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Undifferentiated uterine sarcoma metastatic to the brain.

Stofko DL - Surg Neurol Int (2013)

Bottom Line: Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed.Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect.Histopathology confirmed UUS metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA.

ABSTRACT

Background: Undifferentiated uterine sarcoma (UUS) is a rare tumor with an aggressive growth pattern. They occur in women from 40 to 60 years and are generally characterized by poor prognosis, a high rate of local recurrence, and distant metastases. UUS accounts for 0.2% of all gynecological malignancies. Possible treatments include surgery, radiotherapy, and chemotherapy.

Case description: A 65-year-old female with postmenopausal bleeding was found to have a uterine mass for which she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The pathologic evaluation was consistent with undifferentiated endometrial sarcoma. She began experiencing headaches with associated visual disturbances. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm. Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Histopathology confirmed UUS metastases.

Conclusion: Randomized trials analyzing these treatment options are limited due to the rarity of this disease; therefore, a standard therapy is not established. Based on a review of the literature, this is only the fourth case reported of UUS metastatic to the brain.

No MeSH data available.


Related in: MedlinePlus

Gadlinium-enhanced T1 weighted MRI. Axial image showing enhancing mass lesion in right occipital lobe
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Figure 1: Gadlinium-enhanced T1 weighted MRI. Axial image showing enhancing mass lesion in right occipital lobe

Mentions: One year follow up imaging revealed multiple lung metastases for which she underwent a needle biopsy, consistent with metastatic undifferentiated uterine endometrial sarcoma. She completed six doses of a single chemotherapy agent, Adriamycin, with good radiographic response on interval CT and positron emission tomography (PET) scan. Three months later she began complaining of headaches and visual complaints. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm with a small amount of surrounding edema [Figure 1]. Due to the rarity of uterine sarcoma metastasizing to the brain, this was believed to represent a meningioma. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Postoperative imaging revealed complete resection of the dural-based mass [Figure 2]. Histopathology confirmed UUS metastases [Figures 3 and 4]. The patient was discharged on postoperative day one and started on taxol and carboplatin chemotherapy, as well as Gamma Knife stereotactic radiosurgery to the tumor bed.


Undifferentiated uterine sarcoma metastatic to the brain.

Stofko DL - Surg Neurol Int (2013)

Gadlinium-enhanced T1 weighted MRI. Axial image showing enhancing mass lesion in right occipital lobe
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3815079&req=5

Figure 1: Gadlinium-enhanced T1 weighted MRI. Axial image showing enhancing mass lesion in right occipital lobe
Mentions: One year follow up imaging revealed multiple lung metastases for which she underwent a needle biopsy, consistent with metastatic undifferentiated uterine endometrial sarcoma. She completed six doses of a single chemotherapy agent, Adriamycin, with good radiographic response on interval CT and positron emission tomography (PET) scan. Three months later she began complaining of headaches and visual complaints. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm with a small amount of surrounding edema [Figure 1]. Due to the rarity of uterine sarcoma metastasizing to the brain, this was believed to represent a meningioma. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Postoperative imaging revealed complete resection of the dural-based mass [Figure 2]. Histopathology confirmed UUS metastases [Figures 3 and 4]. The patient was discharged on postoperative day one and started on taxol and carboplatin chemotherapy, as well as Gamma Knife stereotactic radiosurgery to the tumor bed.

Bottom Line: Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed.Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect.Histopathology confirmed UUS metastases.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Philadelphia College of Osteopathic Medicine, Philadelphia, PA 19131, USA.

ABSTRACT

Background: Undifferentiated uterine sarcoma (UUS) is a rare tumor with an aggressive growth pattern. They occur in women from 40 to 60 years and are generally characterized by poor prognosis, a high rate of local recurrence, and distant metastases. UUS accounts for 0.2% of all gynecological malignancies. Possible treatments include surgery, radiotherapy, and chemotherapy.

Case description: A 65-year-old female with postmenopausal bleeding was found to have a uterine mass for which she underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The pathologic evaluation was consistent with undifferentiated endometrial sarcoma. She began experiencing headaches with associated visual disturbances. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm. Due to the rarity of metastatic uterine sarcoma to the brain, this was believed to represent a meningioma and subsequently observed. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Histopathology confirmed UUS metastases.

Conclusion: Randomized trials analyzing these treatment options are limited due to the rarity of this disease; therefore, a standard therapy is not established. Based on a review of the literature, this is only the fourth case reported of UUS metastatic to the brain.

No MeSH data available.


Related in: MedlinePlus