Case History
A 63-year-old female with uterine mass and postmenopausal bleeding
What is the diagnosis:
- High-grade serous carcinoma
- Carcinosarcoma
- Undifferentiated endometrial sarcoma
- Adenosarcoma with sarcomatous overgrowth
Uterine tumor 
Vimentin + 
CK LMW (CAM 5.2+) Answer: “B” Carcinosarcoma
Discussion
Carcinosarcoma (malignant mixed Mullerian tumor) typically occurs in postmenopausal women. Symptoms include postmenopausal bleeding and enlarged uterus. Up to two-thirds of patients present at an advanced stage. There is an association with tamoxifen therapy or unopposed estrogen usage. Patients with a history of previous radiation can develop carcinosarcoma in up to 37%.
Microscopically tumor shows admixture of malignant epithelial and mesenchymal components. Homologous (endometrial stromal sarcoma, leiomyosarcoma, undifferentiated sarcoma) or heterologous (rhabdomyosarcoma, chondrosarcoma) sarcomatous components are present. In this case LMW keratin stained carcinoma component and vimentin stained sarcoma component.
Five-year survival rate is 40-60% for stage I-II tumors. Overall recurrence rate is 55%.
Treatment: hysterectomy with bilateral salpingo-oophorectomy and chemotherapy
McCluggage, W. A practical approach to the diagnosis of mixed epithelial and mesenchymal tumours of the uterus. Mod Pathol29, S78–S91 (2016) doi:10.1038/modpathol.2015.137