A 55-year-old nulliparous black woman has a large, fungating tumor projecting from her cervix. A biopsy reveals a background of spindle-shaped cells with over 10 mitoses HPF. Many of the mitoses have abnormal mitotic spindles. The patient most likely has a

The patient has a leiomyosarcoma, which usually arises de novo and not from sarcomatous degeneration of a leiomyoma. The incidence is higher in black women who have never married. Leiomyosarcomas are bulky tumors with areas of necrosis and hemorrhage. Microscopic examination reveals increased numbers of mitoses, with 10 or more mitoses per high-powered field, or 5 to 10 atypical mitoses per high-powered field. Tumors that have 5 to 10 normal mitoses per high powered field are considered borderline. Leiomyosarcomas are highly aggressive sarcomas with a tendency for recurrence. Patients with these tumors have a 25% to 30% 5-year survival rate.Stromal rumors include stromal nodules (benign), endolymphatic stromal myoses, which are low-grade malignancies, and stromal sarcomas, which are high grade malignancies. Malignant mixed miillerian tumors have an increased association with previous pelvic irradiation. Like leiomyosarcomas, they are bulky polypoid tumors that often protrude from the cervix and bleed. Unlike pure leiomyosarcomas, however, they are an adenocarcinoma plus a malignant sarcoma, or a malignant sarcoma that is not indigenous to the uterus (rhabdomyosarcoma, chondrosarcoma, or osteogenic sarcoma). A carcinosarcoma is another designation for an adenocarcinoma that is mixed with a leiomyosarcoma.Well-differentiated endometrial carcinomas and well-differentiated cervical carcinomas are composed of malignant glands and malignant squamous cells, respectively.