Uterine Carcinosarcoma Arising From an Endometrial Polyp

Abstract

terine carcinosarcomas are uncommon malignant tumors, characterized histologically by the presence of both malignant glandular and sarcomatous components.1 They are also called malignant mixed müllerian tumors and usually appear in postmenopausal women.1 Most of them have a highly aggressive behavior, and their prognosis used to be very poor, even in stage I.2,3 Traditionally, these tumors have been considered a subtype of uterine sarcoma; however, recent data have shown that most carcinosarcomas have a monoclonal origin. 4Specific preoperative diagnosis is often very difficult because, in most instances, an endometrial biopsy specimen can indicate either carcinoma or sarcoma. 2 We report a case of uterine carcinosarcoma arising from an endometrial polyp in a postmenopausal woman evaluated by 3-dimensional (3D) power Doppler angiography and positron emission tomography/computed tomography (PET/CT). Case ReportA 60-year-old multiparous postmenopausal woman was admitted to the Department of Gynecology at the Caracas University Hospital with postmenopausal bleeding and uterine prolapse. Her medical history was unremarkable. Uterine prolapse was confirmed at physical examination. Transvaginal sonography was performed and showed a heterogeneous 24-mm-thick endometrial stripe. The cervix was apparently normal, and the myometrialendometrial interface was well defined (Figure 1). Threedimensional power Doppler angiography was performed subsequently and showed a highly vascularized lesion with a main feeding vessel arising from the uterine fundus with an abnormal branching pattern, aneurysmatic dilatations, and distribution of vessels inside the uterine lesion (Figure 2). A polypoid malignant lesion with no myometrial invasion was suspected.

Synchronous endometrial adenocarcinoma and carcinosarcoma in endometrial polyp

“…Carcinosarcoma tends to behave aggressively even if it is confined to an endometrial polyp. Nieves et al 13 reported a case of carcinosarcoma with liver metastasis despite being totally inside an endometrial polyp in the histology specimen. A preoperative CT scan for our patient did not show any evidence of distant metastasis.…”

F-18 Fluorodeoxyglucose Positron Emission Tomography/Computed Tomography in a Rare Case of Recurrent Malignant Mixed Mullerian Tumor

“…[13] Several studies have demonstrated that the sarcoma fluorodeoxyglucose (FDG) uptake level can be used to evaluate tumor response to treatment as FDG uptake is related to disease recurrence and to survival of patients with sarcomas. [14] The use of PET for uterine sarcoma can be extended with the use of other tracers such as C-11 choline, C-11 methionine, C-11 tyrosine, F-18 fluorotyrosine and F-18 fluorothymidine, all of which characterize tumor biology other than glucose metabolism.…”