Uterine Carcinosarcoma with Alpha-Fetoprotein-Producing Hepatoid Component: A Case Report and Literature Review

Abstract

A 67-year-old woman presented with postmenopausal vaginal bleeding. Full body imaging demonstrated an intrauterine mass with deep myometrial invasion but no nodal or other metastatic disease. Uterine curettage was performed. Histologically, the tumor was an endometrioid adenocarcinoma with sarcomatous element and a hepatoid component, the latter was immunohistochemically positive for alpha-fetoprotein, HepPar-1, and arginase-1. The patient underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Serum alpha-fetoprotein level decreased from 31896 ug/l preoperatively to 2063 ug/l postoperatively. Eight weeks later, a rise in serum alpha-fetoprotein was detected, and a biopsy-proven vaginal recurrence was diagnosed. Palliative chemotherapy led to tumor shrinkage and a concurrent decrease in the serum alpha-fetoprotein level. A rise in serum alpha-fetoprotein, refractory to second-line chemotherapy, was accompanied by subsequent development of ureteric obstruction, ascites, and radiological evidence of peritoneal metastases. This is an unusual case of uterine carcinosarcoma with an alpha-fetoprotein-producing hepatoid adenocarcinoma component. Serum alpha-fetoprotein level corresponds to disease recurrence and progression.

Yolk sac tumor differentiation in urothelial carcinoma of the urinary bladder: a case report and differential diagnosis

“…Sarcomatoid and chordoid urothelial carcinoma were excluded after the identification of areas with classical YST pattern and immunohistochemistry results. Carcinoma with enteroblastic differentiation has been reported in several organs (gastrointestinal, lung, etc) [16], while carcinoma with hepatoid differentiation has been mainly reported in gynecologic tumors [17], and in urinary tract tumors already mentioned [4]. These neoplasms show some histologic and immunohistochemical features, similar to those identified in our case.…”

Carcinosarcoma of the stomach with alpha-fetoprotein-producing hepatoid adenocarcinoma: an unexpected combination of two rare subtypes of gastric cancer in one tumor

“…To date, there have been only four cases of carcinosarcoma associated with HAC across all tumors, and all were in the uterus. 33 – 35 …”

Yolk Sac tumor differentiation in urothelial carcinoma of the urinary bladder: A case report and differential diagnosis

“…Sarcomatoid and chordoid urothelial carcinoma were excluded after the identification of areas with classical YST pattern and immunohistochemistry results. Carcinoma with enteroblastic differentiation has been reported in several organs (gastrointestinal, lung, etc) [16], while carcinoma with hepatoid differentiation has been mainly reported in gynecologic tumors [17], and in urinary tract tumors already mentioned [4].…”