Abstract
Introduction: Carcinosarcoma or Malignant Mixed Mullerian Tumor (MMMT) of the uterus is a rare malignant tumor comprising both carcinomatous and sarcomata’s components. Worldwide it accounts for two to five percentages of all uterine malignancies. However, there is a paucity of reports in Nepalese literature.
 Case report: A 62 year’s postmenopausal woman with diabetes and hypertension presented with urinary symptoms for two months and passage of fleshy mass per vagina for two days. Ultrasound was inconclusive, whereas, Magnetic Resonance Imaging (MRI) showed an endo-cervical mass. Pre-operative biopsy of the masssuggested leiomyosarcoma. Abdominal hysterectomy with bilateral salpingo-oophorectomy and pelvic andpara-aortic lymphadenectomy was performed. Per-operatively, an atrophic uterus, a dimple in the funds, andballooning of the lower uterine segment and vagina were noted. The cut section showed an exophytic polypoidalmass with base in the fundus. Histopathology revealed Stage IA carcinosarcoma with aggressive mitotic figures. Immunohistochemistry confirmed the diagnosis of carcinosarcoma with a heterogonous rhabdomyosarcomatouscomponent. Adjuvant chemotherapy and radiation therapy was advised.
 Conclusion: The preoperative diagnosis of carcinosarcoma or MMMT was difficult and might be missed on biopsy as well. Owing to its aggressive nature and higher rates of post-surgical recurrence, carcinosarcoma accounts for around one-fifth of deaths due to uterine malignancies. Surgery is the primary treatment modality, yet much study is needed before evidence-based adjuvant management for improving its outcome is established.
Highlights
Carcinosarcoma or Malignant Mixed Mullerian Tumor (MMMT) of the uterus is a rare malignant tumor comprising both carcinomatous and sarcomatous components
Carcinosarcomas are rare but, highly aggressive and biphasic tumors with mixed epithelial and mesenchymal components have been reported to occur in the vagina, cervix, and ovary.[4,5,6]
A 62-year-old para two woman, post-menopausal for fifteen years with type II diabetes mellitus under oral hypoglycemics, essential hypertension controlled on antihypertensive medication, and previous two caesarian sections, presented with complaint of urinary symptoms for four months and passage of painless fleshy mass per vagina for two days
Summary
Carcinosarcoma are rare and aggressive tumors that are difficult to diagnose preoperatively. Due to the rarity of the tumor, the sample size is restricted for case study purpose. Case series, and reports should be published regarding the disease. Surgery is the primary treatment modality as offered in our case. Our case has benefitted from adjuvant chemotherapy and radiation therapy being disease-free to date. A largerscale study is needed regarding adjuvant management to establish the improved treatment outcome
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