Malignant mixed Mullerian tumour of the uterus
Malignant mixed Mullerian tumour (MMMT) of the uterus, also known a uterine carcinosarcoma, is the commonest (up to 50%) uterine sarcomas. They are thought to account for 2-8% of all malignant uterine cancers 1-2. The uterus is the commonest site for malignant mixed Mullerian tumours 1.
A uterine MMMT can be either homologous or heterologous.
Similar to MMMT's in general, they are composed or both carcinomatous (epithelial) and sarcomatous (mesodermal) components. Usually, the epithelial component dominates 2.
Prevalent sub types for the epitheloid component include:
- endometroid adenocarcinoma: most common epitheloid sub type 2
- clear cell carcinoma
- mucinous carcinoma
- papillary-serous carcinoma
Prevalent sub types for the sarcomatoid component include:
Uterine MMMT's commonly present as an intracavitary mass with coexistent dilatation of the endometrial canal.
Often hyperechoic on ultrasound 1.
Often heterogeneously hypodense and ill-defined on contrast-enhanced CT 1. Dilatation of uterine cavity can be appreciated the vast majority of cases.
They are not considered to have a pathognomonic appearance on MRI, with appearances often indistinguishable from those of endometrial adenocarcinoma.
However reported general signal characteristics include 3.
- T1: predominantly isointense to both myometrium (~75%) and endometrium (~70%)
- hyper-intense to myometrium (~90%)
- either hypo-intense (~55%) or isointense (~41%) to endometrium
C+ dynamic contrast
- <1 min: hypointense (~40%) or isointense (33%) to myometrium
- 1-4 min: hypointense (~60%) to myometrium
- >4 min: isointense (56%) to myometrium
Like other malignant mixed Mullerian tumours, they are highly aggressive tumours and carry a poor prognosis.
General considerations include:
- 1. Teo SY, Babagbemi KT, Peters HE et-al. Primary malignant mixed mullerian tumor of the uterus: findings on sonography, CT, and gadolinium-enhanced MRI. AJR Am J Roentgenol. 2008;191 (1): 278-83. doi:10.2214/AJR.07.3281 - Pubmed citation
- 2. Ho SP, Ho TH. Malignant mixed Mullerian tumours of the uterus--a ten-year experience. Singapore Med J. 2002;43 (9): 452-6. - Pubmed citation
- 3. Bharwani N, Newland A, Tunariu N et-al. MRI appearances of uterine malignant mixed müllerian tumors. AJR Am J Roentgenol. 2010;195 (5): 1268-75. doi:10.2214/AJR.10.4419 - Pubmed citation
- 4. Mccluggage WG. Uterine carcinosarcomas (malignant mixed Mullerian tumors) are metaplastic carcinomas. Int. J. Gynecol. Cancer. 12 (6): 687-90. - Pubmed citation