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Case Report
A 35-year-old patient was admitted to the hospital on March 27th, 2005 because of profuse leukorrhea for 3 months and progressive abdominal pain for half a month. The leukorrhea, which started for no apparent reason, contained streaks of blood and had an odor. One month prior to her hospitalization, her symptoms intensified and she was diagnosed by pathological examination with chronic inflammation of the mucous membranes of the cervix. A half month before being admitted, the patient’s symptoms became more serious with abdominal distension and pain.
The results of the initial diagnosis were unremarkable, i.e. her general condition was good, there were no cardiac or lung problems and she only had a slightly elevated abdomen, moderate tension and clear ambulatory dull sound. A gynecologic examination showed some vaginal hemorrhagic secretions, with hyperemia of the cervix accompanied by ulceration. A supersonic B examination revealed a lump at the right annexa accompanied by ascites, suggesting the presence of right ovarian cancer. Hyster-auxesis was found, accompanied by an abnormal echo. A CT examination indicated the presence of a metastatic tumor of the right ovary, with profuse ascites. Laboratory examination showed the following: CA125: 347.20(<35). Upon operation, no hyster-auxesis was found but there were multiple tumorous nodi of various sizes by the right annexa and cervix, as well as in the greater omentum.
Macroscopy showed that there was a cedar-color protuberant swelling in the urine cavity, with a size of 5.5 cm × 3.5 cm × 2.5 cm. The cut surface was solid, with a partial spongy region and tender fish-like texture. Both ovaries were enlarged and off-white multiple nodi were seen in the greater omentum, with sizes of 0.3 cm to 1.0 cm. Microscopic examination showed that the tumor tissue was formed by compartments of various sizes and irregular mutual conjoining, with an obvious hysteromorphism of the lining cells, big nuclei, dark staining and frequent mitoses (Fig. 1). The entire uterus was infiltrated and the parametrium and external aperture of the cervix were invaded by the tumor tissues, thus causing metastasis associated with the ovaries and greater omentum. Immunohistochemical results were as follows: Vim, CD34 and FVHI (Fig.2) were positive, and CK, SMA, CD 10, S-100 and CD68 were positive. A pathological examination indicated the presence of an angiosarcoma of the uterus, accompanied by extensive metastasis. Postoperative systemic chemotherapy was conducted using the IAP regimen, but her death occurred with extensive celiac and pulmonary metastasis after 3 months.
Heteromorphism of the lining neoplastic cells in the lumen of blood vessel was overt, see the remnant endometrial gland (H&E × 200).
There was a positive expression of the FVIII factors of the tumor cells (Envision method × 200).
Discussion
Uterine angiosarcoma is a malignant tumor originating from the vascular endothelial cells of the uterus. The major clinical manifestations include hypermenorrhea and pelvic mass, without specific symptoms. It is easily misdiagnosed as a benign lesion such as hysteromyoma before operation, and the diagnosis mainly depends on a histopathological examination. A clear hysteromorphism can be observed upon microscopy of the tumorous tissue. Besides the common pathological mitotic figures, the irregular and mutually communicated vascular compartment is formed in most of the tumors. The hairy-eell vascular net formed by tumor cells can be clearly displayed by reticular fiber staining. Further objective basis can be used for the diagnosis, by combining positive immunohistochemical endothelial-cell markers, such as the CD31, CD34 and the FVIII factors, etc. Under ultramicroscopy and using specific markers of the endothelial cells, such as the W-P body, one can better diagnose the disease at the molecular level. Uterine angiosarcoma has the characteristics of high malignancy and poor prognosis. According to a report from Mendm,[1] the average rate of recurrence was 8.2 months, with a 1-year survival of 43%. Cases with several years of survival after operation were reported, but all were in an early stage of development.
- Received November 7, 2006.
- Accepted December 1, 2006.
- Copyright © 2006 by Tianjin Medical University Cancer Institute & Hospital and Springer
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