PMC6024524_01
(A) Coronal sequence, (B) axial sequence, (C) lateral sequence (November 2013): A computed tomographic scan revealed a huge pelvic mass of 14 cm x 10 cm x 13 cm with prominent colliquative aspects and heterogeneous contrast enhancement uptake.
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A computed tomographic (CT) scan showed a huge pelvic mass of 14 cm x 10 cm x 13 cm with prominent colliquative aspects (Figure 1A to C).
(A) Adenosarcoma with periglandular stromal condensation (Hematoxylin and Eosin, 100 x), (B) sarcomatous overgrowth with significant stromal pleomorphism (Hematoxylin and Eosin, 400 x), (C) the tumour cells show a heterogeneous immunoreactivity for CD10 (100 x), and (D) diffuse positivity for oestrogen receptor (100 x).
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Immunohistochemical expression of mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2) was preserved (Figure 2A to D).
December 2013: A post-operative computed tomographic scan revealed multiple peritoneal implants, confluent in a lobated mass with colliquative aspects.
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The subsequent CT scan evaluation showed mesenteric multiple hyperdense solid lesions of 23 mm, 33 mm, and 20 mm in diameter, respectively; these were suspected of being peritoneal implants, and they increased substantially and became confluent in a lobed mass after few weeks (Figure 3).
(A) Axial sequence, (B) coronal sequence (December 2013): A computed tomographic scan evaluation after 1 cycle of epirubicin and ifosfamide, performed earlier due to sudden onset of abdominal pain, showed a prominent increase in the pelvic mass (16 cm x 10 cm x 6 cm in diameter), with intra-lesional heterogeneous colliquative features and irregular and thick septa.
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An emergency CT scan revealed a prominent increase in the pelvic mass (16 cm x 10 cm x 6 cm of diameter), with intra-lesional heterogeneous colliquative features and irregular and thick septa, suggestive of early radiologic response, according to Choi criteria (Figure 4A and B).
January 2014: A computed tomographic scan evaluation after 3 cycles of epirubicin and ifosfamide showed a marked shrinkage of the pelvic mass (8.6 cm x 3.3 cm x 3.3 cm in diameter), largely necrotic and with heterogeneous aspects (axial sequence).
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She completed the planned treatment, and in January 2014, after 3 cycles, the CT scan evaluation showed a marked shrinkage of the pelvic mass (8.6 cm x 3.3 cm x 3.3 cm in diameter), which was largely necrotic and had heterogeneous aspects, together with a relevant clinical benefit (Figure 5A and B).
(A) Axial sequence, (B) lateral sequence (March 2015): During a regular surveillance programme, a computed tomographic scan evaluation showed a pelvic solid mass, 6 cm x 3 cm x 4 cm of diameter, suggestive of relapse.
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The subsequent clinical and instrumental follow-up was negative until March 2015, when a CT scan revealed a pelvic solid mass, 6 cm x 3 cm x 4 cm in diameter, suggestive of relapse (Figure 6A and B).
(A) March 2015: ileal relapse of high-grade sarcomatous component of adenosarcoma with high mitotic count (Hematoxylin and Eosin, 50 x), (B) magnification of the high mitotic count highlighted by black arrows (Hematoxylin and Eosin, 400 x).
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The histologic examination and immunohistochemical features confirmed an ileal localization of high-grade sarcoma compatible with a relapse of the sarcomatous component of the previous adenosarcoma (Figure 7A and B).