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Cervical metaplastic carcinomas, including most cases of malignant mixed müllerian tumours (MMMTs), or carcinosarcomas, and sarcomatoid carcinomas, are rare biphasic neoplasms.1 ,2 Recent research suggests that both elements share a common epithelial origin, with sarcomatous/sarcomatoid component derived from a metaplastic process.3 We report a series of three cases, one cervical MMMT and two cervical sarcomatoid carcinomas, with their clinicopathological features, immunohistochemical profile and human papillomavirus (HPV) infection status and genotype. Materials and methods are provided in online supplementary appendix 1.
Clinical history and sequence of events
Case 1 was a 45-year-old woman, gravida 2, para 1 (G2P1), who presented with abnormal vaginal bleeding for 6 months. On pelvic examination, a cauliflower-like cervical mass was found. Biopsy and subsequent investigations showed stage IB2 homologous MMMT. The patient underwent neoadjuvant chemotherapy. Then total abdominal hysterectomy, bilateral salpingo-oophorectomy (TAH-BSO) with pelvic and para-aortic lymphadenectomy was performed, followed by concurrent chemoradiotherapy. Six months later, metastatic lesions were found in the vaginal stump, bladder and rectum. Because of poor response to subsequent chemoradiotherapy, she gave up further treatment.
Case 2 was a 38-year-old woman, G2P1, who presented with abnormal vaginal bleeding for 3 years. Pelvic examination showed a cervical exophytic mass. Biopsy showed squamous cell carcinoma. The patient then underwent TAH-BSO with pelvic lymphadenectomy. Final pathology confirmed stage IB1 cervical sarcomatoid carcinoma. The patient then received radiochemotherapy and remained disease-free for >5 years.
Case 3 was a 61-year-old woman, G2P1, who presented for abnormal pap smear. Pelvic examination …