Carcinosarcoma of the uterine cervix initially interpreted as myoma nascens

Abstract

A 76-year-old nulligravid Caucasian woman was referred with vaginal bleeding of 1 month duration. General physical examination was unremarkable and disclosed an essentially healthy appearance and normal vital signs. Pelvic examination revealed a 4 cm sized glistering grey -tan polypoid mass protruding into the vagina from a dilated cervical canal; otherwise, no abnormalities were detected. The mass was initially interpreted as myoma nascens; however, biopsy of the mass demonstrated carcinosarcoma. Imaging studies including X-ray of the chest and computerised tomography scanning of the chest, abdomen and pelvis did not disclose abnormal findings apart from enlarged uterine cervix.At laparotomy, a normally sized uterine body and enlarged uterine cervix were observed. The tubes were tortuous and somewhat swollen. The ovaries and other pelvic and abdominal organs were normal. There were no ascites. Total abdominal hysterectomy, bilateral salpingo-oophorectomy, omental biopsy and bilateral pelvic lymph node sampling were performed. Gross sectioning of the uterine specimen revealed a 4 cm grey -tan cauliflower-like tumour originating from the left and posterior walls of the endocervical canal on a wide base ranging from the external cervical os to 3 mm below the level of the uterine isthmus. The tumour was almost entirely filling and obstructing the dilated endocervical canal and did not involve the uterine isthmus and uterine body cavity (Figure 1). Microscopic examination of the tumour showed a biphasic tumour composed of an admixture of carcinomatous (epithelial) and sarcomatous (mesenchymal) components ( Figure 2). The carcinomatous component was comprised of papillary serous carcinoma. The sarcomatous component was comprised of high-grade stromal sarcoma containing heterologous elements of chondrosarcoma, liposacroma, osteosarcoma and rhabdomyosarcoma. On immunohistochemical staining, the carcinoma cells were positive for cytokeratin, while the sarcoma cells were diffusely positive for vimentin and focally positive for S-100 protein, desmin, myoglobin, CD-10 and caldesmon. The tumour invaded the cervical stroma to a maximal depth of 5 mm, whereas the thickness of the cervical wall was 11 mm. No vascular invasion and no tumour cell necrosis were identified. Microscopic examination confirmed that the upper limit of the tumour in the cervix was at a level of 3 mm beneath the uterine isthmus and that there was no involvement of the uterine isthmus and uterine body. On microscopic examination, the endometrium was atrophic but contained an isolated small focus of endometrial intraepithelial carcinoma that had no connection with the cervical tumour. The omentum, ovaries and fallopian tubes were unremarkable. No tumour was identified in five removed pelvic lymph nodes.Following an uneventful postoperative recovery, the patient received adjuvant pelvic radiotherapy consisting of external megavoltage photon irradiation employing a 10 MeV linear accelerator delivering 5,040 cGy to the whole pelvis in 28 daily fractions of 18...

Carcinosarcoma del cuello uterino: reporte de caso y revisión de la literatura

“…Treatment. In the case reports reviewed, 24 patients ranging between 36 and 80 years of age were identified (6,10,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27). The treatment used in those cases were surgery followed by radiotherapy in 11 patients (6, 10, 11, 17, 20-22, 26, 27); surgery plus chemotherapy and radiotherapy in 6 cases (12,14,16,21,23); surgery plus chemotherapy in 2 cases (21,22); surgery alone in 3 cases (15,18,24); and radiotherapy in 2 cases (19,25).…”

“…Regarding clinical manifestations of cervical carcinosarcoma, the most frequent signs and symptoms are abnormal uterine haemorrhage, pelvic pain, dyspareunia, polypoid or papillary cervical mass, or large mass replacing the cervix. In advanced stages, patients present with weight loss and symptoms associated with the obstructive effect of the tumour on the gastrointestinal or urinary tracts (10).…”

“…Unfortunately, at the time of diagnosis and onset of symptoms, this neoplasm has usually already involved the lymphatic system, which might explain in part its worse prognosis when compared to the squamous cell subtype or adenocarcinomas (7). There is no consensus at the present time regarding the best therapeutic option for the treatment of this entity (4,10).…”

Coexistence of homologous-type carcinosarcoma of the cervix with undifferentiated carcinoma of the endometrium: A case report with Immunohistochemical analysis and literature review

“…In more advanced stages, patients present symptoms associated with the obstructive effect of the tumour on the gastrointestinal or urinary tracts ( Piura et al, 2007 ).…”

Carcinosarcoma of the Uterus: A Study From the Surveillance Epidemiology and End Result (SEER) Database

“…As a result of the insufficient data in CS outcome, demographic and clinical factors remain poorly understood. However, recent case reports are emerging of CS being a part of or mistaken for myomas, making clinical knowledge of the characteristics and risk factors for CS essential, and especially crucial for gynecologists to avoid improper management or inadvertent cancer dissemination during surgery [ 22 - 25 ]. The current study examines a large modern cohort of primary CS patients from the Surveillance, Epidemiology, and End Result (SEER) database over 38 years to better understand the temporal associations demographic and management trends and to determine unique factors predictive of clinical outcomes.…”