INTRODUCTION

Carcinosarcoma, also referred to as “malignant mixed mullerian tumor” or “MMMT,” is a neoplasm composed of malignant-appearing epithelial and mesenchymal elements. Although they can arise in any genital organ, carcinosarcomas are found most frequently in the uterus, where they represent less than 5% of malignant neoplasms. These tumors are increasingly thought of as carcinomas that demonstrate sarcomatoid differentiation. Revisions to the FIGO staging system and the seventh edition of the AJCC Cancer Staging Manual now formally encourage the same staging scheme as for carcinomas: tacit recognition that, in general, carcinosarcomas are closely related to carcinomas. Advances in our understanding of the interplay of tumor biology and epidemiology, along with the increasing use of comprehensive surgical staging and treatment with effective chemotherapeutic agents, have led to the conclusion that carcinosarcoma constitutes a specific clinicopathologic entity, distinct from many other biphasic uterine tumors. The typical carcinosarcoma is a biphasic, mixed epithelial and mesenchymal tumor, the clinical evolution of which is more aggressive than high-grade endometrial carcinoma.

CLINICAL CHARACTERISTICS

The mean age of patients with endometrial carcinosarcoma is in the seventh decade. Carcinosarcoma is uncommon earlier in life. Vaginal bleeding is typical, but the prototypic presentation is a polypoid mass that protrudes through the cervical os.

The five-year survival rate for carcinosarcoma is approximately 30%, and the five-year survival rate in surgical stage I disease (confined to uterus) is approximately 50%. This very aggressive profile contrasts with that of other high-grade endometrial cancers where five-year survival rates in stage I disease are approximately 80%.