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Malignant mixed müllerian tumor mimicking cervical carcinoma

Case report A 58 year old female patient presented with fever lasting for 30 days, frequent urination, pressure in the lower abdomen and vaginal discharge. Laboratory findings showed elevated serum inflammatory parameters and normal level of tumor markers (CA 125, CA 19-9, Ca 15-3). Gynecological examination revealed necrotic mass in the vagina with the suspicion of bilateral parametrial invasion and invasion of the pelvic wall. Abdominal ultrasound (US) revealed a 9 cm uterine mass and transvaginal US identified cystic mass within the cervix filled with probably purulent content. Clinical diagnosis was cervical carcinoma FIGO3B. Cervical biopsy was repeated for five times in the next 20 days but histopathology revealed necrosis without tumor elements. Due to disconcordance of clinical and histopathological findings, magnetic resonance (MR) imaging of pelvis was performed. MR revealed large, well defined heterogenous cervical mass protruding in vagina, but no signs of vaginal wall or parametrial infiltration were detected (Figure 1). On contrast enhanced images the upper part of the tumor mass showed progressive enhancement indicating high content of fibrous tissue. The lesion was necrotic in the lower part which explained repeated negative cervical biopsies. Based on MRI appearance cervical carcinoma with parametrial invasion was ruled out and abdominal hysterectomy and adnexectomy was performed. Final histopathological diagnosis was malignant mixed Mullerian tumour (Figure 2). Discussion Malignant mixed Mullerian tumors (MMMTs) are extremely rare tumours, comprising only 1–2% of uterine neoplasms (1) and are composed of carcinomatous and sarcomatous components. MMMT has an aggressive metastatic potential, resulting in a poor prognosis but surgery alone can be curative if the malignancy is contained within the uterus. Preoperative MR imaging criteria are not formally included in the revised FIGO staging of uterine carcinoma, and MR is reccomended in staging of cervical carcinona (2). In this article, we emphasize the crucial role of MR imaging of uterine and cervical carcinoma on determining the treatment strategy. In addition, MR imaging also provide the true volume and the extent of the tumor, since accurate preoperative assessment enables the most appropriate management pathway, which ensures individualized treatment and the best clinical outcome.

Magnetic Resonance Imaging Cervical Carcinoma Figo Staging Preoperative Magnetic Resonance Imaging Vaginal Discharge

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