Malignant mixed Müllerian tumor: Analysis of 21 cases at tertiary care rural hospital

Introduction: Malignant mixed Müllerian tumor (MMMT)/carcinosarcoma is an exceptionally rare tumor, representing just 1%–5% of all gynecological malignancies, but leading to 15% of gynecological malignancy-related deaths, with an occurrence of <2/1,00,000 women/year. Material and Methods: Twenty-one patients with MMMT of the uterus accounting for 1.7% of total uterine malignancies were included in the study. The histologic subtypes of the carcinoma and sarcoma components were examined and recorded. The proportions of carcinoma and sarcoma components were semi-quantitatively evaluated and recorded within the primary tumor site in the hysterectomy specimen. Among the metastatic sites and recurrent tumors, the histologic component (carcinoma vs. sarcoma) was evaluated. Results: Of these 21 cases, the carcinomatous component was further subtyped as 11 cases with endometrioid morphology, four cases each of clear cell and serous morphology, and two cases had undifferentiated epithelial component. Most of the tumors had carcinomatous components and 55% of tumors were high grade. Prognostic factors include the presence of bleeding (P = 0.05) which is associated with poor outcomes. Other known prognostic factors like myometrial invasion (P = 0.46) and stage of disease (P = 0.86) did not show any prognostic significance in present study. Conclusions: The elderly age, higher stage, and a poorly differentiated tumor are associated with poor outcomes. Utmost efforts should be made to educate women in early cancer detection by creating awareness on risk factors and symptoms. Study on the trends of gynecological cancers is essential to plan and evaluate cancer control programs.