Coexistence of uterine adenosarcoma and endometrioid endometrial carcinoma: A case report and literature review

Abstract

Uterine adenosarcoma coexisting with endometrial carcinoma is a very rare disease. Herein, we reported the case of uterine adenosarcoma coexisting with endometrioid endometrial carcinoma. Transvaginal ultrasound, computed tomography, and magnetic resonance imaging examinations all indicated a space-occupying lesion in the uterine cavity, and initially was considered endometrial carcinoma. Subsequently, total hysterectomy combined with bilateral salpingo-oophorectomy, pelvic lymphadenectomy, and para-aortic lymphadenectomy were performed. The coexistence of uterine adenosarcoma and endometrioid endometrial carcinoma was histologically confirmed postoperatively. The patient recovered well after surgery and was discharged on postoperative day 7. At a follow-up examination 10 months after surgery, we found no evidence of discomforting symptoms and recurrence or metastasis. Since the coexistence of uterine adenosarcoma and endometrial carcinoma is rare, it is easy to be overlooked the presence of uterine adenosarcoma on imaging or morphology, and thus be misdiagnosed as a more common disease, namely endometrial carcinoma. Observing the cystic structure within the lesion on magnetic resonance imaging is helpful for the diagnosis of uterine adenosarcoma. This article summarizes the imaging characteristics, clinicopathological features, molecular correlation, treatment, and prognosis of the disease.

Keywords: Uterine adenosarcoma; endometrial carcinoma; endometrioid endometrial carcinoma; imaging; magnetic resonance imaging.

Figure 1.

Imaging characteristics of this case. (A) Transvaginal ultrasound showed a mixed echogenic mass in the uterine cavity, and the endometrium was unclear. (B) CT enhanced scan showed mass shadows in the uterine cavity with progressive uneven enhancement, and uneven thickening of the endometrium. (C) MRI T2WI transverse view showed mixed slightly high signal and isointense mass shadow in the uterine cavity, with higher signal small cystic lesions in it, and uneven thickening of the endometrium. (D) MRI enhanced scan T1WI showed that the mass in the uterine cavity was obviously unevenly enhanced, and the degree of enhancement was similar to that of the myometrium. There were small cystic non-enhanced lesions in the mass. The thickened endometrium was slightly enhanced.

Figure 2.

Pathological features of this case. (A) The gross appearance showed the thickened endometrium (long white arrow) and the polypoid mass (short white arrow). (B) The glandular epithelial cells of EEC with eosinophilic cytoplasm and round irregular nuclei and prominent nucleoli were arranged in a disorderly, depolarized, and stratified manner (H&E staining, 400 ×). (C) Immunostaining for MLH1 showed a positive reaction (200 ×). (D), The UAS showed bidirectional differentiation (H&E staining, 100 ×). (E) The mitosis was easy to be found in stroma (400 ×). (F) Immunohistochemical staining showed CD10 was positive in stromal cells while negative in epithelial cells (200 ×).