A rare case report of vault carcinoma of malignant mixed mullerian tumor in a post hysterectomy patient

Abstract

Introduction: Carcinosarcoma is composed histologically of a mixture of sarcoma and carcinoma. Malignant mixed mullerian tumors (MMMT) are rare biphasic malignant neoplasm. The commonest site of occurrence of female genital tract MMMT is the uterine corpus. Predominantly these carcinomas are found in postmenopausal women presenting with uterine bleeding and uterine enlargement. Case Summary: A 52 years P4L4 female presented with Postmenopausal bleeding and abdominal pain. Patient underwent hysterectomy 10 years back for menorrhagia. On Per speculum examination a 8cm X 5cm firm to hard and rubbery growth was seen involving the anterior vaginal wall. On per vaginal examination growth was found to be involving the bilateral fornices and it bleeds on touch. On Ultrasound findings of a large well marginated rounded and solid hypoechoic mass with internal septations in the vault region. Mass measuring approximately 8.4 X 7 cm? Cervical mass. She underwent Exploratory laparotomy followed by removal of vault mass and left salpingoophorectomy. A mass of around 10 x 7 x 7 cm globular mass involving anterior vaginal wall was removed. It was indenting the posterior wall of bladder. On HPR, the features were suggestive of Poorly Differentiated Malignant Mixed Mullerian Tumor. Conclusion: Malignant mixed Mullerian tumors are extremely rare and aggressive tumors. There should be a high index of suspicion for a postmenopausal hysterectomised patient presenting with per vaginal bleeding and should consider the possibility of malignant mixed Mullerian tumor. The outcome depends on the stage of disease and the depth of invasion. Combination chemotherapy and radical surgery remains the mainstay of treatment