PMC6016168_01
Large uterine tumor with deep myometrial invasion (MRI pelvis, T2 weighted sagittal).
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There was no pelvic or inguinal lymphadenopathy [Figure 1].
Serum AFP progression.
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Serum alpha-fetoprotein (AFP) dropped from 31896 ug/l preoperatively to 2063 ug/l postoperatively [Figure 2]. Serological response was sustained throughout the six cycles of chemotherapy, with a postchemotherapy serum AFP level of 4770 ug/l [Figure 2]. Serum AFP did not show response and was further elevated to 41826 ug/l after cycle two [Figure 2], accompanied by the development of ureteric obstruction, ascites, and radiological evidence of liver and peritoneal metastases [Figure 6].
Cut surface of the resected uterus.
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The resected specimen weighted 575 g and measured 11.0 x 9.5 x 8.0 cm with an anterior exophytic tumor measuring 7.5 x 6.0 x 4.0 cm with a tan cut surface [Figure 3] and detached hemorrhagic fragments.
(a) Endometrioid adenocarcinoma components (H&E); (b) chondrosarcomato id components (H&E).
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Histologic findings were those of a carcinosarcoma with endometrioid adenocarcinoma (20%), hepatoid adenocarcinoma (20%), and sarcomatous components consisting of chondroid (10%) and spindle cell components (50%) [Figure 4].
(a) Hepatoid adenocarcinomatous components in trabeculae, polygonal cells with eosinophilic cytoplasm (H&E); (b) AFP (Dako A0008, 1:2000, citrate at 98 C for 30 min); (c) HepPar-1 (Dako M7158, 1:900, EDTA at 98 C for 32 min); (d) arginase-1 (Cell Marque 380R-16, 1:400, EDTA at 98 C for 30 min).
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IHC staining was repeated and the profile was the same as the curettage specimen [Figure 5].
Liver metastasis (CT abdomen and pelvis, noncontrast transverse).
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fig6
Serum AFP did not show response and was further elevated to 41826 ug/l after cycle two [Figure 2], accompanied by the development of ureteric obstruction, ascites, and radiological evidence of liver and peritoneal metastases [Figure 6].