Disappearing Uterine Carcinosarcoma Following Uterine Artery Embolisation

Abstract

Aims To report the resolution of uterine carcinosarcoma in a patient who presented with profuse vaginal bleeding requiring uterine artery embolisation (UAE) to control bleeding. Background A 55-year-old woman presented with profuse vaginal bleeding and shock. Pelvic examination found a 6cm circumferential irregular ulcerated mass on the cervix with fleshy growth at right cervical lip and suspected left parametrial involvement. CT abdomen and pelvis showed a large well circumscribed mass in cervix and lower uterus measuring 8.1 x 8.9 x 11.7 cm. The mass was mainly hypodense hypoenhancing but showed irregular enhancing area with hypervascularity on arterial phase. Methods She underwent emergency bilateral UAE which stopped the bleeding. Cervical mass biopsy showed carcinosarcoma. MRI pelvis (8 days after UAE) showed irregular soft tissue mass distending the uterine cervix measuring 3.8 x 4.3 x 9.0cm with extension to involve endometrial cavity, uterine myometrium, anterior vaginal fornix and left parametrium. She was then referred to our hospital for further management. Pelvic examination was repeated (23 days after UAE) which revealed normal appearance of cervix with no cervical mass found and normal parametrium. MRI pelvis was repeated (33 days after UAE) which showed no cervical or endometrial mass, and only ill-defined signal at the lower uterine segment with early arterial enhancement. She then underwent robotic assisted total hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy and omental biopsy (36 days after UAE). Post-operative recovery was uneventful. Results Histopathology showed no evidence of residual malignancy in all the surgical specimens. Options of observation, adjuvant radiotherapy or chemotherapy was discussed with the patient and she opted for observation. Conclusions Uterine carcinosarcoma may resolve after UAE. If there is significant change in clinical findings, further imaging should be considered which may aid in planning of further treatment.