Objective: A malignant mixed müllerian tumor (MMMT) is a high-grade neoplasm commonly arising from the uterus. Patients present with bleeding and a mass protruding from the cervix. This study was designed to correlate Papanicolaou (Pap) smear findings with histological findings in women diagnosed with MMMT. Study Design: Women diagnosed with MMMT were identified. Preoperative Pap tests were correlated with histological findings. Statistical analysis was performed to assess associations between abnormal Pap tests and histological findings. Results: Forty patients with MMMT were included in the study. Age ranged from 37-85 years and tumor size ranged from 1.2 to 21 cm. In presurgical Pap tests (4 conventional and 36 liquid based), 11 smears (27.5%) were diagnosed as negative, 5 (12.5%) as atypical squamous cells of undetermined significance, 6 (15%) as atypical glandular cells, 16 (40%) as malignant and 2 (5%) as high-grade squamous intraepithelial lesion. Malignant cells detected on Pap smears showed a strong correlation with endocervical involvement by MMMT (p = 0.002). Larger tumors were more likely to involve the cervix (p = 0.0115). Conclusions: The Pap test can predict cervical involvement by MMMT. On Pap smears, MMMT cells showed no correlation with other adverse histological features (lymphovascular invasion, myoinvasion or adnexal involvement).

Keywords:
Carcinosarcoma, Cervical involvement, Cervicovaginal smear, Malignant mixed müllerian tumor, Papanicolaou test
1.
Vaidya AP, Horowitz NS, Oliva E, Halpern EF, Duska LR: Uterine malignant mixed mullerian tumors should not be included in studies of endometrial carcinoma. Gynecol Oncol 2006;103:684-687.
2.
Zelmanowicz A, Hildesheim A, Sherman ME, Sturgeon SR, Kurman RJ, Barrett RJ, Berman ML, Mortel R, Twiggs LB, Wilbanks GD, Brinton LA: Evidence for a common etiology for endometrial carcinomas and malignant mixed mullerian tumors. Gynecol Oncol 1998;69:253-257.
3.
Sartori E, Bazzurini L, Gadducci A, Landoni F, Lissoni A, Maggino T, Zola P, La Face B: Carcinosarcoma of the uterus: a clinicopathological multicenter CTF study. Gynecol Oncol 1997;67:70-75.
4.
Yamada SD, Burger RA, Brewster WR, Anton D, Kohler MF, Monk BJ: Pathologic variables and adjuvant therapy as predictors of recurrence and survival for patients with surgically evaluated carcinosarcoma of the uterus. Cancer 2000;88:2782-2786.
5.
Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ: Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys 2004;58:786-796.
6.
Snyder MJ, Robboy SJ, Vollmer RT, Dodd LG: An abnormal cervicovaginal cytology smear in uterine carcinosarcoma is an adverse prognostic sign: analysis of 25 cases. Am J Clin Pathol 2004;122:434-439.
7.
Kernochan LE, Garcia RL: Carcinosarcomas (malignant mixed Müllerian tumor) of the uterus: advances in elucidation of biologic and clinical characteristics. J Natl Compr Canc Netw 2009;7:550-556; quiz 557.
8.
Gupta N, Dudding N, Smith JH: Eight cases of malignant mixed Müllerian tumor (carcinosarcoma) of the uterus: findings in SurePath™ cervical cytology. Diagn Cytopathol 2014;42:165-169.
9.
AJCC Cancer Staging Manual, ed 7. Berlin, Springer, 2010.
10.
Macasaet MA, Waxman M, Fruchter RG, Boyce J, Hong P, Nicastri AD, Remy JC: Prognostic factors in malignant mesodermal (mullerian) mixed tumors of the uterus. Gynecol Oncol 1985;20:32-42.
11.
Clement PB, Zubovits JT, Young RH, Scully RE: Malignant mullerian mixed tumors of the uterine cervix: a report of nine cases of a neoplasm with morphology often different from its counterpart in the corpus. Int J Gynecol Pathol 1998;17:211-222.
12.
Banik T, Halder D, Gupta N, Dey P: Malignant mixed Müllerian tumor of the uterus: diagnosis of a case by fine-needle aspiration cytology and review of literature. Diagn Cytopathol 2012;40:653-657.
13.
Sreenan JJ, Hart WR: Carcinosarcomas of the female genital tract. A pathologic study of 29 metastatic tumors: further evidence for the dominant role of the epithelial component and the conversion theory of histogenesis. Am J Surg Pathol 1995;19:666-674.
14.
Fujii H, Yoshida M, Gong ZX, Matsumoto T, Hamano Y, Fukunaga M, Hruban RH, Gabrielson E, Shirai T: Frequent genetic heterogeneity in the clonal evolution of gynecological carcinosarcoma and its influence on phenotypic diversity. Cancer Res 2000;60:114-120.
15.
Le T: Adjuvant pelvic radiotherapy for uterine carcinosarcoma in a high risk population. Eur J Surg Oncol 2001;27:282-285.
16.
Gu M, Shi W, Barakat RR, Thaler HT, Saigo PE: Pap smears in women with endometrial carcinoma. Acta Cytol 2001;45:555-560.
17.
Skaznik-Wikiel ME, Ueda SM, Frasure HE, Rose PG, Fleury A, Grumbine FC, Fader AN: Abnormal cervical cytology in the diagnosis of uterine papillary serous carcinoma: earlier detection of a poor prognostic cancer subtype? Acta Cytol 2011;55:255-260.
18.
Sams SB, Currens HS, Raab SS: Liquid-based Papanicolaou tests in endometrial carcinoma diagnosis. Performance, error root cause analysis, and quality improvement. Am J Clin Pathol 2012;137:248-254.
19.
Costa MJ, Tidd C, Willis D: Cervicovaginal cytology in carcinosarcoma [malignant mixed mullerian (mesodermal) tumor] of the uterus. Diagn Cytopathol 1992;8:33-40.
20.
Casey MB, Caudill JL, Salomao DR: Cervicovaginal (Papanicolaou) smear findings in patients with malignant mixed Müllerian tumors. Diagn Cytopathol 2003;28:245-249.
21.
Risse EK, Holierhoek JP, Meijer-Marres EM, Ouwerkerk-Noordam E, Boon ME: Increased diagnostic accuracy of atypical glandular cells in cervical liquid-based cytology using cell blocks. Cytopathology 2011;22:253-260.
22.
Patel C, Ullal A, Roberts M, Brady J, Birch P, Bulmer JN, Wadehra V: Endometrial carcinoma detected with SurePath liquid-based cervical cytology: comparison with conventional cytology. Cytopathology 2009;20:380-387.
23.
Mount S, Harmon M, Eltabbakh G, Uyar D, Leiman G: False positive diagnosis in conventional and liquid-based cervical specimens. Acta Cytol 2004;48:363-371.
24.
Guidos BJ, Selvaggi SM: Detection of endometrial adenocarcinoma with the ThinPrep Pap test. Diagn Cytopathol 2000;23:260-265.
© 2015 S. Karger AG, Basel
2015
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.