PMC7455848_01
Grayscale ultrasound image of the uterus (a) demonstrates a heterogeneous uterine echotexture with poorly defined masses (arrow, (a)). The endometrial stripe is thickened (clippers, (a)) and measures up to 3.0 cm. Color Doppler image (b) shows a soft tissue mass within the posterior wall of the urinary bladder (arrow, (b)) with vascularity.
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Ultrasound of the pelvis (Figure 1) showed heterogeneous echotexture of the uterus with possible masses, a thickened endometrial stripe, and a vascular soft tissue lesion within the posterior wall of the urinary bladder.
Axial (a), coronal (b), and sagittal (c) postcontrast CT images show a large heterogeneous mass centered within the lower uterus and cervix (solid arrows) which involves more than 50% of the myometrium and is enhancing less than the normal myometrium. There is local invasion to the urinary bladder (dotted arrows, (b, c)) and bilateral pelvic and retroperitoneal lymphadenopathy (circles/ellipses, (a-c)). There is no clear distinction with loss of the fat plane between the vagina and the rectum. Air focus within the vagina (dashed arrow, (c)) is suspicious for a rectovaginal fistula.
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Computed tomography (CT) of the chest, abdomen, and pelvis (Figure 2) demonstrated a large heterogeneous mass centered within the uterus and cervix which involved more than 50% of the myometrium.
Lateral right elbow radiograph (a) shows a lytic lesion within the proximal ulna with permeative or moth-eaten appearance and wide zone of transition, suggestive of an aggressive lesion. Sagittal noncontrast T1-weighted (b), fluid-sensitive (c), and postcontrast (d) MRI images demonstrate an infiltrative mass centered within the proximal ulna (solid arrows, (b-d)) with soft tissue invasion (dotted arrow, (c, d)). There is replaced normal bone marrow signal (b), increased T2 signal (c), and postcontrast enhancement (d). The adjacent muscle demonstrates increased signal on the fluid-sensitive image (dashed arrow, (c)) with mild enhancement (dashed arrow, (d)), due to soft tissue invasion.
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A right elbow radiograph showed findings concerning an aggressive lytic lesion within the proximal ulna (Figure 3). Magnetic resonance imaging (MRI) of the right elbow (Figure 3) confirmed an enhancing mass centered within the proximal ulna with soft tissue invasion.
(a) Low power: 80x magnification showing replacement of the normal endometrium by malignant cells with necrosis. (b) High power: 200x magnification showing pleomorphic malignant cells effacing the normal endometrial tissue. (c) p53 staining: 100x magnification showing positive staining for p53 in malignant cells.
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The pathology report from the cervical biopsy (Figure 4) revealed infiltrating malignant high-grade carcinoma with areas of undifferentiated sarcomatous morphology, which was positive for vimentin.