PMC3855919_01
MRI images before the primary surgery. The tumor invaded the left pelvic wall (A; axial fat-saturated T1-weighted image) and the vagina (B; sagittal T2-weighted image).
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Fig1
A major portion of the mass formed a 5-cm cystic lesion in the pouch of Douglas, infiltrating to the left acetabular, left ureter and rectum (Figure 1A). The remainder of the mass infiltrated through the posterior vaginal fornix, and formed the polypoid mass occupying the entire vagina (Figure 1B).
Tumor Pathology. At the primary surgery, the tumor was diagnosed as an adenosarcoma containing a benign epithelial component (an endometriotic gland, bottom left) surrounded by an atypical hypercellular stromal component (A; x200). However, the autopsy following the rapid tumor regrowth revealed malignant stromal components with sarcomatous overgrowth (D; x200). At autopsy, the expression levels of estrogen (E) and progesterone (F) receptors were reduced compared to those at the primary surgery (B and C, respectively).
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Fig2
The final pathologic diagnosis was an extrauterine adenosarcoma arising from the recto-vaginal septum (Figure 2A). Both of the epithelial and stromal components were positive for estrogen and progesterone receptors (Figure 2B and 2C). In these stromal components, the expression levels of estrogen and progesterone receptors were reduced (Figure 2E and 2F).
CT images during dienogest therapy. Based on the RECIST criteria, a partial response was obtained at 6 months after initiating oral DNG treatment (A: 0 months; B: 6 months) and the tumor was stable up to 21 months.
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Fig3
Based on the RECIST criteria, a partial response was obtained at six months after initiating oral DNG treatment (Figure 3).
CA125 changes through the clinical course.
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Fig4
The CA125 gradually fell to 16 U/ml over a six month period (Figure 4) and no adverse effects occured.