Synchronous occurrence of primary malignant mixed müllerian tumor in ovary and uterus
A 57-year-old woman was admitted on January 2011 because of irregular vaginal bleeding for the last 10 months and recently aggravating in amount. She experienced the menopause on her age of 50. She had visited other clinic on June 2010 and was advised to follow up for the uterine tumor. Her family history was not contributory. Vital signs were within normal range and consciousness was clear. On physical examination, no abdominal tenderness or rebound tenderness was identified. Necrotic tissue covered with blood clot was noticed on cervix observed through vaginal speculum. The results of complete blood count, urinalysis, serologic tests, electrocardiogram, and chest X-ray were within normal range. Serum CA-125 and CA-19-9 levels were 12 U/mL and 2 U/mL, respectively. On abdominopelvic computed tomography (CT) examination, a mass of 8 cm in diameter arising from uterine corpus and 5.5 cm sized cystic and solid mass on right ovary were identified ().\nExplo-laparotomy was performed on February 2011 under the impression of endometrial cancer with ovarian metastasis. Low midline incision was placed under general anesthesia. Right ovarian mass was fixed on the posterior aspect of uterus and rectal wall by dense adhesive band and surrounded by necrotic tissue debris and blood clot. Extrafascial hysterectomy and bilateral adnexectomy was performed. Right ovarian mass was ruptured during the manipulation. Poorly differentiated sarcoma was suspected from frozen biopsy of both uterus and right ovary. Left adnexa was grossly free of tumor. However, multiple metastases of diameter 0.5 to 2 cm were identified on greater omentum. Partial omentectomy and appendectomy was performed. Small metastatic nodules were identified and all removed from right pelvic wall and mesentery of small intestine. No gross residual tumor was left.\nOn gross examination, huge polypoid mass of 8×4 cm was identified in uterine cavity and two myomatous nodule in myometrium. Cervix and both fallopian tubes were free of tumor (). On microscopic examination, endometrial tumor was composed of mostly invasive cells with large and polymorphic nucleus with pale and distinct plasmid. Sarcomatous component was overwhelming and included small area of adenomatous component which was attributed as adenosarcoma of MMMT (). Immunohistochemical staining with CD10 of both ovary and uterus was positive. The tumor arising from ovary was mostly composed of sarcoma while the individual cells looked different from those of uterine tumor and did not include adenomatous component (). The metastatic nodules showed the histologic feature that are similar to that of the ovarian tumor suggesting the metastases originated from the ovary. This case was diagnosed as primary MMMT arising from uterus and from ovary as well.\nOral intake was initiated on postoperative day 3 and no significant complication was noticed. She was discharged on day 9 and three cycles of chemotherapy with paclitaxel 175 mg/m2 plus carboplatin with area under the curve (AUC) 5. The follow-up was lost because she refused further treatment.