Malignant Mixed Mesodermal Tumor (MMMT)

--- A Case Report

[Introduction]

　　　MMMT ( 50% of all uterine sarcoma, 3-6% of all uterine tumor ) is most found at postmenopausal women and radiotherapy is one of the predisposing causes. Vaginal bleeding and abdominal discomfort with mass prolapsed into vagina could be seen at these cases. 75% of cases were diagnosed by diagnostic D&C ( endometrial in origin ). It maybe confused with submucous myoma.

[Case Report]

　　　A 73 y/o female patient suffered from vaginal bleeding off and on with abdominal discomfort for several months. She had the history of breast Ca. ( operation at 台北市立仁愛醫院 ) and on chemotherapy for 6 years. Pap smear revealed atypical glandular cell favor neoplasm and sonography ( Figure 1 ) showed an intrauterine complex mass measured about 7.9*6.4*4.8 cm in size. The mass grows rapidly up to 13.1*8.9*8 cm in 2 months. Under the impression of uterine myoma, LAVH was performed. Unfortunately, MMMT was diagnosed by pathology ( Figure 2 ). And then she was referred to 台北國泰醫院婦癌中心 for further treatment. Microscopically, it shows mixed mullerian mesodermal tumor with admixture of malignant epithelium and sarcomatous stroma. Immunohistiochemistry reveals positive staining for cytokeratin and CEA in epithelium component, and negative staining for desmin in all tumor cells.

[Discussion]

　　　The clinical diagnosis of uterine sarcoma is frequently overlooked and pathologic diagnosis of uterine sarcoma is often extremely difficult. Its obvious signs were vaginal bleeding, rapid enlargement of uterus, sometimes with abdominal pain due to compression to intra-abdominal organs to cause urinary or bowel problems. A necrotic fungating mass at the vagina apex could be seen. Microscopically, it also termed carcinosarcoma due to its content include malignant glands and heterotrophic elements ( bone, striated muscles , cartilage, fat ). Treatment include TAH + BSO with chemotherapy ( cisplatin, ifosfamide, doxorubicin ) and radiotherapy.