PMC9909557_01
Macroscopic appearance of the specimen indicating endometrial carcinoma of uterine corpus (green circle) and cervical carcinosarcoma (red circle).
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F1
In November 2021, she underwent "transabdominal tumor cytoreduction (total hysterectomy + right adnexal resection + greater omentectomy + pelvic lymph node [LN] dissection + para-aortic LN dissection) + pelvic adhesion release." When the uterus is cut open, a cervical tumor (5 cm x 4.5 cm x 4 cm) and uterine tumor (6.8 cm x 6 cm x 4 cm) were seen (Figure 1).
Histopathology of the hysterectomy specimen HE stained and immunohistochemical staining of EMA in cervical carcinosarcoma. (A) Panoramic view of the histological appearance of a cervical cancer sarcoma under low magnification (HE). (B) The components of carcinoma and sarcoma are closely related and are mixed together under high-magnification microscopy. The morphology of cervical cancer is mainly sarcomatous with chondrogenic differentiation. (C) Immunohistochemistry of a cervical mass showing that the tumor cell cytosol was EMA positive. (D) A uterine mass showing endometrial adenocarcinoma. (E) The red line to the left indicates the uterine mass and the green line to the right indicates the cervical mass, both of them meeting at the endocervix, with normal endocervical glands and interstitium visible at low magnification (between the red and green lines). (F) High-magnification of a cervical mass involving the cervical mesenchyme with surface glandular phosphorylation:magnification. (G) Low-magnification microscopy of a cervical mass involving the endocervix:magnification. (H) Low-magnification view of the intersection of endometrial adenocarcinoma and cervical carcinosarcoma in the body of the uterus. The collision of these two tumors shows a clear border.
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F2
Postoperative pathological diagnoses are as follows: (1) the "body of the uterus" is a highly differentiated endometrioid adenocarcinoma (Figures 2D, F), infiltrating deep myometrium (> 1/2 layer), involving the cervical glands and interstitium, without definite nerve invasion or choroidal carcinoma embolism; immunohistochemistry is recommended for follow-up treatment. The first supplementary report revealed a cervical tumor, combined with HE morphology and immunophenotype, and the lesion was consistent with carcinosarcoma (Figure 2B), a sarcomatous component with chondrogenic differentiation. Immunohistochemistry of tumor cells was positive for EMA (Figure 2C), S100, caldesmon, calponin, P16, MDM2, CDK4, CD99, ER, Brg-1 (SMARCA4), Ki67, CD10, and Fli-1 and negative for Ckpan (AE1/AE3), CK8/18, CK7, desmin, PAX-8, SMA, P40, actin, PR, NKX2.2, WT1, MyoD1, myogenin, SATB2, and ERG. Microscopically, endometrial adenocarcinoma and cervical carcinosarcoma collide at the cervix and show clear boundaries (Figures 2A, E, G, H).