Sarcomatoid carcinoma of the cervix with foci of malignant melanoma

Abstract

Introduction:Sarcomatoid squamous cell carcinoma (SSCC) is a rare malignancy of the cervix. Until date around eighteen cases of SSCC have been reported in the literature. It is an aggressive tumor with poor prognosis. The tumor usually presents at an advanced stage. Similarly, primary melanomas of the uterine cervix are rare tumors with not more than 60 cases reported in the world literature. It also has a poor prognosis. There is no reported case of sarcomatoid carcinoma with malignant melanoma. Here, we are presenting a rare case of cervical carcinoma with histopathology suggestive of SSCC with foci of malignant melanoma proven by immunohistochemistry study.Case Report:The present case report is about a 42-year-old, Mrs. SR, P5 L3 D1 A1 , presented with the complaints of intermittent bleeding per vaginum since last 3 years and severe pain in the right lower limb since 1 month. On examination, there was a proliferative growth in the cervix. Her magnetic resonance imaging (MRI) showed cervical mass lesion with right parametrial extension invading the right ureter and bladder wall causing hydroureteronephrosis with contiguous bilateral pelvic nodes. There were multiple lesions in the left femur. Diagnosis of carcinoma of cervix International Federation of Gynecology and Obstetrics stage IIIB with distant metastasis was made. Histopathology report was suggestive of sarcomatoid carcinoma with foci of melanocytic melanoma. She was planned to be treated with palliative radiation.Discussion:About 90% of cervical carcinomas are squamous cell carcinoma. Adenocarcinoma constitute about 3-4% of all cervical carcinomas. Other rare pathologies are lymphoma, melanoma, sarcoma and metastatic tumors. Our case is a rare combination of sarcomatoid carcinoma with foci of malignant melanoma of cervix.

Dynamic contrast-enhanced MR and PET/CT findings of uterine sarcomatoid carcinoma: a case report

“…To the best of our knowledge, only two reports have discussed the MRI or PET features of USC in the literature [ 11 , 12 ]. Shrivastava et al found that USC showed hyperintensity on T2WI and isointensity on T1WI similar to cervical mass lesions with extra-uterine extension [ 11 ].…”

“…To the best of our knowledge, only two reports have discussed the MRI or PET features of USC in the literature [ 11 , 12 ]. Shrivastava et al found that USC showed hyperintensity on T2WI and isointensity on T1WI similar to cervical mass lesions with extra-uterine extension [ 11 ]. Milind et al described abnormal FDG accumulation of USC in the region of the cervix and the upper vagina by PET, with maximum SUVs of 5.7 and 10.6 for the vagina and the cervix, respectively [ 12 ].…”

Primary Malignant Melanoma of the Cervix: A Case Report and a Review of the Literature

“…Because the majority of cases with mucosal melanoma frequently present as large polypoid masses, this system is of little use in disease staging [ 2 ]. As a result, the International Federation of Gynecology and Obstetrics (FIGO) staging system has prevailed among authors and has been widely applied, since it correlates better with prognosis and survival and given the similar clinical presentation and pattern of spread of PMMC and cervical adenocarcinoma [ 5 , 8 , 24 , 28 , 34 , 37 , 47 ].…”

“…Due to the lack of recommendations and specific guidelines, most patients with PMMC are usually treated according to the treatment protocols established for cervical squamous cell carcinoma [ 47 ]. Surgical treatment usually consists of total or radical hysterectomy with or without bilateral salpingo-oophorectomy (RAH/TAH+BSO), usually combined with or without pelvic lymphadenectomy (LND) and/or partial-superior vaginectomy (PV).…”

“…However, it is argued that RAH results in better outcome regarding overall survival (OS) than TAH, based on a report of 14 cases of PMMC (66.8 months VS 19.5 months, P = 0.016) [ 28 ]. The main concern, as noted, should be the negative margins postoperatively; nonetheless, some authors recommend clean surgical margins of at least 2 cm, due to the aggressiveness of the disease [ 38 , 47 , 50 ]. Pelvic lymphadenectomy (PL) remains a subject of controversy.…”