Three histologically distinct cancers of the uterine corpus: A case report and review of the literature

Uterine collision tumor. Case report and review of the literature

Objectives

To report the case of a patient with a uterine collision tumor and to conduct a review of the literature.

Material and methods

A 76-year-old patient who presented to the national cancer referral center in Bogota (Colombia), where she was diagnosed with a uterine collision tumor consisting of a seroustype endometrial adenocarcinoma and a cervical adenosarcoma. The patient underwent surgical treatment followed by chemotherapy and supplemental radiotherapy, and died 16 months later. A search was conducted in the Medline via PubMed and Embase databases, including reports and case series of women with a diagnosis of uterine collision tumor, with retrieval of information regarding diagnosis, treatment and prognosis. A narrative summary of the findings was made.

Results

The search identified 36 titles, of which 14 studies with 17 patients were included. The most frequent histopathological diagnosis was endometrial adenocarcinoma and high and low grade endometrial sarcoma (47 %). Primary treatment was surgery and adjuvant treatment with chemotherapy and radiotherapy (15 %) was performed in close to 50 % of cases. One-year survival was 75 %.

Conclusions

No cases of uterine collision tumors with the histopathology or in the location of the reported case were found in the literature. If this reported case is taken into account, 2-year mortality is 28 %. Further studies to describe the immunohistochemistry, treatment and prognosis of this condition are needed.

One biopsy, two tumors: A case report of collision tumor consisting in breast and endometrioid carcinoma detected on bioptic sample of peritoneal carcinomatosis

Collision tumors are rare and very few cases were described in which collision was revealed in a metastatic lesion. Herein we report a case of woman with a peritoneal carcinomatosis underwent to bioptic procedure in correspondence of a nodule of Douglas peritoneum with clinical suspect of ovarian/uterine origin. Histologic examination revealed two different colliding epithelial neoplasms: an endometrioid carcinoma and a ductal breast carcinoma, the latter not suspected at the time of biopsy. Morphology and immunohistochemistry, in particular GATA3 and PAX8, defined clearly the two different colliding carcinomas.

Case report: Highly differentiated endometrial adenocarcinoma that collided with uterine cervical carcinosarcoma

Uterine collision tumor is a rare pathological type composed of two or more malignant tumors. The components of these malignant tumors do not have histological mixing and are separated by the normal mesenchyme. Collision cancer is very rare, with uterine collision tumors being even rarer. Only a few cases have been reported in relation to uterine collision tumors. At present, there is no standard treatment guideline for uterine collision tumors, and a comprehensive treatment composed of surgery, radiotherapy, and chemotherapy is suggested. In this study, we report a 54-year-old female patient diagnosed with highly differentiated endometrial adenocarcinoma with cervical carcinosarcoma. The endometrial adenocarcinoma component invaded the deep myometrium (> 1/2 layer), involving the cervical glands and interstitium. The regional lymph node metastasis from endometrial adenocarcinoma was also detected. The patient underwent "transabdominal tumor cytoreduction (total hysterectomy + right adnexal resection + greater omentectomy + pelvic lymph node dissection + para-aortic lymph node dissection) + pelvic adhesion release." In addition, she has completed adjuvant radiotherapy and chemotherapy. After reviewing previous reports of collision tumors in different positions of the uterus, we found that collision tumors between the cervix and uterine body are very uncommon. In addition, we have not found any reports on the metastasis of sarcoid components, no matter what the composition is.

Dedifferentiated endometrioid adenocarcinoma with trophoblastic components: Prolonged remission after treatment with bleomycin, etoposide, and cisplatin

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DEAC with trophoblastic components is a rare neoplasm.

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The neoplasm is difficult to treat and has a poor overall prognosis.

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Multiple adjuvant chemotherapy treatment regimens have been reported.

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The neoplasm appears to have a good response to bleomycin, etoposide, and cisplatin.

Dedifferentiated endometrial adenocarcinoma (DEAC) with trophoblastic components is a rare neoplasm with an aggressive behavior and a poor prognosis. Only seven cases have been reported in the literature. We present a 61-year-old patient who was diagnosed with Stage IB dedifferentiated endometrioid adenocarcinoma with trophoblastic elements. A post-operative β-hCG was elevated at 1877 mIU/mL. The patient received 6 cycles of carboplatin and paclitaxel with normalization of β-hCG; however, three months after completion of chemotherapy, her β-hCG increased to 39 mIU/mL and a mass overlaying the psoas muscle was noted on imaging. The mass was resected and confirmed to be recurrent disease. Four cycles of bleomycin, etoposide, and cisplatin were administered, and the patient remains without evidence of disease 3 years after completing treatment. Due to the small number of reported cases of DEAC with trophoblastic components, there is limited information regarding the appropriate first-line adjuvant chemotherapy regimen.

Collision Tumor of Endometrial Large Cell Neuroendocrine Carcinoma and Low-Grade Endometrial Stromal Sarcoma: A Case Report and Review of the Literature

Large cell neuroendocrine carcinoma (LCNEC) of the endometrium is an exceedingly rare histologic subtype of endometrial cancer (0.8%). These tumors are highly aggressive with a propensity for metastasis and have a poor prognosis. Among the 17 cases reported to date, 9 cases were pure large cell neuroendocrine tumors and 8 were collision tumors of LCNEC with endometrial carcinomas (7 endometrioid and 1 serous). In this article, we report a case of collision tumor composed of an endometrial LCNEC and a low-grade endometrial stromal sarcoma (LGESS). The patient was a 48 year-old woman who presented with a large abdominal mass for about 10 years and underwent total hysterectomy, bilateral salpingo-oophorectomy, and tumor debulking. Microscopic evaluation demonstrated an LGESS with extensive osseous metaplasia that penetrated through the myometrium and invaded into pelvic and abdominal cavity, forming a 40.0-cm mass. Cytogenetic analysis of the LGESS revealed an abnormal female karyotype (45, XX) with multiple structural abnormalities. Incidentally, small foci of LCNEC were identified within the endometrium. The LCNEC focally invaded the myometrium with involvement of the endocervix, extensive lymph-vascular space invasion, and metastases to bilateral ovaries. Subsequently, the patient was treated with cisplatin/etoposide chemotherapy and had been doing well for about a year until presenting with recurrence of LCNEC in the abdomen. She passed away a month later due to medical complications. This report reveals an extremely rare endometrial collision tumor with unusual pathologic features and clinical presentations.

Endometrial Carcinoma With Trophoblastic Components: Clinicopathologic Analysis of a Rare Entity

Somatic endometrial carcinomas with trophoblastic components have only rarely been described. To better characterize this distinctive combination of histotypes, we report herein 4 new cases, representing the largest cohort reported thus far, and review previously reported cases. The 4 new patients ranged in age from 61 to 77 yr (mean, 68 yr). The first patient had a grade 2 endometrioid carcinoma, surgical International Federation of Gynecology and Obstetrics stage IA, that recurred 5 months later at the vaginal apex with purely choriocarcinoma elements, suggestive of unsampled trophoblastic areas in the uterus. The 3 other patients were all International Federation of Gynecology and Obstetrics stage III, and included 2 cases of dedifferentiated endometrial carcinoma with 40% and 20% choriocarcinoma components, and 1 case of grade 1 endometrioid carcinoma with a 40% choriocarcinoma component. Postoperative serum β-human chorionic gonadotropin was elevated in all patients. All received adjuvant combination chemotherapy, but all were dead of disease with distant metastases at an average of 11.75 mo (range, 7-16 mo) after primary staging. Data from our cases were combined with those from 24 cases that had previously been reported in the literature between 1972 and 2016. Analysis of this combined data indicates that endometrial carcinoma with trophoblastic component is a rare neoplasm that occurs primarily in postmenopausal patients. The trophoblastic component is most commonly a choriocarcinoma and the somatic component is most commonly an endometrioid carcinoma or an adenocarcinoma/carcinoma reported without further specification; the somatic component may be a diverse array of histotypes or histotype admixtures. Serum and/or urine β-human chorionic gonadotropin is elevated in almost all patients, and fluctuations of β-human chorionic gonadotropin generally correlated with tumor relapses or recurrences. The stage distribution and patient outcomes in the current and previously reported patients suggests that trophoblastic differentiation usually, but not invariably denotes clinical aggressiveness.

Dedifferentiated endometrioid adenocarcinoma with trophoblastic components and elevated serum alfa-fetoprotein: A case report and literature review

RATIONALE

Dedifferentiated endometrioid adenocarcinoma (DEAC) consisted of a combination of undifferentiated and differentiated carcinoma is more aggressive than other conventional endometrioid adenocarcinomas.

PATIENT CONCERNS

A 33-year-old woman with atypical vaginal bleeding was refereed to our hospital. She had an endometrial biopsy in a local clinic which showed differentiated endometrioid carcinoma with trophoblastic components. High levels of β-Human chorionic gonadotropin (β-hCG) and alfa-fetoprotein (AFP) were detected in the patient's serum.

INTERVENTIONS

The patient underwent total hysterectomy with bilateral salpingo-oophorectomy, total omentectomy and systemic pelvic lymphadenectomy in our center.

DIAGNOSIS

Pathological investigation indicated that the tumor had well differentiated and undifferentiated adenocarcinoma as well as trophoblastic components.

OUTCOMES

Serum β-hCG and AFP dropped significantly after operation. But three weeks later, the patient had developed pulmonary metastases and elevation of serum β-hCG. She died of the disease five months after surgery.

LESSONS

DEAC with trophoblastic differentiation seems to follow an aggressive course with early metastasis and poor clinical prognosis. However, due to small number of cases, further studies are necessary.