PMC8325592_01
PMC8325592_02
Preoperative pelvic CT findings: (a) 1 year and 6 months after initiation of treatment: myoma fibroids were noted; (b) 1 year and 10 months after initiation of treatment: the patient experienced abdominal pains, and imaging diagnosis demonstrated an infection of a degenerated myoma uteri fibroid; (c) 2 years after initiation of treatment: elevated serum D-dimer and LDH were noted, and imaging diagnosis noted a differential diagnosis of uterine sarcoma or uterine metastasis from lung cancer.
CRIOG2021-1809017.001.jpg
PMC8325592_02_CRIOG2021-1809017.001.jpg
fig1
On CT imaging diagnosis, a sudden increase in the size of the uterine tumor compared to CT scans taken 6 weeks earlier was observed (Figure 1), but no other apparent metastatic lesions were noted.
Pelvic MRI imaging: (a) T1-enhanced images; (b) T2-enhanced images; (c) ADC map b = 1000; (d) diffusion-weighted images. The tumor demonstrated moderate to strong T2-enhanced images; marked diffusion-weighted enhancement was noted on the tumor that had almost completely invaded the uterine myometrium.
CRIOG2021-1809017.002.jpg
PMC8325592_02_CRIOG2021-1809017.002.jpg
fig2
T2-enhanced images and also presented with marked diffusion-weighted enhancement, and a flow void was noted within the tumor. The endometrium as well as cervical epithelium was intact, and there was also a lack of focal hemorrhage or necrotic findings (Figure 2).
Macroscopic finding during surgery. Large diffuse nodular disseminated tumors were noted on the serosal surface of the uterus.
CRIOG2021-1809017.003.jpg
PMC8325592_02_CRIOG2021-1809017.003.jpg
fig3
Macroscopically, the uterine endometrium was smooth and there was no spread of the uterine tumor to either the adnexa or to the uterine cervix (Figure 3).
Postoperative pathological findings: (a) HE stain: tumor cells with increased chromatin, enlarged nuclei, lightly acidic cytoplasm, and increased N/C ratios were noted to proliferate in a solid nest. Localized geographic necrosis was also observed. (b) Immunohistochemical finding: the tumor demonstrated positivity for neurosecretory tumor profiles including partial positivity for CD 56, slight positivity for synaptophysin, and negativity for chromogranin A. The immunohistochemical profile was similar to that of the primary lung cancer.
CRIOG2021-1809017.004.jpg
PMC8325592_02_CRIOG2021-1809017.004.jpg
fig4
Based upon these findings, the final histopathological diagnosis was metastatic small cell carcinoma of the uterus originating from the primary lung cancer (Figure 4).
PMC8325592_03