scholarly journals Uterine Carcinosarcoma with Alpha-Fetoprotein-Producing Hepatoid Component: A Case Report and Literature Review

2018 ◽  
Vol 2018 ◽  
pp. 1-5
Author(s):  
Joshua J. X. Li ◽  
Jacqueline H. S. Lee ◽  
Vicky T. C. Chan ◽  
Mei-yung Yu
Keyword(s):  
Myometrial Invasion ◽  
Subsequent Development ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Disease Recurrence ◽  
Alpha Fetoprotein ◽  
Endometrioid Adenocarcinoma ◽  
Uterine Carcinosarcoma ◽  
Arginase 1 ◽  
Serum Alpha Fetoprotein

A 67-year-old woman presented with postmenopausal vaginal bleeding. Full body imaging demonstrated an intrauterine mass with deep myometrial invasion but no nodal or other metastatic disease. Uterine curettage was performed. Histologically, the tumor was an endometrioid adenocarcinoma with sarcomatous element and a hepatoid component, the latter was immunohistochemically positive for alpha-fetoprotein, HepPar-1, and arginase-1. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Serum alpha-fetoprotein level decreased from 31896 ug/l preoperatively to 2063 ug/l postoperatively. Eight weeks later, a rise in serum alpha-fetoprotein was detected, and a biopsy-proven vaginal recurrence was diagnosed. Palliative chemotherapy led to tumor shrinkage and a concurrent decrease in the serum alpha-fetoprotein level. A rise in serum alpha-fetoprotein, refractory to second-line chemotherapy, was accompanied by subsequent development of ureteric obstruction, ascites, and radiological evidence of peritoneal metastases. This is an unusual case of uterine carcinosarcoma with an alpha-fetoprotein-producing hepatoid adenocarcinoma component. Serum alpha-fetoprotein level corresponds to disease recurrence and progression.

scholarly journals A Stage 4 Hepatoid Adenocarcinoma of the Endometrium: a Case Report and Review of Literature

2018 ◽  
Vol 24 (1) ◽  
pp. 56
Author(s):  
Duygu Altin ◽  
Ayca Kirmizi ◽  
Cevriye Cansiz Ersoz ◽  
Salih Taskin ◽  
Bulent Berker ◽  
...  
Keyword(s):  
Palliative Chemotherapy ◽  
Medical Condition ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Hepatoid Adenocarcinoma ◽  
Review Of Literature ◽  
Peritoneal Washing ◽  
Stage 4 ◽  
Serum Alpha Fetoprotein ◽  
Paraaortic Lymph Node Dissection

<p>We report a case of 72-year-old woman who was hospitalized with vaginal bleeding and abdominal pain. Magnetic resonance imaging showed tumor both in endometrial cavity and ovaries with multiple distant metastasis. Her serum alpha-fetoprotein level was &gt;54000 ng/mL. Total abdominal hysterectomy with bilateral salpingo-oophorectomy, total omentectomy, appendectomy, bilateral pelvic and paraaortic lymph node dissection, a 20 cm ileal resection with ileal anastomosis, metastasectomy were performed and peritoneal washing was obtained. The pathologic diagnosis was endometrial hepatoid adenocarcinoma. Because of her poor medical condition, she received only palliative chemotherapy. After two days of 5-fluorouracil she died within 2 months. Hepatoid adenocarcinomas are extrahepatic neoplasms that exhibit features of hepatocellular carcinoma. It was first reported as gastric neoplasm but is seen in many different organs and its frequency is increasing. To date only 11 cases of hepatoid adenocarcinoma of the endometrium were reported. It has a poor prognosis and there isn’t an effective treatment yet.</p>

Cure of metastatic uterine carcinosarcoma to lungs: A case report

2003 ◽  
Vol 13 (1) ◽  
pp. 88-89
Author(s):  
A. Shamseddine ◽  
A. Taher ◽  
Y. Abou-Mourad ◽  
M. Seoud ◽  
A. Khalil
Keyword(s):  
Case Report ◽  
Systemic Chemotherapy ◽  
Pulmonary Nodules ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Sarcoma ◽  
Uterine Carcinosarcoma ◽  
Pelvic Radiotherapy ◽  
Term Survival

Most patients with advanced or recurrent uterine sarcoma experience disease progression and ultimately die. We present a case of uterine sarcoma with lung metastasis treated with systemic chemotherapy and with no evidence of disease for more than 5 years. A 77-year-old woman underwent total abdominal hysterectomy with bilateral salpingo-oophorectomy for carcinosarcoma of the uterus followed by external pelvic radiotherapy. Ten months later, the tumor recurred in the apex of the vagina and was treated with brachytherapy. After 6 months of remission, she presented with pulmonary metastasis. After four cycles of systemic chemotherapy with cisplatin and ifosfamide, the pulmonary nodules completely disappeared. Currently she is still in complete remission after more than 5 years, but unfortunately she has developed myelodysplastic syndrome. This is the first reported case in the literature of cured metastatic uterine carcinosarcoma to lungs, with long-term survival of 5 years.

Impact of treatment strategies on local control and survival in uterine carcinosarcomas.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e16526-e16526
Author(s):  
Selim Yalcin ◽  
Omer Dizdar ◽  
Nadire Kucukoztas ◽  
Samed Rahatli ◽  
Ozlem Ozen ◽  
...  
Keyword(s):  
Uterine Cancer ◽  
Treatment Strategies ◽  
Stage Iv ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Uterine Carcinosarcoma ◽  
Treatment Regimens ◽  
Stage Iv Disease ◽  
Standardized Treatment

e16526 Background: Carcinosarcoma is a biphasic neoplasm composed of a mixture of malignant epithelial and mesenchymal components. Uterine carcinosarcomas comprise only 3% of all uterine malignancies, however they account for a disproportionally higher rate of mortality from uterine cancer because of their agressive nature. No standardized treatment has yet been established. The purpose of this study was to determine the clinical characteristics, patterns of recurrence and survival outcomes in patients with uterine carcinosarcoma treated in our institution. Methods: Records of the patients with uterine carcinosarcoma were retrospectively evaluated and 29 pts with carcinosarcoma diagnosed between 2007 and 2012 were identified. All patients were initially treated surgically by the same surgeon with comprehensive staging, i.e. total abdominal hysterectomy, bilateral salphingooopherectomy , bilateral pelvic and paraaortic lymph node dissection and omentectomy. Demographic features, tumor characteristics, treatment regimens and patient outcomes in terms of relapse-free survival (RFS) and overall survival (OS) were analyzed. Results: Median age was 63 (range 43-78). 13 patients (45%) had stage I disease, 5 patients (17%) had stage III and 11 patients (38%) had stage IV disease at diagnosis. Median tumor size was 6 cm (range 1.7-20 cm) and lymphovascular invasion was present in 17 patients 59%). Twenty patients (69%) received chemotherapy (90% with paclitaxel and carboplatin) for 6 cycles. One patient received radiotherapy. Median follow up was 13 mos. Seventeen patients (59%) relapsed and 20 patients (69%) died on follow up. Two patients had vaginal cuff recurrence, 4 had pelvic, 4 had abdominal and 7 had distant recurrences. All recurrences were fatal. 3 year RFS was 31%. 3 year OS was 15%. Conclusions: Our data show that uterine carcinosarcomas tend to be more at more advanced stage at diagnosis and despite the use of chemotherapy and radiotherapy, overall prognosis is poor. Surgery remains the mainstay of treatment. More effective adjuvant strategies are needed to reduce relapse and death rates because recurrences are generally fatal.

scholarly journals EP.TH.717Triple tumour: A myriad of serial incidental findings in a patient presenting with Gallstone pancreatitis

2021 ◽  
Vol 108 (Supplement_7) ◽  
Author(s):  
Cameron Boyle ◽  
Katherine Lowe ◽  
Ahmed Dhaif ◽  
Adeeb Hassan ◽  
Kawan Shalli ◽  
...  
Keyword(s):  
Epigastric Pain ◽  
Pelvic Mass ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Small Bowel Resection ◽  
Gallstone Pancreatitis ◽  
Endometrioid Adenocarcinoma ◽  
Ovarian Adenocarcinoma ◽  
Desirable Outcome ◽  
Benign Ovarian Tumours

Abstract Aim To present a rare incidental synchronous triple tumours - colonic adenocarcinoma, endometroid ovarian adenocarcinoma and benign Brenner tumour in a patient admitted with acute gallstone pancreatitis. Methods A 75-year-old female presented with epigastric pain. Blood-tests and USS abdomen confirmed gallstones and pancreatitis. She was treated conservatively. USS also showed incidental pelvic mass which was further characterised by CT and MR scans. These scans confirmed heterogeneous lobulated mass in the left adnexa. CT scan also picked-up incidental mass in transverse colon, which was confirmed as cancer by colonoscopy. She was offered therapeutic resection after discussion in Colorectal and Gynaecology MDT. Intra-operatively, transverse colonic tumour was invading into the proximal ileum. Laprascopic surgery concluded with extended right hemicolectomy, small bowel resection-anastomosis, omentectomy, total abdominal hysterectomy and bilateral salpingo-oophorectomy. Results The patient had gradual recovery without any complications. Histopathology showed T4N2 poorly differentiated adenocarcinoma of colonic mass, FIGO grade 1 stage 1c endometrioid adenocarcinoma of left ovary and benign brenner tumour of right ovary. Post-operative MDT did not offer adjuvant-therapy due to slow recovery and fraility. So far, two-years of follow-up did not show any recurrence. Conclusion This report adds to the limited literature of triple synchronous tumours, including rare Brenner accounting for 5% of benign ovarian tumours and endometrioid ovarian tumour with an incidence of 4 -7%. Multi-disciplinary approach and combined surgery can achieve a desirable outcome in such complex cases. It is crucial to identify the primary status of the tumours as it will guide the adjuvant treatment.

Doppler study of myometrium in invasive gestational trophoblastic disease

2004 ◽  
Vol 14 (5) ◽  
pp. 972-979 ◽  
Author(s):  
S. Oguz ◽  
A. Sargin ◽  
H. Aytan ◽  
S. Kelekci ◽  
H. Dumanli
Keyword(s):  
Color Doppler ◽  
Single Agent ◽  
Resistance Index ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Color Doppler Ultrasound ◽  
Gestational Trophoblastic Disease ◽  
Trophoblastic Disease ◽  
Doppler Study

ObjectiveIn this prospective study, we aimed to assess the prognostic and diagnostic role of color Doppler flow of myometrium in patients with invasive gestational trophoblastic disease (GTD).MethodsThirty-seven patients, who were enrolled in the study with invasive mole, were assessed with the help of transvaginal color Doppler ultrasound before and after chemotherapy. The place and the size of the myometrial invasions were assessed.ResultsThirty patients of 37 were treated with the help of single-agent chemotherapy – methotrexate (mtx). In this group, the resistance index (RI) ratios ranged between 0.26 and 0.45 and the size of the myometrial invasion varied between 10 and 50 mm. On the other hand, six patients were treated with mtx and actinomycin D combination and one patient was treated with the help of total abdominal hysterectomy. In this group, the RI ratios ranged between 0.16 and 0.25 and the size of the myometrial invasion varied between 60 and 90 mm. Remission was achieved in all patients.ConclusionTransvaginal color Doppler study can easily detect invasive GTD. When the depth and the width of the myometrial invasion increase and when there is a low diastolic/systolic ratio, the number of courses and the need for combination of chemotherapy increase.

scholarly journals Peritoneal Keratin Granulomatosis Associated with Endometrioid Adenocarcinoma of the Uterine Corpus in a Woman with Polycystic Ovaries: A Potential Pitfall—A Case Report and Review of the Literature

2017 ◽  
Vol 2017 ◽  
pp. 1-6
Author(s):  
Helen J. Trihia ◽  
Maria Papazian ◽  
Natasa Novkovic ◽  
John Provatas ◽  
Sotiria Tsangouri ◽  
...  
Keyword(s):  
Female Genital Tract ◽  
Rare Condition ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Pelvic Lymphadenectomy ◽  
Endometrioid Adenocarcinoma ◽  
Polycystic Ovaries ◽  
Squamous Differentiation ◽  
Uterine Corpus ◽  
Multiple Biopsies

Peritoneal keratin granulomatosis is a rare condition included under granulomatous lesions of the peritoneum. It can be secondary to neoplasms of the female genital tract and can mimic carcinomatosis intraoperatively. A case of a 40-year-old woman with a history of polycystic ovaries and a chief complaint of vaginal bleeding is presented. She was diagnosed with endometrioid adenocarcinoma with squamous differentiation in endometrial curettings. Intraoperatively, many peritoneal nodules were found, interpreted as peritoneal carcinomatosis. The woman underwent a total abdominal hysterectomy with bilateral salpingo-oophorectomy, omentectomy, bilateral pelvic lymphadenectomy, and appendicectomy. Multiple biopsies were taken, as well as peritoneal washings. Microscopic examination revealed multiple keratin granulomas on the serosal surface of the ovaries, fallopian tubes, appendix, and omentum. Lymph node metastasis was not found. Peritoneal keratin granulomas (PKGs) have been reported in cases of endometrioid adenocarcinoma with squamous differentiation of the uterine corpus, ovary, and atypical adenomyoma. It should be noted that the prognosis of cases of peritoneal keratin granulomas without viable tumor cells is favourable and that the histologic examination is essential for its diagnosis. We report a case of PKG in a patient with endometrial carcinoma with squamous differentiation, being the first in a woman with polycystic ovaries.

scholarly journals Rare Presentation of Chorioadenoma Destruens as Acute Haemoperitoneum Mimicking Ruptured Ectopic Pregnancy

2015 ◽  
Vol 12 (4) ◽  
pp. 288-291 ◽  
Author(s):  
M Sinha ◽  
R Kaur ◽  
R Gupta ◽  
R Rani ◽  
A Aggarwal
Keyword(s):  
Ectopic Pregnancy ◽  
Lower Abdominal Pain ◽  
Myometrial Invasion ◽  
Exploratory Laparotomy ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Acute Onset ◽  
Rare Presentation ◽  
Placental Site ◽  
Invasive Mole

Gestational trophoblastic neoplasms (GTN) are proliferative degenerative disorders of placental elements and include complete or partial mole (90%), invasivemole (5-8%), choriocarcinoma (1-2%) and placental site tumor (1-2%). Chorioadenoma destruens is a trophoblastic tumor, characterized by myometrial invasion through direct extension or via venous channels. We present a case of invasive mole eroding uterus and uterine vasculature, causing sudden rupture of uterus with massive haemoperitoneum mimicking ectopic pregnancy. A 20 year old G1P0 at 6 weeks gestation presented in Casualty of Kasturba Hospital complaining of severe acute onset lower abdominal pain for one hour. Clinical examination revealed shock. Sonography suggested ectopic pregnancy and immediate exploratory laparotomy was decided. On laparotomy, 2000cc of haemoperitoneum was noted. Grape like vesicles protruding through fundal perforation with profuse active bleeding was seen. Bleeding persisted despite evacuation. Step wise uterine devascularisation failed to achieve haemostasis. Total abdominal hysterectomy was performed as a life saving measure.Kathmandu University Medical Journal Vol.12(4) 2014; 288-291

scholarly journals Endometrioid Adenocarcinoma in the Native Ureter of a Renal Transplant Patient: Case Report and Review of the Literature

2010 ◽  
Vol 10 ◽  
pp. 1714-1722 ◽  
Author(s):  
Kelly A. Healy ◽  
Kenneth J. Carney ◽  
Adeboye O. Osunkoya
Keyword(s):  
Renal Transplant ◽  
Renal Transplant Patient ◽  
Transplant Patient ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Filling Defect ◽  
Malignant Degeneration ◽  
Endometrioid Adenocarcinoma ◽  
Benign Condition ◽  
Grade Ii

Endometriosis is characterized by endometrial-like tissue outside the uterus, primarily on the pelvic peritoneum, ovaries, and rectovaginal septum, and, in rare cases, within the urinary tract (1–3%). Although endometriosis is a benign condition, malignant transformation of endometriosis is a well-described phenomenon. Malignancies arising in endometriosis are uncommon at extragonadal pelvic sites. A case of endometrioid adenocarcinoma in the native ureter of a postmenopausal renal transplant patient presented with painless gross hematuria and hydroureteronephrosis. The patient had a history of total abdominal hysterectomy and bilateral salpingo-oophrectomy 14 years prior for menorrhagia and had since been on unopposed estrogen replacement therapy. Workup revealed a filling defect in the native left mid-ureter secondary to a large 2.5-cm ureteral tumor. Endoscopic biopsies of the native left ureteral mass showed endometrioid adenocarcinoma, grade II-III. The patient ultimately underwent an open native left nephroureterectomy and temporary diverting colostomy. Final pathology confirmed endometrioid adenocarcinoma, grade II-III, arising in a background of endometriosis with negative perirectal lymph nodes. This case of ureteral endometrioid adenocarcinoma highlights the importance of obtaining a careful history and maintaining a high index of suspicion for malignant degeneration, especially in the context of hyperestrogenism.

Correlation between clinical and histopathologic risk factors and lymph node metastases in early endometrial cancer (a multivariate analysis of 183 cases)

1994 ◽  
Vol 4 (5) ◽  
pp. 306-309 ◽  
Author(s):  
A. Ayhan ◽  
R. Tuncer ◽  
Z. S. Tuncer ◽  
K. YÜCe ◽  
T. KÜÇÜKali
Keyword(s):  
Endometrial Cancer ◽  
Lymph Node ◽  
Lymph Node Metastases ◽  
Clinical Stage ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Lymph Node Status ◽  
Peritoneal Cytology ◽  
Node Metastases

This study includes 183 patients with clinical stage I endometrial cancer subjected to peritoneal cytology, total abdominal hysterectomy, bilateral salpingo-oophorectomy, bilateral pelvic and para-aortic lymphadenectomy and omental biopsy during a 12-year period in a single institution. The factors analyzed were age, menopausal state, cell type, grade, mitotic activity, myometrial invasion, lymphovascular space invasion, cervical involvement, microscopic vaginal metastases, adnexal metastases, peritoneal cytology, presence of concomitant endometrial hyperplasia and lymph node status. The overall incidences of pelvic and para-aortic lymph node metastases were found to be 15.3% (28/183) and 9.3% (17/183), respectively. In five of 17 patients (29.4%) with para-aortic nodal metastases, pelvic nodes were free of tumor. The most significant prognostic factors for positive pelvic and/or para-aortic nodes were found to be the depth of myometrial invasion, grade of tumor and age.

scholarly journals The Uterine Adenosarcoma in a Young Woman Treated by TAH/BOS and Combined Adjuvant Therapy: A Case Report

2020 ◽  
Author(s):  
Soodabeh Shahidsales ◽  
Marjaneh Farazestanian ◽  
Noorieh Sharifi‐Sistani ◽  
Sara Rasta ◽  
Seyed Alireza Javadinia
Keyword(s):  
Adjuvant Therapy ◽  
Myometrial Invasion ◽  
Total Abdominal Hysterectomy ◽  
Abdominal Hysterectomy ◽  
Advanced Stage ◽  
Deep Myometrial Invasion ◽  
One Year ◽  
Disease Free

We aimed to report a woman suffering from uterine adenosarcoma in the perimenopause period. The patient had undergone total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) and also received adjuvant chemotherapy and radiotherapy. Moreover, she was reported as disease-free with no evidence of recurrence or metastasis despite the existence of numerous risk factors such as deep myometrial invasion as well as sarcomatous overgrowth after one year of follow-up. The results obtained about this patient could highlight the role of adjuvant therapy in terms of managing treatments for patients suffering from MASO, especially in the presence of deep myometrial invasion and an advanced stage.

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