Investigation of Uterine Carcinosarcoma: Case Report and Cohort Analysis

Timothy N. Hembree, DO, PhD, Jamie K. Teer, PhD, Ardeshir Hakam, MD, and Alberto A. Chiappori, MD

Disclosures

Cancer Control. 2016;23(1):61-66. 

In This Article

Case Report

Presentation

A 61-year-old postmenopausal, gravida 3, para 3 woman with uncontrolled type 2 diabetes mellitus, hypertension, and a 32-pack-year smoking history (quit 12 years prior) but no history of gynecological cancer or exogenous estrogen exposure presented with urinary retention for 2 days and weight loss of 24 pounds during the previous 2 to 3 months. She denied abdominal pain, hematuria, abnormal vaginal bleeding, changes in her bowel pattern, night sweats, shortness of breath, and cough. She had undergone tubal ligation after her last pregnancy and also reported abnormal results on a Papanicolaou test 6 months before her presentation. Findings on physical examination were benign, except for a palpable but nontender mass above the pubic symphysis. Serum levels of cancer antigen 125, cancer antigen 19-9, and carcinoembryonic antigen were all within normal limits.

Computed tomography (CT) revealed a large, 16-cm heterogeneous intrapelvic mass with no invasion into the surrounding structures, no mesenteric or retroperitoneal lymphadenopathy, and no ascites. Secondary to the large pelvic mass, external compression of the bilateral distal ureters was present that resulted in severe bilateral hydroureteronephrosis and urethral obstruction. Based on these findings, the diagnosis of uterine malignancy was suggested and surgical debulking was recommended for diagnostic and therapeutic purposes to relieve the urethral obstruction and bilateral hydroureteronephrosis.

Exploratory laparotomy, modified radical hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking were performed. Physical examination under anesthesia revealed a fixed mass involving the entire uterus and gross tumor spillage in the vagina. Midline laparotomy confirmed a grossly necrotic tumor in the cul-de-sac, arising from the uterus, and all visible tumors were excised and submitted for pathology.

Results

Histopathology with uterine carcinosarcoma was consistent with the diagnosis of high-grade primary uterine heterologous carcinosarcoma. The carcinoma component was endometrioid adenocarcinoma and the sarcomatous component was rhabdomyosarcoma (Fig 1).

Figure 1.

A–B.— Histopathological features of uterine carcinosarcoma. (A) denocarcinoma. (B) Rhabdomyosarcoma.

Fluorodeoxyglucose positron emission tomography/CT was obtained of the skull base to the midthigh and revealed at least 5 metabolically active pulmonary nodules (2 nodules on the right and 3 nodules on the left; Fig 2). CT angiography of the chest showed pulmonary thromboembolism in the left lower lobe and also confimed bilateral pulmonary metastases (Fig 3). The patient was started on carboplatin and paclitaxel therapy but did not respond. Subsequently, she died from complications of progressive disease.

Figure 2.

Postoperative positive emission tomography obtained for the case patient.

Figure 3.

Postoperative computed tomography obtained for the case patient.

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