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CASE REPORT
Year : 2018  |  Volume : 33  |  Issue : 2  |  Page : 152-153  

Fluorodeoxyglucose Positron Emission Tomography-computed Tomography Evaluation of an Interesting Case of Uterine Carcinosarcoma with Isolated Appendicular Skeletal Metastases


Department of Nuclear Medicine, PET and Therapy, Amala Institute of Medical Sciences, Thrissur, Kerala, India

Date of Web Publication15-Mar-2018

Correspondence Address:
Dr. Chidambaram Natrajan Balasubramanian Harisankar
Department of Nuclear Medicine, Meenakshi Mission Hospital and Research Centre, Lake Area, Melur Road, Madurai - 625 107, Tamil Nadu
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijnm.IJNM_9_18

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   Abstract 


Uterine carcinosarcomas, also known as malignant mixed mullerian tumors, are one of the rare and most aggressive neoplasms of the uterus. They have an aggressive course and can spread to distant organs. Owing to the low incidence of these tumors, the optimal adjuvant management after surgery is not well established. Many patients develop distant metastases during follow-up. An interesting case of uterine carcinosarcoma who developed metastases to the femur, tibia, and calcaneum during follow is presented.

Keywords: Acral metastases, calcaneal metastases, fluorodeoxyglucose positron emission tomography-computed tomography, mixed mullerian tumor, uterine carcinosarcoma


How to cite this article:
Balasubramanian Harisankar CN. Fluorodeoxyglucose Positron Emission Tomography-computed Tomography Evaluation of an Interesting Case of Uterine Carcinosarcoma with Isolated Appendicular Skeletal Metastases. Indian J Nucl Med 2018;33:152-3

How to cite this URL:
Balasubramanian Harisankar CN. Fluorodeoxyglucose Positron Emission Tomography-computed Tomography Evaluation of an Interesting Case of Uterine Carcinosarcoma with Isolated Appendicular Skeletal Metastases. Indian J Nucl Med [serial online] 2018 [cited 2019 Dec 16];33:152-3. Available from: http://www.ijnm.in/text.asp?2018/33/2/152/227514




   Introduction Top


Uterine carcinosarcoma is rare malignant tumors of the uterus. They are biphasic tumors with both carcinomatous component and sarcomatous component. Carcinosarcomas can also arise from the skin, salivary glands, lungs, and esophagus. A rare case of uterine carcinosarcoma with peripheral skeletal metastases is presented in this case report.


   Case Report Top


A 56-year-old female, a previously treated case of uterine carcinosarcoma, presented to the oncologist with pain in the right lower limb. She had undergone total abdominal hysterectomy and bilateral salpingo-oophorectomy for uterine carcinosarcoma before 2 years. On evaluation, there was tenderness around the right knee joint and right leg. Radiography showed a lytic lesion in the lateral condyle of the right femur and the proximal tibia. Biopsy from tibia was consistent with metastases from uterine carcinosarcoma. The patient was referred for a whole body 18 fluoride (18F)-fluorodeoxyglucose (FDG) positron emission tomography-computed tomography (PET-CT). 18F-FDG PET-CT performed [Figure 1]a-maximum intensity projection-head to upper thigh and b-lower limbs] showed intense FDG uptake (SUVmax 19.7) in multiple lytic lesions with soft-tissue components in the right lower limb as follows: lateral condyle of right femur [Figure 1]c - axial CT and d - Fused PET-CT], the right calcaneum [Figure e - axial CT and f - Fused PET-CT], and multiple lesions in the right tibia [Figure 1]g - coronal fused PET-CT and h - sagittal fused PET-CT]. No evidence of local recurrence in the pelvis was noted. No obvious site of metastatic disease was present in the other organs. The patient was treated with chemotherapy but did not show a significant response.
Figure 1: 18 Fluoridefluorodeoxy glucose positron emission tomography-computed tomography performed (a: maximum intensity projection-head to upper thigh; b: lower limbs) showed intense fluorodeoxyglucose uptake (SUVmax 19.7) in multiple lytic lesions with soft tissue components in the right lower limb as follows: lateral condyle of right femur (c: axial computed tomography; d: Fused positron emission tomography-computed tomography), the right calcaneum (e: axial computed tomography; f: Fused positron emission tomography-computed tomography) and multiple lesions in the right tibia (g: coronal fused positron emission tomography-computed tomography and h: sagittal fused positron emission tomography-computed tomography). No evidence of local recurrence was noted. No other site of metastatic disease was present in the other organs

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   Discussion Top


Uterine sarcomas, also known as malignant mixed mullerian tumors, are rare uterine neoplams constituting <5% of all uterine malignancies.[1] They are known to occur in patients who have received pelvic irradiation.[2] They are also one of the most aggressive neoplasms with dismal prognosis.[3] Due to their monoclonal origin, they are now being considered as a metaplastic carcinoma.[4] The reported incidence of this condition is roughly eight new cases per million women.[5]

Surgery is the main line of treatment which includes hysterectomy with or without pelvic lymphadenectomy. No consensus is available as to the appropriate adjuvant therapy postsurgery. Carcinosarcomas have propensity for transperitoneal spread like high-grade endometrial neoplasm. Metastatic disease to the lungs have also been described.[6] A case of carcinosarcoma metastases to the calcanuem has been previously reported.[7] Acral skeletal metastases are very rare and the most common cancers producing metastases to the peripheral skeleton are lung, renal, and thyroid cancers.[8] Carcinosarcomas should also be considered in the differential diagnosis of patients with acral metastases.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Park HJ, Kim HJ, Wu HG, Kim H, Ha SW, Kang SB, et al. The influence of adjuvant radiotherapy on patterns of failure and survivals in uterine carcinosarcoma. Radiat Oncol J 2011;29:228-35.  Back to cited text no. 1
    
2.
Pothuri B, Ramondetta L, Eifel P, Deavers MT, Wilton A, Alektiar K, et al. Radiation-associated endometrial cancers are prognostically unfavorable tumors: A clinicopathologic comparison with 527 sporadic endometrial cancers. Gynecol Oncol 2006;103:948-51.  Back to cited text no. 2
    
3.
Nemani D, Mitra N, Guo M, Lin L. Assessing the effects of lymphadenectomy and radiation therapy in patients with uterine carcinosarcoma: A SEER analysis. Gynecol Oncol 2008;111:82-8.  Back to cited text no. 3
    
4.
McCluggage WG. Uterine carcinosarcomas (malignant mixed mullerian tumors) are metaplastic carcinomas. Int J Gynecol Cancer 2002;12:687-90.  Back to cited text no. 4
    
5.
Chi DS, Mychalczak B, Saigo PE, Rescigno J, Brown CL. The role of whole-pelvic irradiation in the treatment of early-stage uterine carcinosarcoma. Gynecol Oncol 1997;65:493-8.  Back to cited text no. 5
    
6.
Bhoil A, Kashyap R, Bhattacharya A, Mittal BR. F-18 fluorodeoxyglucose positron emission tomography/computed tomography in a rare case of recurrent malignant mixed mullerian tumor. World J Nucl Med 2014;13:64-6.  Back to cited text no. 6
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7.
Rice BM, Todd NW, Jensen R, Rush SM, Rogers W. Metastatic calcaneal lesion associated with uterine carcinosarcoma. J Foot Ankle Surg 2014;53:364-8.  Back to cited text no. 7
    
8.
Koyama M, Koizumi M. FDG-PET images of acrometastases. Clin Nucl Med 2014;39:298-300.  Back to cited text no. 8
    


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