A Rare and Aggressive Uterine Cancer: Carcinosarcoma

Article Information

Catarina Reis-de-Carvalho1*, André Borges2, Dusan Djokovic2

1Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Portugal

2Department of Obstetrics and Gynecology, Centro Hospitalar Lisboa Ocidental, Portugal

*Corresponding Author: Dr. Catarina Reis-de-Carvalho, Department of Obstetrics, Gynecology and Reproductive Medicine, Centro Hospitalar Universitário Lisboa Norte, Portugal

Received: 15 March 2020; Accepted: 02 April 2020; Published: 09 April 2020

Citation: Catarina Reis-de-Carvalho, André Borges, Dusan Djokovic. A Rare and Aggressive Uterine Cancer: Carcinosarcoma. Journal of Radiology and Clinical Imaging 3 (2020): 056-057.

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Uterine carcinosarcoma; Mullerian tumor; Uterine cancer; Carcinosarcoma

Uterine carcinosarcoma articles, Mullerian tumor articles, Uterine cancer articles, Carcinosarcoma articles

Article Details

1. Case Presentation

Uterine carcinosarcoma (UCS), previously known as malignant mixed Mullerian tumor, is a very rare tumor of the female reproductive tract, composed of both high-grade sarcomatous and carcinomatous elements [1]. In the United States its incidence is 1-4 per 100,000 women, is more frequently find in black women and the median age at diagnosis is between 62-67 years old [1]. Risk factors for developing UCS include advanced age, obesity, nulliparity, exogenous estrogen use, pelvic radiation, and tamoxifen [2]. Due to its aggressive nature, up to 60% have an extrauterine disease at presentation [3]. A pelvic ultrasound is the first-line imaging study. The typical appearance is a heterogeneous solid intrauterine mass with an irregular shape, hypoechoic and septated cystic echotexture, an ill-defined boundary, possible expansion of the endometrial canal, and abundant blood flow signals [4, 5]. UCS has a worse prognosis compared to other high-risk uterine endometrial cancers, with reported five-year disease-specific survival rates of 59% for stage I/II disease, 22% for stage III disease, and 9% for stage IV disease, regardless of therapy [2].

This image concerns a 58-year-old P1G1 woman with postmenopausal uterine bleeding and pelvic pain over the past 2 months. Ultrasound assessment, with endovaginal (Figure 1) and abdominal probes, revealed an enlarged uterus reaching the supraumbilical level and bearing a solid tumor with multiple cystic areas and a color Doppler score 4. The Pipelle sampling confirmed the diagnosis of carcinosarcoma in this patient who died two days later.


Figure 1: Ultrasound assessment, with endovaginal.

Transvaginal ultrasonography is appropriate for an initial evaluation of postmenopausal bleeding. Endometrial thickness of 4 mm, or less, has a greater than 99% negative predictive value for endometrial cancer [6]. The ultrasound is not accurate to distinguish carcinosarcomas from other endometrial malignancies since the features of high-grade endometrial cancer also include heterogeneous echogenicity, high Color Doppler score, multifocal vessel pattern, and irregular myometrial-endometrial junction [6]. However, symptoms and clinical signs, along with the recognition of suspected ultrasound features presented here, should trigger prompt medical assistance to improve patient survival.


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