Uterine carcinosarcoma arising from an endometrial polyp: assessment by 3-dimensional power Doppler angiography and positron emission tomography/computed tomography

Imaging Features of Carcinosarcoma Arising from Adenofibroma of the Uterus: A Case Report

BACKGROUND

Adenofibroma is a benign tumor composed histologically of epithelial elements and mesenchymal stroma. Carcinosarcoma is a malignant neoplasm that contains elements of carcinoma and sarcoma. Carcinosarcoma arising from adenofibroma of the uterus has never been reported in the literature in English language. Case Presentaion: We report a case of a 56-year-old woman who complained vaginal spotting persisting for several months. We described here for the first time a case of malignant transformation of uterine endometrial adenofibroma into carcinosarcoma that was depicted as a multilocular cystic lesion with enhancing solid portions and stalk-like structure between the myometrium and endometrial mass.

Synchronous endometrial adenocarcinoma and carcinosarcoma in endometrial polyp

Introduction:

Carcinosarcoma is a rare gynecological malignancy and it usually follows an aggressive clinical course. Rarely, it can be confined to an endometrial polyp or be synchronous with another gynecological malignancy. Herein, we report a rare case of synchronous carcinosarcoma confined to an endometrial polyp and endometrioid endometrial adenocarcinoma arising from a distinct uterine wall site.

Case presentation:

A 57-year-old female patient presented with heavy vaginal bleeding. She underwent hysterectomy with bilateral salpingo-oophorectomy for endometrioid endometrial adenocarcinoma that was diagnosed preoperatively through dilation and curettage. Full histopathological examination of the uterine specimen revealed carcinosarcoma confined to a 4 cm endometrial polyp in addition to a stage IA endometrioid endometrial adenocarcinoma which arose from a distinct uterine wall.

Conclusion:

Having an endometrioid endometrial cancer diagnosis preoperatively through dilation and curettage and at examination of the frozen section specimen following surgical resection should not preclude the standard full histopathological examination of the uterine specimen, since this could reveal an additional uterine malignancy, such as carcinosarcoma. Such a finding would alter the post-operative management, prognosis, and outcome even if it is confined to an endometrial polyp.

F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a rare case of recurrent malignant mixed mullerian tumor

We report a case of 66-year-old female with previous history of histopathologically proven. Malignant mixed mullerain tumor of the uterus in whom positron emission tomography/computed tomography (CT) done for characterization of soft tissue lesion in pelvis noticed on CT, showed extensive recurrent disease in the pelvis with pulmonary metastases.

Malignant mixed Müllerian tumors of the uterus: sonographic spectrum

OBJECTIVE

To describe the sonographic findings for malignant mixed Müllerian tumors (MMMTs) of the uterus with particular emphasis on their features on saline contrast sonohysterography (SCSH) and color Doppler sonography, and to determine how they relate to pathological findings.

METHODS

The SCSH and color Doppler findings in 29 histologically proven cases of uterine MMMT were reviewed retrospectively and their relationship to gross and histological findings were investigated.

RESULTS

Of the 29 uterine tumors, 16 were located only in the corpus, nine only in the fundus and four in both the corpus and fundus. Mean tumor size was 5.4 cm. The most common appearance was a polypoid mass projecting into the endometrial cavity, found in 23 cases. Twenty-eight tumors had an irregular surface, which was papillary in 20 cases and lobulated in eight. Most appeared heterogeneously isoechoic (n = 16) or hypoechoic (n = 12), occasionally with a trabecular appearance, and they often had clefts or fissure-like cystic areas (n = 10), necrosis (n = 4) or hemorrhagic areas (n = 7). Myometrial invasion was present in 27 cases and dilatation of the endometrial cavity was seen in 11. Color Doppler sonography showed moderate to marked vascularity in 20 out of the 24 cases in which it was performed, with a mean resistance index of 0.41, and appeared as feeding (n = 15) or randomly dispersed (n = 9) vessels.

CONCLUSIONS

Uterine MMMTs have distinct sonographic features that are related to pathological findings. Knowledge of the sonographic appearance of MMMTs may facilitate diagnosis.

Role of PET or PET/CT in the post-therapy surveillance of uterine sarcoma

OBJECTIVE

To evaluate the clinical accuracy and clinical impact of positron emission tomography (PET) or positron emission tomography/computed tomography (PET/CT) in detecting and treating tumor recurrence in patients with treated uterine sarcoma.

METHODS

Results of 36 patients who underwent PET or PET/CT in post-therapy surveillance of uterine sarcoma were retrospectively assessed. Histopathologic confirmation or clinical/radiological outcome at least 6 months after PET or PET/CT was standard of reference.

RESULTS

The 36 patients underwent 48 PET or PET/CT scans as part of post-therapy surveillance. Thirty scans (8 PET and 22 PET/CT) were performed due to suspicion of disease recurrence on CT, whereas 18 scans (4 PET and 14 PET/CT) were performed as part of routine post-therapy surveillance in asymptomatic patients. The sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of PET or PET/CT were 92.9%, 100%, 94.4%, 100% and 80%, respectively, in patients with suspected recurrence and 87.5%, 95.5%, 93.3%, 87.5% and 95.5%, respectively, in asymptomatic patients. PET or PET/CT influenced the management of 12 patients (33.3%), by initiation of previously unplanned treatment in 8 patients and by avoidance of previously planned treatment in 4 patients.

CONCLUSION

PET or PET/CT was highly effective in discriminating true recurrence in patients with suspected recurrence and was highly sensitive in detecting recurrence in asymptomatic patients. It had impacts on clinical decision making in a high proportion of patients.

18F-fluorodeoxyglucose positron emission tomography in uterine carcinosarcoma

PURPOSE

Uterine carcinosarcomas clinically confined to the uterus usually harbor occult metastases. We conducted a pilot study to evaluate the value of (18)F-fluorodeoxyglucose (FDG) positron emission tomography (PET) in uterine carcinosarcoma.

METHODS

Patients with histologically confirmed uterine carcinosarcoma were enrolled. Abdominal and pelvic magnetic resonance imaging (MRI)/whole-body computed tomography (CT) scan, and whole-body (18)F-FDG PET or PET/CT were undertaken for primary staging, evaluating response, and restaging/post-therapy surveillance. The clinical impact of (18)F-FDG PET was determined on a scan basis.

RESULTS

A total of 19 patients were recruited and 31 (18)F-FDG PET scans (including 8 scans performed on a PET/CT scanner) were performed. Positive impacts of scans were found in 36.8% (7/19) for primary staging, 66.7% (2/3) for monitoring response, and 11.1% (1/9) for restaging/post-therapy surveillance. PET excluded falsely inoperable disease defined by MRI in two patients. Aggressive treatment applying to three patients with PET-defined resectable stage IVB disease seemed futile. Two patients died of disease shortly after salvage therapy restaged by PET. With PET monitoring, one stage IVB patient treated by targeted therapy only was alive with good performance. Using PET did not lead to improvement of overall survival of this series compared with the historical control (n = 35) (P = 0.779).

CONCLUSIONS

The preliminary results suggest that (18)F-FDG PET is beneficial in excluding falsely inoperable disease for curative therapy and in making a decision on palliation for better quality of life instead of aggressive treatment under the guidance of PET. PET seems to have limited value in post-therapy surveillance or restaging after failure.

Positron emission tomography imaging for gynecologic malignancy

PURPOSE OF REVIEW

The utility of positron emission tomography (PET) in gynecologic malignancy has increased rapidly in recent years. This review examines publications in this area.

RECENT FINDINGS

PET scans are mostly performed using 18-fluorodeoxyglucose (FDG-PET). It is valuable in primary staging of untreated advanced cervical cancer, for posttreatment unexplained tumor marker elevation and restaging of potentially curable recurrent cervical cancer. Its value in early-stage cervical cancer is limited. In ovarian cancer, sequential imaging predicts response to neoadjuvant chemotherapy and survival. It also provides benefits when increases in serum CA 125 or computed tomography/magnetic resonance imaging defined recurrence is noted but biopsy deemed infeasible. A few studies have shown that FDG-PET may facilitate optimal management of endometrial cancer, especially for posttherapy surveillance and after salvage therapy. FDG-PET is potentially useful in selected gestational trophoblastic neoplasia by monitoring response and localizing viable tumors after chemotherapy. Scanty studies have been reported in vulvar and vaginal cancer. The methodology and prospects of using integrated PET/computed tomography in the management of gynecological cancer are discussed. Other PET compounds are briefly introduced.

SUMMARY

The role of PET or PET/computed tomography has evolved from a diagnostic tool into a potential indicator of response to treatment and prognosis. Evaluating this tool by clinical impact is an attractive end point.