Carcinosarcoma in the pouch of douglas.
Only one case of carcinosarcoma in the pouch of douglas has been reported in the English literature. The author herein reports a case of carcinosarcoma of the pouch of douglas. A rapidly growing tumor (10 cm in diameter) was found in the pelvic cavity of a 51-year-old woman, and an operation was performed for the clinical diagnosis of left ovarian malignancy. However, it was found that the tumor was located in the pouch of douglas, free of ovarian involvement. Because the tumor was impossible to resect totally, an incisional biopsy was performed. Histologically, the tumor showed a mixture of squamous cell carcinoma, atypical epithelial cells occasionally forming tubules, myxomatous spindle cell sarcoma, and chondrosarcoma. The tumor showed abundant vessels, hemorrhage and necrosis. Immunohistochemically, the squamous cell carcinoma and atypical epithelium components were positive for cytokeratins, CEA, CA125, and p53 protein. The spindle cell sarcoma and chondrosarcoma components were positive for vimentin and p53 protein. The overall Ki-67 labeling was 30%. The author diagnosed the present case as carcinosarcoma of heterologous type. The present case shows that carcinosarcoma can occur in the pouch of douglas. It may arise from misplaced Mullerian duct remnants in the pouch of douglas.