PMC5931808_01
MRI of the pelvis; T2W and SPAIR hyper-intense polypoidal mass arising from the cervix measuring 6.2 x 6.9 x 7.2 cm3.
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However, as her symptoms did not subside, she sought further treatment elsewhere, where magnetic resonance imaging (MRI) of the pelvis in August 2017 showed a T1W hypointense, T2W and SPAIR hyper-intense polypoidal mass arising from the cervix measuring 6.2 x 6.9 x 7.2 cm with mild diffusion restriction and the mass was filling the vaginal fornices (Figure 1(A-C)).
FDG PET CT a 7.0 x 5.5 x 6.3 cm3 large exophytic mass arising from uterine cervix and normal lung study done as a part of metastatic work up (physiological uptake in lung).
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High-grade spindle cell areas with many bizarre giant cells.
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The post-operative histopathology report was in favour of a high grade or poorly differentiated malignancy with the possibility of pleomorphic spindle cell sarcoma/carcinosarcoma (Figure 3 and 4).
High-grade spindle cell areas with many mitoses.
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The post-operative histopathology report was in favour of a high grade or poorly differentiated malignancy with the possibility of pleomorphic spindle cell sarcoma/carcinosarcoma (Figure 3 and 4).
High-grade tumour comprising sheets of plump spindle cells with eosinophilic cytoplasm and enlarged pleomorphic hyperchromatic nuclei.
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The post-operative histopathological examination report showed undifferentiated endocervical sarcoma of cervix with all resected lymph nodes, margins and omentum free of tumour (Figure 5(A-C)).
Photomicrograph showing tumour cells showing SMA positivity (200 x).
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Photomicrograph showing tumour cells showing Vimentin positivity (20 x).
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Contoured volumes, cyan-PTV volume, green-CTV tumour volume, blue-CTV nodal volume, red-rectum, orange-urinary bladder.
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The patient has completed adjuvant external beam radiation therapy (EBRT) (Figure 8) and intravaginal brachytherapy with a dose of 6 Gy in three sessions and the patient has received a third cycle of gemcitabine (900 mg/m2) and docetaxel (75 mg/m2) given every 21st day until the end of March 2018.