Abstract
AimThe purpose of our study was to analyze the clinical and imaging features of uterine carcinosarcoma (UCS) and cervical carcinosarcoma (CCS), and to explore the diagnostic and staging accuracy of computed tomography (CT) and magnetic resonance imaging (MRI) examinations.Methods41 patients including 37 with UCS and 4 with CCS from July 2011 to September 2020 were enrolled in the study. Of the 37 UCS cases, 7 had CT images, 27 had MRI images, and 3 had both CT and MRI images. The Clinical data, CT or MRI imaging findings were analyzed. Diagnosis and staging accuracy of CT and MRI images were also analyzed.ResultsCarcinosarcoma usually occurs in postmenopausal women (40/41), with the typical clinical symptom being vaginal bleeding (33/41). The CA125 degree was significantly different between the two invasion depth groups (p = 0.011). Most uterine carcinosarcomas showed unclear boundaries, uneven density, low or equal signal on T1WI, high or mixed signal on T2WI, uneven high signal on diffusion-weighted image (DWI), and mild enhancement. The diagnostic accuracies of CT and MRI for carcinosarcoma were 0% and 3.33%, respectively. The diagnostic accuracy for malignant tumors on CT and MRI was 50% and 83.33%, respectively.ConclusionsCarcinosarcoma lesions presented with huge mass filling in the cavity, and some presented with small polypoid lesions or endometrial thickening. Evaluation of lymph node metastasis is a significant challenge for imaging staging.
Highlights
Carcinosarcoma of both the uterus and cervix, known as malignant mixed Mullerian tumor, is a rare but highly malignant tumor
Evaluation of lymph node metastasis is a significant challenge for imaging staging
Thirteen (54%) patients with uterine carcinosarcoma (UCS) presented with elevated carbohydrate antigen 125 (CA125) levels
Summary
Carcinosarcoma of both the uterus and cervix, known as malignant mixed Mullerian tumor, is a rare but highly malignant tumor. Among all uterine malignant tumors, the incidence of uterine carcinosarcoma (UCS) is less than 5% [1], but with a mortality rate of more than 15% [2], which is comparable to that of cervical carcinosarcoma (CCS) [3]. Preoperative diagnosis, differential diagnosis, and staging are of great significance for the possible operation or treatment management of these patients. It is very helpful to analyze the imaging manifestations of carcinosarcoma. Pathological biopsy takes a long time, and gets limited materials, which will cause bias to the result. Ultrasonography is often used to detect lesions, while magnetic resonance
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