Uterine carcinosarcoma with heterologous mesenchymal element: a case report of a rare and aggressive tumor

Abstract

Uterine carcinosarcoma (UCS), also known as malignant mixed Müllerian tumor, is a rare malignancy, which consists of both carcinomatous and sarcomatous elements, with a clinical picture resembling endometrial carcinoma. We report a case of a 74-year-old woman is reported with UCS, diagnosed after a 7 months history of vaginal bleeding and abdominal pain. Previous transvaginal sonography showed nonspecific findings, but a repeated one revealed a central uterine mass. Dilatation and curettage and several biopsies were performed. The initial histological report suggested high-grade endometrial stromal sarcoma. After total hysterectomy with salpingo-oophorectomy, pathology confirmed UCS whose sarcomatous element was heterologous type included osteosarcoma and chondrosarcoma. The patient is receiving adjuvant chemotherapy. This case highlights the importance of pathology evaluation after hysterectomy to raise the confidence of diagnosis with emphasis on prognostic outcomes that can be significantly affected in patients with this type of sarcomatous element.

Figure 1

Uterine Sonography.

Figure 2

Histopathology of the tumor showing carcinomatous element: High-grade endometrioid carcinoma (Arrow) and heterologous type of sarcomatous element: Chondroid (^*), Hematoxylin and eosin, ×20.

Figure 3

Histopathology of the tumor showing sarcomatous element: Spindle and pleomorphic cells (Arrows), Hematoxylin and eosin, ×20.

Figure 4

Histopathology of the tumor showing the heterologous type of Sarcomatous element: Chondroid (^*) and carcinomatous element: High-grade endometrioid carcinoma (Arrow), Hematoxylin and eosin, ×20.

Figure 5

Chest X-ray.

Figure 6

Axial lung base CT Slice.