Lymphoepithelioma-like carcinoma with carcinosarcoma of the endometrium: a case report and literature review

Abstract

This report describes a 56-year-old female diagnosed with lymphoepithelioma-like carcinoma with carcinosarcoma of the endometrium (LELCCSE). She experienced vaginal bleeding and lower abdominal discomfort without any obvious cause following six years of menopause. She sought treatment at our hospital in Hangzhou, China. An ultrasound examination revealed a hypoechoic mass within the uterus. Subsequently, a biopsy confirmed it as lymphoepithelioma-like carcinoma (LELC) with carcinosarcoma.The patient underwent a total hysterectomy, bilateral salpingo-oophorectomy, and associated lymphadenectomy. The postoperative pathology suggested LELC complicated with carcinosarcoma and an IIC grade by the 2023 FIGO staging system. She received adjuvant chemotherapy and radiotherapy without any molecular testing due to her financial constraints. A gene which encodes the catalytic subunit of DNA polymerase epsilon(POLE) mutation was found by the retrospective molecular testing; however, no recurrence or metastasis occurred after 12 follow-up months.

Keywords: carcinosarcoma; clinicopathology; endometrium; lymphoepithelioma-like carcinoma; molecular pathology.

Figure 1

An ultrasound examination reveals a hypoechoic mass in the left posterior wall of the uterus.

Figure 2

(a) Microscopic examination of the biopsy indicates that the tumor was composed of nests of undifferentiated carcinoma cells, including syncytial cells and vacuolated nuclei, along with abundant lymphocytic and plasma cell infiltration. (Magnification, x200; the scale bar measured 100µm; H&E). (b) Microscopic examination of the surgical specimen shows that the tumor comprised poorly differentiated endometrioid carcinoma (red arrow) and intermediate-grade sarcoma (blue arrow) components. (Magnification, x50; the scale bar measured 400µm; H&E). (c) At the base of the mass, poorly differentiated endometrioid carcinoma (right-side blue line area) was observed adjacent to a smaller LELC component (left area of the blue line). (Magnification, x50; the scale bar measured 400µm; H&E).

Figure 3

(a) Immunohistochemistry shows the expression of EMA in LELC. (Magnification, IHC x200; the scale bar measured 100 µm). (b) Immunohistochemistry shows the expression of Pax8 in LELC. (Magnification, IHC x200; the scale bar measured 100 µm). (c) Immunohistochemistry shows the expression of SMA in sarcoma. (Magnification, IHC x100; the scale bar measured 200 µm).

Figure 4

(A) POLE mutations (c.1376C>T p.S459F) occurring at frequencies of 18.53% in LELC. (B) POLE mutations (c.1376C>T p.S459F) occurring at frequencies of 42.8% in carcinosarcoma.