Eight cases of malignant mixed müllerian tumor (carcinosarcoma) of the uterus: Findings in surepath™ cervical cytology

Abstract

Malignant mixed Müllerian tumor (MMMT)/carcinosarcoma is a rare neoplasm of the female genital tract characterized by a mixture of epithelial and mesenchymal components. There are published reports of conventional cervical smear findings in uterine MMMT, but to the best of our knowledge the cytomorphology of MMMT in SurePath™ liquid-based cytology samples has not been described. We present a series of eight cases of uterine MMMT in SurePath™ cervical samples. The mean age of the women was 65.5 years (range, 60-82 years) and the most common presenting symptom was postmenopausal bleeding. Three out of the eight cases had both epithelial and sarcomatous elements in highly cellular cervical samples. In two cases, abnormal glandular cell clusters were closely associated with the mesenchymal component. The glandular component was usually represented by three-dimensional clusters of malignant glandular cells and a dispersed population of large, round to oval malignant epithelial cells with single prominent nucleoli. Necrosis or tumor diathesis was not seen in any cases. Six out of the eight cases were initially reported as adenocarcinoma, endometrial type, and two cases as normal. Five cases had an atrophic background and tiny atypical glandular clusters that could easily be overlooked. Although cervical sample is not the method of choice for primary uterine carcinosarcoma screening, the possibility of the same should be kept in mind, when reporting a cervical sample from a woman with postmenopausal vaginal bleeding.

Malignant Mixed Müllerian Tumor with an Extensive Squamous-Cell Carcinomatous Component: A Potential Pitfall in Liquid-Based Cervical Cytology

“…Our case confirmed that the sarcomatous component does not shed easily, even in a case of predominant sarcoma on histology [18]. The presence of a sarcomatous component in a cervical Pap smear has also been identified as a characteristic feature [4,11]. …”

“…clusters of malignant epithelial cells in a necrotic background, were not evident or were not considered as such. Gupta et al [11 ]also reported that necrosis is not evident on liquid-based (SurePath) cytology. The introduction of LBC in cytology in recent years, and in particular in cervical cytology, represents a revolution in cervical cancer screening.…”

“…With the diffusion of liquid-based cytology (LBC) in screening programs for uterine cervix carcinoma, the possibility of encountering such tumors has increased [10]. However, only a few reports regarding the cytological features of MMMTs in LBC have been described [11]. …”

Atypical Findings on Cervicovaginal Smears Correlate with Cervical Involvement by Malignant Mixed Müllerian Tumors of the Uterus

“…2, 3). Several other studies [6,8,19,20] and our observation show that the mesenchymal component is a rare finding in both liquid-based and conventional specimens, and only 2 of our study patients had malignant spindle cells on the Pap smears suggesting a biphasic tumor. …”

“…Earlier studies have described the cytological features of MMMTs based on conventional cervicovaginal cytology [6], but few studies have been published regarding findings on liquid-based Papanicolaou (Pap) smears [8]. …”