Carcinosarcomas of the female genital tract, previously known as malignant mixed Müllerian tumors (MMMTs), are uncommon malignancies that can occur anywhere along the female genital tract.
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Terminology
Carcinosarcomas of the female genital tract were previously known as malignant mixed Müllerian tumors to reflect the admixed histology comprising both epithelial and mesenchymal tissue. There is now increasing evidence to show that carcinosarcoma tumor cells instead demonstrate epithelial-mesenchymal transition. Thus the 5th edition of the WHO classification of female genital tumors (2020) recommends that the term "malignant mixed Müllerian tumor" is no longer used 5.
Pathology
It is comprised of both epithelial (carcinomatous) and stromal (sarcomatous) components.
Implicated risk factors include 1:
- advanced age
- excess estrogen exposure
- nulliparity
- prior pelvic irradiation: estimated in 10-30% of cases
- tamoxifen
Location
- carcinosarcoma of the uterus 1: most common site (accounts for ~5-8% of all malignant uterine cancers)
- carcinosarcoma of the ovary 2
- carcinosarcoma of the cervix 3
- carcinosarcoma of the vagina 5
Radiographic features
Imaging features are somewhat dependent on location and are best discussed under respective sections. In general, they tend to be large, bulky lesions.
Treatment and prognosis
They are aggressive neoplasms. Lung, liver, and bone are common sites of metastases.