Malignant mixed Müllerian tumor of the fallopian tube: report of two cases and review of literature

Malignant mixed Müllerian tumor of the fallopian tube: Case report and literature review

Carcinosarcoma, also known as malignant mixed Müllerian tumor (MMMT), includes both malignant epithelial and mesenchymal elements. While the endometrium is the most frequent known site for carcinosarcomas, their development in the fallopian tube is rare condition, only accounting for 0.1 to 0.5% among all gynecological malignancies. Fallopian tube MMMT is associated with an aggressive progression. A total of 94 previous case reports were reviewed and divided, after applying the exclusion criteria, into 2 groups: No evidence of disease (NED) Group including 33 patients reported to be without any residual disease at the end of the follow-up period; death of disease (DOD) Group including 51 patients who died due to the progression of fallopian carcinosarcoma or its complications. The gathered data were statistically analyzed together with a case from our clinical experience: a 65-year-old postmenopausal patient with a final histological diagnosis of fallopian carcinosarcoma staged FIGO IC2, synchronous with a serous endometrial intraepithelial carcinoma. Patient age between 41 and 60 years, symptoms at presentation and computed tomography (CT)/magnetic resonance imaging (MRI) tumor evidence are prognostic factors (P<0.05). Omentectomy [odds ratio (OR)=0.3545] and pelvic lymphadenectomy (OR=0.3732) were found to be significant factors for survival (P<0.05). Fimbrial localization of the tumor is a negative prognosis factor (OR=4.263), as well as the heterologous type of tumor (OR=2.880). Chemotherapy was found to improve survival (OR=0.2679) while radiotherapy had no influence on patient prognosis. Reporting these rare cases could be essential for obtaining more precise information regarding the treatment and prognosis of patients with MMMT of the fallopian tube, in order to improve patient survival and quality of life.

A rare case of carcinosarcoma of the fallopian tube presenting with torsion, rupture and hemoperitoneum

► Fallopian tube carcinosarcomas may present emergently with hemoperitoneum. ► Fallopian tube carcinosarcomas may be detected better with MR than with CT. ► Heterologous fallopian tube carcinosarcomas have been reported more often than the homologous type.

Chemotherapy consisting of paclitaxel and carboplatin benefits a patient with malignant mixed müllerian tumor of the fallopian tube

Malignant mixed müllerian tumors (MMMT) of the fallopian tube are extremely rare, and optimal therapy for them is unknown. A 71-year-old woman presented to us with symptoms of abdominal distension and nausea. A right salpingo-oophorectomy was performed. Pathological examination determined International Federation of Gynecology and Obstetrics (FIGO) stage IIIc MMMT of the right fallopian tube. Of note, multiple tumoral nodules were attached to the sigmoid colon. The patient received three courses of chemotherapy, consisting of 175 mg/m(2) paclitaxel and AUC=5 carboplatin (TC therapy), administered at 3-week intervals. A second, debulking, surgery was then performed, consisting of total abdominal hysterectomy, left salpingo-oophorectomy, and pelvic and paraaortic lymphadenectomy. The tumor attached to the sigmoid colon had shrunk by 60% after chemotherapy. The patient received an additional five courses of adjuvant TC therapy. The patient is alive and free of disease 28 months after the debulking surgery. TC therapy may be effective for MMMT of the fallopian tube.

Malignant mixed Mullerian tumor of the fimbriated end of the fallopian tube: origin as an intraepithelial carcinoma

BACKGROUND

A paucity of examples of malignant mixed Mullerian tumors (MMMT) of the fimbriated end of the fallopian tube has been reported.

CASE

We report a first case of FIGO Stage IV primary MMMT, heterologous type, in the right fimbria of a 77-year-old woman associated with symptomatic pleural spread who succumbed with recurrent disease 12 months after resection and postoperative paclitaxel and carboplatin chemotherapy.

CONCLUSIONS

The identification of intraepithelial carcinoma in this tumor lends support to a role of the epithelial component in fimbrial MMMT histogenesis as seen for MMMT at other anatomic sites. Comparison of the clinical management of these tumors shows prolonged survival of patients whose treatment included postoperative pelvic external radiotherapy.

Paratubal and tubal abnormalities

The fallopian tubes are the essential genital ducts that convey the female sex cells for fertilization. They are differentiated and detectable early in fetal life. There are numerous paratubal and tubal abnormalities that can occur at any point in the female life. Some of these are rare but may initiate significant morbidity and/or manifest as life-threatening clinical problems. A comprehensive understanding of symptoms, diagnosis, optimal imaging modalities, and medical and surgical management is vital to identify the best treatment option. The clinical entities described in this article include torsion, hydatids of Morgagni, paraovarian cysts, infections including tuboovarian abscess/pyosalpinx and salpingitis isthmic nodosa, ectopic pregnancy, tumors, and genetic disorders.

Malignant mixed mullerian tumor of fallopian tube with multiple distinct heterologous components

We experienced a case of primary malignant mixed müllerian tumors (MMMTs) of the fallopian tube of FIGO stage I. In addition to endometrioid adenocarcinomas, multiple apparent heterologous elements encompassing myxoid chondrosarcoma, osteosarcoma, myxoid liposarcoma, and well-differentiated angiosarcoma were recognized separately in each nodule. Those findings that divergent sarcomatoid differentiations are apparently present masquerading malignant mesenchymoma have not been described in MMMTs of the female genital tract.

Malignant mixed mesodermal tumours: biology and clinical aspects

Mixed mesodermal tumours (MMTs) are relatively rare gynaecological tumours that have been poorly studied in clinical and molecular terms. They are chemosensitive (at least initially), although ultimately they have a poor prognosis. The biology of the tumour is fascinating in view of its composition of both epithelial and mesenchymal entities. We review herein the literature on the clinical and biological aspects of this malignancy.

Diagnosis and clinical management in malignant Müllerian tumors of the fallopian tube. A report of four cases and review of recent literature

Four out of 42 cases of primary tubal malignancy diagnosed in our histopathological laboratory were malignant mixed Müllerian tumors (MMMT). All four patients were postmenopausal with a mean age of 66.5 years at diagnosis. A correct preoperative diagnosis was made only in one case. Tumor staging (FIGO) revealed stage IIa, IIIc and IV. One patient died of postoperative pulmonary embolism, a second patient of an unknown cause five month after surgery and a third patient died of disease after 11 months with secondary deposits in pelvic peritoneum, omentum and paraaortic lymph nodes. The fourth patient is still alive. One patient received chemotherapy alone, one by radiation and chemotherapy and two patients by radiation alone. Tumor spread at the time of diagnosis and the residual tumor volume were the most important prognostic factors. All tumors were histologically the homologous type of MMMT (carcinosarcomas). No heterologous elements were found. Metastatic tumors showed only sarcomatous elements.