An High-Grade Stromal Sarcoma Localized in the Left Fallopian Tube: A Diagnostically Challenging Case and a Literature Review

Abstract

High‑grade stromal sarcoma (HGSS) confined to the fallopian tube has not been clearly documented and may be mis‑classified among other rare tubal sarcomas or malignant mixed Müllerian tumours (MMMT). A systematic search of PubMed, Scopus and Google Scholar (inception to 31 May 2025) using the terms “high‑grade stromal sarcoma”, “endometrial stromal sarcoma”, “fallopian tube”, “adnexal sarcoma”, “carcinosarcoma”, “malignant mixed Müllerian tumour” was performed. Reference lists of relevant articles were screened manually. Eligibility criteria included English‑language case reports, series or reviews that described a sarcomatous component arising in the fallopian tube.Thirty‑nine primary tubal sarcomas were identified, most commonly leiomyosarcoma (n = 22) and undifferentiated pleomorphic sarcoma (n = 5). No publication described a pure HGSS arising de‑novo in the tube. Ninety‑four cases of tubal MMMT/carcinosarcoma were retrieved; in four reports the sarcomatous element demonstrated high‑grade stromal morphology but was biphasic with carcinoma. One recent case illustrated epithelial–mesenchymal transition of a high‑grade serous carcinoma into carcinosarcoma at metastatic sites. Molecular data from extra‑uterine high‑grade endometrial stromal sarcoma (HG‑ESS) highlight recurrent YWHAE‑NUTM2 and BCOR alterations, but such profiles have not been demonstrated in tubal lesions. To date, a primary high‑grade stromal sarcoma of the fallopian tube has not been confirmed. Sarcomatous differentiation in the tube most often represents MMMT or leiomyosarcoma. Accurate histo‑molecular work‑up is essential to avoid mis‑classification and to guide management.