case_images: PMC11782939_01
case_images: A: Plain MR image of the pelvis before treatment (T2-weighted image): A low-signal-intensity tumor occupying the uterine cervix to corpus was observed. In the inner area of the tumor, hemorrhage was noted. On the anterior wall side, infiltration beyond the serous membrane was suspected.. B: Thoracic CT image: In the bilateral lung fields, masses suggestive of multiple metastases were observed.
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case_images: F1
case_images: On the anterior wall side, infiltration beyond the serous membrane was suggested (Figure 1-A). Contrast-enhanced CT of the thorax-pelvis: Multiple lung metastases (Figure 1-B) were detected.
case_images: Preoperative pathological findings. A: Cervical biopsy (HE staining, x4). There was no atypia of the covering stratified squamous epithelium. In the deep layer, a large number of tumor nests were observed like small clusters to diffusely.. B: Cervical biopsy (HE staining, x20). Crushed bare-nucleus-like cells with a high N/C ratio and rough nuclear chromatin showed alveolar, solid sheet-like proliferation.. C: Cytodiagnosis of the endometrium (Papanicolaou staining, x40). As described for the cervical specimen, overlapping clusters of bare nucleus-like cells with a high N/C ratio were observed.
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case_images: F2
case_images: There was no atypia of the covering stratified squamous epithelium of the superficial layer, but a large number of tumor nests consisting of bare nucleus-like atypical cells diffusely distributed from small clusters, with a high N/C ratio, were observed in the deep layer (Figure 2-A). Tumor cells showed a rough chromatin pattern (Figure 2-B).
case_images: Macroscopic findings of the extirpated uterus and bilateral appendages. A tumor involving the uterine cervix to corpus and measuring approximately 4x4 cm was observed.
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case_images: F3
case_images: The tumor diameter was 4x4 cm, and the tumor was consecutively located in the uterine cervix to corpus (Figure 3).
case_images: Histopathological findings of the extirpated uterus. A: Eosinophilic substance-containing fused duct-like proliferation (HE staining, x20). B: Fissure-like to irregular duct-like proliferation (HE staining, x20). C: Cord-like proliferation (HE staining, x20). D: Solid alveolar proliferation (HE staining, x20)
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case_images: F4
case_images: Histology of surgical materials: In the tumor area, round to polygonal nuclear cells showed various carcinoma features: eosinophilic substance-containing fused duct-like (Figure 4-A), fissure-like to irregular duct-like (Figure 4-B), and sparse ductal structure-containing cord-like (Figure 4-C) or solid alveolar (Figure 4-D) structures.
case_images: Histopathological findings of the extirpated uterus (HE staining, x20). A sarcomatous area consisting of fascicular proliferation of atypical spindle cells
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case_images: F5
case_images: Furthermore, partially, a sarcomatous area with fascicular proliferation of atypical spindle cells was observed (Figure 5). Furthermore, a reduction in GATA3 expression or its disappearance was observed in a portion of the tumor, an area with spindle cell proliferation, suggesting sarcomatous differentiation (Figure 5).
case_images: Immunostaining. A: Positive for GATA3 (x20). B: Positive for CD10 (x20)
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case_images: F6
case_images: On immunostaining, tumor cells were positive for GATA3 (Figure 6-A), CD10 (Figure 6-B), calretinin, TTF-1, and Pax-8 at various degrees, but were negative for ER.
case_images: T2-weighted cerebral MRI revealed high-signal-intensity lesions with cysts in the bilateral cerebral hemispheres.
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case_images: F7
case_images: Contrast-enhanced cerebral MRI revealed multiple high-signal-intensity masses with cysts in the white matter of the bilateral cerebral hemispheres on T2-weighted images, suggesting multiple metastases (Figure 7).