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case_images: (A) Coronal sequence, (B) axial sequence, (C) lateral sequence (November 2013): A computed tomographic scan revealed a huge pelvic mass of 14 cm x 10 cm x 13 cm with prominent colliquative aspects and heterogeneous contrast enhancement uptake.
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case_images: A computed tomographic (CT) scan showed a huge pelvic mass of 14 cm x 10 cm x 13 cm with prominent colliquative aspects (Figure 1A to C).
case_images: (A) Adenosarcoma with periglandular stromal condensation (Hematoxylin and Eosin, 100 x), (B) sarcomatous overgrowth with significant stromal pleomorphism (Hematoxylin and Eosin, 400 x), (C) the tumour cells show a heterogeneous immunoreactivity for CD10 (100 x), and (D) diffuse positivity for oestrogen receptor (100 x).
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case_images: Immunohistochemical expression of mismatch repair proteins (MLH1, MSH2, MSH6, and PMS2) was preserved (Figure 2A to D).
case_images: December 2013: A post-operative computed tomographic scan revealed multiple peritoneal implants, confluent in a lobated mass with colliquative aspects.
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case_images: The subsequent CT scan evaluation showed mesenteric multiple hyperdense solid lesions of 23 mm, 33 mm, and 20 mm in diameter, respectively; these were suspected of being peritoneal implants, and they increased substantially and became confluent in a lobed mass after few weeks (Figure 3).
case_images: (A) Axial sequence, (B) coronal sequence (December 2013): A computed tomographic scan evaluation after 1 cycle of epirubicin and ifosfamide, performed earlier due to sudden onset of abdominal pain, showed a prominent increase in the pelvic mass (16 cm x 10 cm x 6 cm in diameter), with intra-lesional heterogeneous colliquative features and irregular and thick septa.
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case_images: An emergency CT scan revealed a prominent increase in the pelvic mass (16 cm x 10 cm x 6 cm of diameter), with intra-lesional heterogeneous colliquative features and irregular and thick septa, suggestive of early radiologic response, according to Choi criteria (Figure 4A and B).
case_images: January 2014: A computed tomographic scan evaluation after 3 cycles of epirubicin and ifosfamide showed a marked shrinkage of the pelvic mass (8.6 cm x 3.3 cm x 3.3 cm in diameter), largely necrotic and with heterogeneous aspects (axial sequence).
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case_images: She completed the planned treatment, and in January 2014, after 3 cycles, the CT scan evaluation showed a marked shrinkage of the pelvic mass (8.6 cm x 3.3 cm x 3.3 cm in diameter), which was largely necrotic and had heterogeneous aspects, together with a relevant clinical benefit (Figure 5A and B).
case_images: (A) Axial sequence, (B) lateral sequence (March 2015): During a regular surveillance programme, a computed tomographic scan evaluation showed a pelvic solid mass, 6 cm x 3 cm x 4 cm of diameter, suggestive of relapse.
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case_images: The subsequent clinical and instrumental follow-up was negative until March 2015, when a CT scan revealed a pelvic solid mass, 6 cm x 3 cm x 4 cm in diameter, suggestive of relapse (Figure 6A and B).
case_images: (A) March 2015: ileal relapse of high-grade sarcomatous component of adenosarcoma with high mitotic count (Hematoxylin and Eosin, 50 x), (B) magnification of the high mitotic count highlighted by black arrows (Hematoxylin and Eosin, 400 x).
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case_images: The histologic examination and immunohistochemical features confirmed an ileal localization of high-grade sarcoma compatible with a relapse of the sarcomatous component of the previous adenosarcoma (Figure 7A and B).