An Unusual Site of Metastasis of Malignant Mixed Müllerian Tumor of the Uterus

Muhammad Omar¹, Joel Tjarks², Kashif Abbas Shaikh¹, Kalyan Chakravarthy Potu¹, Uma M Mothapothula^{1, 3} and Maheedhar Gedela^1,

¹Department of Internal Medicine, University of South Dakota Sanford school of Medicine, Sioux Falls, SD, USA

²Department of Pathology, University of South Dakota Sanford school of Medicine, Sioux Falls, SD, USA

³Department of Hospital Medicine, Sanford Clinic, Sioux Falls, SD, USA

Cite this paper

Muhammad Omar, Joel Tjarks, Kashif Abbas Shaikh, Kalyan Chakravarthy Potu, Uma M Mothapothula and Maheedhar Gedela. An Unusual Site of Metastasis of Malignant Mixed Müllerian Tumor of the Uterus. American Journal of Medical Case Reports. 2016; 4(2):41-43. doi: 10.12691/AJMCR-4-2-2

Abstract

Malignant mixed Müllerian tumors (carcinosarcomas) are biphasic tumors of the uterus and uterine cervix with carcinomatous and sarcomatous components. Malignant mixed Müllerian tumors (MMMT) are rare tumors, accounting for <5% of uterine cancers. They most commonly metastasize to the vagina, pelvic wall, lungs, and ovaries. We report a unique case of MMMT, which developed in a 69-year-old woman after she presented with hip and knee pain. Ultimately, her pain was found to be caused by metastatic tumor deposits in her psoas muscle. The primary tumor was found to be a MMMT of the uterine corpus. We recommend practitioners be aware of this entity and include it and other metastatic lesions in their differential diagnosis in difficult cases of non-resolving pain.

Keywords

Malignant mixed müLlerian tumor, metastasis, malignancy, uterus

Copyright

This work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/

References

[1]	Robinson-Bennett, B., R.Z. Belch, and A.C. Han, Loss of p16 in recurrent malignant mixed mullerian tumors of the uterus. Int J Gynecol Cancer, 2006. 16(3): p. 1354-7.
[2]	Nguyen, C.P., et al., Coexistent choriocarcinoma and malignant mixed mesodermal tumor of the uterus. Gynecol Oncol, 2000. 79(3): p. 499-503.
[3]	Bostwick, D.G. and L. Cheng, Urologic surgical pathology. Third edition. ed. 2014, Philadelphia, PA: Elsevier/Saunders. p.
[4]	Gadducci, A., et al., The management of patients with uterinesarcoma: a debated clinical challenge. Crit Rev Oncol Hematol, 2008. 65(2): p. 129-42.
[5]	Lopez-Garcia, M.A. and J. Palacios, Pathologic and molecular features of uterine carcinosarcomas. Semin Diagn Pathol, 2010. 27(4): p. 274-86.
[6]	Kernochan, L.E. and R.L. Garcia, Carcinosarcomas (malignant mixed Mullerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw, 2009. 7(5): p. 550-6; quiz 557.
[7]	Iwasa, Y., et al., Prognostic factors in uterine carcinosarcoma: a clinicopathologic study of 25 patients. Cancer, 1998. 82(3): p. 512-9.
[8]	Callister, M., et al., Malignant mixed Mullerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys, 2004. 58(3): p. 786-96.
[9]	Ali, S. and M. Wells, Mixed Mullerian tumors of the uterine corpus: a review. Int J Gynecol Cancer, 1993. 3(1): p. 1-11.
[10]	Lotocki, R., et al., Mixed Mullerian tumors of the uterus: clinical and pathologic correlations. Int J Gynaecol Obstet, 1982. 20(3): p. 237-43.
[11]	Ulbricht, L.J., et al., Intracardiac metastasis of a Malignant Mixed Mullerian tumor (MMMT): progressive dyspnoea due to obstruction of the left atrium and the left ventricle without left ventricular dysfunction or primary lung disease. Wien Med Wochenschr, 2009. 159(13-14): p. 355-8.
[12]	N'Kanza, A.L., et al., Central nervous system involvement from malignant mixed Mullerian tumor (MMMT) of the uterus. Arch Gynecol Obstet, 2005. 273(1): p. 63-8.
[13]	Plaza, J.A., et al., Metastases to soft tissue: a review of 118 cases over a 30-year period. Cancer, 2008. 112(1): p. 193-203.
[14]	Horn, L.C., M. Dallacker, and K. Bilek, [Carcinosarcomas (malignant mixed Mullerian tumors) of the uterus. Morphology, pathogenetic aspects and prognostic factors]. Pathologe, 2009. 30(4): p. 292-301.
[15]	Herring, C.L., Jr., J.M. Harrelson, and S.P. Scully, Metastatic carcinoma to skeletal muscle. A report of 15 patients. Clin Orthop Relat Res, 1998(355): p. 272-81.
[16]	Komatsu, S., et al., [A case of malignant psoas syndrome diagnosed while treating sciatica]. Masui, 2013. 62(7): p. 863-6.
[17]	Gharaibeh, K.A., A. Lopez-Ruiz, and T. Yousuf, Psoas muscle infiltration masquerading distant adenocarcinoma. Case Rep Gastrointest Med, 2014. 2014: p. 986453.
[18]	Kenny, J.B., et al., Malignant involvement of the iliopsoas muscle: CT appearances. Eur J Radiol, 1990. 10(3): p. 183-7.
[19]	Williams, J.B., et al., MR imaging of skeletal muscle metastases. AJR Am J Roentgenol, 1997. 168(2): p. 555-7.
[20]	Avery, G.R., Case report: Metastatic adenocarcinoma masquerading as a psoas abscess. Clinical Radiology, 1988. 39(3): p. 319-320.
[21]	Lenchik, L., D.J. Dovgan, and R. Kier, CT of the iliopsoas compartment: value in differentiating tumor, abscess, and hematoma. American Journal of Roentgenology, 1994. 162(1): p. 83-86.
[22]	Singh, R., Review literature on uterine carcinosarcoma. J Cancer Res Ther, 2014. 10(3): p. 461-8.
[23]	Raspollini, M.R., et al., COX-2, c-KIT and HER-2/neu expression in uterine carcinosarcomas: prognostic factors or potential markers for targeted therapies? Gynecol Oncol, 2005. 96(1): p. 159-67.