The epidemiology ofthese tumours is less well-defined than endome-trial carcinoma, although cases of mixed Mullerian tumour have been reported following tamoxifen therapy. The mixed Mullerian tumours (MMTs) are divided into homologous and heterologous.

Homologous MMTs are composed of tissues native to the uterus, whereas heterologous MMTs involve tissue from outside the uterus. The tumours vary also in the frequency of mitoses seen on pathology sections, and this predicts prognosis. Tumours with fewer than 5 mitoses per 10 high-power fields are regarded as low-grade and carry a good prognosis, whereas those with a mitotic rate of over 20 per 10 high-power fields often have a more aggressive course with a high risk of nodal and systemic metastasis. Even low-grade tumours can behave unpredictably and if there is any residual disease it tends to be very unresponsive to non-surgical treatment.

Fibrosarcomas may arise de novo or rarely are found in a fibroid uterus. These tumours also exhibit a spectrum of mitotic activity that determines prognosis.

Successful treatment depends very much on surgery for loca-ized disease. Residual disease or tumours with nodal or distant metastases are usually incurable. Hysterectomy and bilateral salpingo-oophorectomy should be performed, together with pelvic and para-

aortic lymphadenectomy to stage the disease. Residual disease can be treated with radiation. Adjuvant radiation may improve pelvic control but does not confer a survival benefit. Chemotherapy (e.g. doxorubicin and ifosfamide) can be prescribed for metastatic disease, especially outside the pelvis, but long-term survival is very poor under these circumstances.

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