Explanation:
The correct answer is E. Malignant mixed müllerian tumor is a tumor with 2 components, stromal and epithelial
(endometrial glands), both of which are malignant. This is a rare and highly aggressive tumor that has a 25%
5-year survival rate. It usually affects older patients and presents with post-menopausal bleeding. The stromal
component can contain metaplastic components such as cartilage and bone. Interestingly, usually only the
epithelial component metastasizes.
Endolymphatic stromal myosis (choice A) is a type of endometrial stromal tumor of intermediate malignancy. It
appears as small pieces of stroma between myometrial bundles that infiltrate lymph channels. Patients may
have pain or bleeding, or may be asymptomatic. Recurrences happen late in the course of the disease (years)
in half of patients and metastasis occurs in 15%. There is no epithelial component, so this is an incorrect
choice.
Endometrial carcinoma (choice B) is a malignancy of the epithelial glandular component of the endometrium.
Abnormal bleeding is the usual presentation. High estrogen states cause this tissue to proliferate. There is no
stromal component of this tumor, so this is an incorrect choice.
Endometrial stromal sarcoma (choice C) is a true sarcoma arising from the endometrial stroma that infiltrates
the myometrium and invades vessels. There is no epithelial component.
Leiomyosarcoma (choice D) is a true sarcoma arising from the uterine smooth muscle. It commonly has satellite
lesions within the uterus. Leiomyosarcomas usually recur after removal; survival is greater with well
differentiated lesions. Poorly differentiated lesions have a 10 to 15% 5-year survival rate. Distant metastasis is via blood vessels. There is no epithelial component.
17 Dhjetor 2007 22:38
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