Ovarian carcinosarcoma associated with bilateral tubal intraepithelial carcinoma: a case report

Carcinosarcomas (malignant mixed müllerian tumors) of the ovary are rare tumors. This report describes a case of a 64 years old patient presenting with a large tumor in the true pelvis, intraoperatively originating from the right ovary, with peritoneal metastatic deposits. Histologically, a dominant sarcomatoid component consisted of short spindle and epithelioid round cells. The nuclei were round to oval, with pleomorphism, hyperchromasia and frequently conspicuous nucleoli. Mitotic activity was brisk. The cells were aligned in hypercellular to myxoid hypocellular arrangements. Large epithelioid cells displayed abundant deeply eosinophilic cytoplasm and mono- to multinucleation. Immunohistochemically, these cells displayed strong reactivities for desmin, WT1 in a cytoplasmic staining pattern, p16, and vimentin. A second and minor tumor component revealed epithelial differentiation with mixed serous- endometrioid and squamous features, and immunohistochemical staining for AE1/AE3 cytokeratin, focally for p16 and p53(ink4), for nuclear WT1 in varying quantities, and weakly for vimentin. The fallopian tubes were remarkable for circumscribed areas of serous tubal intraepithelial carcinoma (STIC), found at the fimbria of the right and in the tubal mucosa close to the fimbria of the left tube. The final diagnosis was carcinosarcoma of the right ovary (malignant müllerian mixed tumor, heterologous type), with rhabdomyosarcomatous differentiations, FIGO stage IIIC. The patient died of recurrent tumor seven month after primary presentation.