Clinical history: A 76-year-old female presented with intraperitoneal hemorrhage and abdominal pain. A CT abdomen showed ascites and a possible pelvic mass.
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Discussion and answer
Microscopically, a biphasic lesion is present composed of carcinomatous and sarcomatous elements. The malignant epithelial component consists of high grade serous carcinoma and squamous cell carcinoma. The sarcomatous component consists of a mixture of fibrosarcoma and chondrosarcoma. Significant tumour necrosis is seen. The lesion is present within the left pelvic region, left and right fallopian tubes, bilateral paraovarian tissues and right ovary. The diagnosis is carcinosarcoma (malignant mullerian mixed tumour), most likely of adnexal origin.
Carcinosarcomas are rare tumours, almost always occurring in post-menopausal women. Serum CA-125 is usually elevated. These tumours are aggressive with a median survival of 2 years.