesenchyma and was uniformly absent in background benign counterparts. Increased expression was associated with extrapelvic disease (P = 0.028), higher stage (P = 0.021), larger tumor size (P = 0.032), shorter progression-free interval (P = 0.035), and reduced estrogen receptor-α expression (P = 0.04). Conclusion: Fascin is aberrantly expressed in both elements of UCS and is associated with aggressive behavior and worse outcome. As a component of EMT and mediator of invasion, fascin may serve as a target in future therapies. [ABSTRACT FROM AUTHOR]

Objective: Clinical outcomes for patients with uterine carcinosarcoma are poor after surgical management alone. Adjuvant therapies including chemotherapy (CT) and/or radiation therapy (RT) have been previously investigated, but the optimal management of this disease remains controversial. The purposes of this study were to analyze the patterns of use of adjuvant CT and RT and to assess the impact on survival of each of these treatment regimens using the National Cancer Data Base. Methods/Materials: The National Cancer Data Base was queried for patients given a diagnosis of uterine carcinosarcoma confined to the pelvis who underwent total hysterectomy/ bilateral salpingo-oophorectomy between 2004 and 2011. Patients were excluded if they survived less than 4 months after diagnosis. Data regarding CT and RT use were collected. Overall survival (OS) was analyzed using the Kaplan-Meier method. Multivariable Cox regression analysis was performed to evaluate the effect of covariates on OS. Results: A total of 4906 patients were included in this study. Median age was 67 years (interquartile range, 60-75 years). Median follow-up was 28.9 months (interquartile range, 15.4-52.9 months). There were 1777 patients (36.2%) who received no adjuvant treatment, 971 (19.8%) who received CT alone, 1060 (21.6%) who received RT alone, and 1098 (22.4%) who received both RT and CT. The 5-year OS for patients receiving no adjuvant therapy, adjuvant RT alone, adjuvant CT alone, and combined CT and RT were 44.9%, 47.1%, 47.5%, and 62.9%, respectively. On pairwise analysis, combined CT and RT was associated with improved survival compared with all other subgroups (P G 0.001). On multivariable Cox regression analysis, combined CT and RT (hazard ratio, 0.50; 95% confidence interval, 0.44-0.57; P G 0.001) and CT alone (hazard ratio, 0.78; 95% confidence interval, 0.69-0.88; P G 0.001) were significantly associated with improved OS, whereas RT alone was not. Conclusions: Combination therapy with CT and RT was associated with significantly improved 5-year OS compared with no further therapy, RT alone, or CT alone. [ABSTRACT FROM AUTHOR]

Background A malignant mixed Mullerian tumor (MMMT), otherwise known as carcinosarcoma, is a rare and aggressive malignancy involving the uterus. Despite aggressive treatment, they have poor outcomes. We performed this study to analyze the clinical profile, prognostic features, and treatment outcomes of patients treated for MMMT of the uterine corpus in our center. Methodology A study sample from a database of patients treated at a tertiary care center in South India between January 2015 and December 2019 was analyzed retrospectively. A total of 29 non-metastatic patients were included in the study. The diagnosis of MMMT was confirmed by a pre-operative biopsy specimen or endometrial curettage. Information regarding the patient, tumor characteristics, details of the surgery, adjuvant therapy, and follow-up details were collected retrospectively. Disease-free survival (DFS) and overall survival (OS) were plotted using the Kaplan-Meier method, and the log-rank test was used to identify any significant prognostic factor. Statistical analyses were performed using IBM SPSS software, version 21 (IBM Corp., Armonk, NY). Results The population's median age was 60 years (interquartile range (IQR): 52-65). The homologous type was the most common pathology seen in 21 patients. The median size of the tumor was 7 centimeters (cm) (IQR: 6-10). Around two-thirds of the patients received adjuvant radiation therapy. Paclitaxel and carboplatin-based adjuvant chemotherapy were used in 60% of the patients. Nearly 90% of the recurrences were distant recurrences. During the follow-up, 17 patients developed a recurrence. The median DFS was 12 months (95% CI: 7.7-16.2). The median OS was 26 months (95% CI: 10.6-41.3). The three-year OS rate was 42%. Patients with an age >60 years had a median overall survival of 11 months, compared to 37 months for patients <60 years (p = 0.026). The median overall survival of patients with tumor sizes >10 cm was 12.5 months, and it was 35 months when the tumor size was less than 10 cm (p = 0.03). Patients receiving radiotherapy (RT) had an improved survival (39 months) compared to those who did not receive RT (12.5 months) (p = 0.046). The median overall survival for patients after the recurrence was 12 months. As most patients were elderly with an Eastern Cooperative Oncology Group (ECOG) performance status of two at baseline, only a few patients were fit for second-line chemotherapy. Conclusion A malignant mixed Mullerian tumor is an aggressive tumor of the uterine corpus with poor survival rates. Surgical resection remains the mainstay of treatment. Adjuvant radiation therapy improves survival. The age of the patient, myometrium invasion, tumor size, and positive peritoneal cytology were found to be prognostic factors., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Vijayaraghavan et al.)

Primary retroperitoneal müllerian adenocarcinoma (PRMA) is an extremely rare clinical entity. We report the case of a 54-year-old woman who presented with a mass in the right lower retroperitoneum, identified during an ultrasound exam. Computed tomography confirmed a retroperitoneal mass measuring 11 cm. The patient underwent laparotomy and the mass was completely excised. The histopathological exam revealed PRMA.

Tamoxifen is used in the treatment of hormone-responsive breast cancer because of its antiestrogenic effect. However, it also has an estrogenic effect on the uterus, thereby increasing the risk of endometrial hyperplasia, endometrial polyp, and malignant mixed Mullerian tumor (MMMT). This case describes the pathogenesis and risk of MMMT due to long-term tamoxifen intake in hormone-responsive breast cancer.

Objective: To present a case of malignant mixed müllerian tumor of the ovary, a rare and aggressive ovarian malignant tumor with poor prognosis. Case Report: A 52-year-old woman consulted our outpatient department with complaints of abdominal distention and a firm palpable mass over her lower abdomen. Physical examination and computerized tomography revealed cystic mass lesions on the bilateral adnexal areas. Ovarian cancer was suspected, so the patient underwent exploratory laparotomy. Optimal debulking surgery was performed, and final pathology revealed malignant mixed müllerian tumor of the ovary. Chemotherapy using ifosfamide and cisplatin were administered postoperatively, and adjuvant was also administered. After six cycles of chemotherapy, the patient is well with no signs of recurrence. Conclusion: Ovarian malignant mixed müllerian tumor usually yields poor outcomes; hence, aggressive treatment with optimal debulking surgery followed by combination chemotherapy using ifosfamide and cisplatin may improve patient outcomes.

Ovarian carcinosarcomas (OCS) are highly aggressive tumors containing both carcinomatous and sarcomatous elements. Patients are typically older postmenopausal women who present with advanced disease, however rarely young women can be affected. A 41-year-old woman undergoing fertility treatment was found to have a new 9–10 cm pelvic mass on routine transvaginal ultrasound (TVUS) 16 days after embryo transfer. Diagnostic laparoscopy revealed a mass in the posterior cul-de-sac that was surgically excised and sent to pathology for evaluation. Pathology was consistent with carcinosarcoma of gynecologic origin. Further work-up revealed advanced disease with apparent rapid progression. Patient underwent interval debulking surgery after four cycles of neoadjuvant chemotherapy with carboplatin and paclitaxel with final pathology consistent with primary ovarian carcinosarcoma and complete gross resection of disease. In the setting of advanced disease neoadjuvant chemotherapy with a platinum-based chemotherapy regimen followed by cytoreductive surgery is a standard approach to treatment of OCS. Given the rarity of disease, most data regarding treatment has been extrapolated from other forms of epithelial ovarian cancer. Specific risk factors for disease development of OCS including the long-term effects of assisted reproductive technology remain understudied. While OCS are rare highly aggressive biphasic tumors that primarily affect older postmenopausal woman, we present a unique case of OCS incidentally found in a young woman undergoing fertility treatment via in-vitro fertilization. • Ovarian carcinosarcoma can rarely affect reproductive-age woman. • Ovarian carcinosarcoma is an aggressive neoplasm with rapid progression of disease. • Cytoreductive surgery with platinum-based chemotherapy regimen is the main therapy. • Additional adjuvant therapies continue to be studied. • Effects of assisted-reproductive technology on ovarian cancer remain understudied. [ABSTRACT FROM AUTHOR]