First reported case of a synchronous occurrence of cervical carcinosarcoma and endometrial adenocarcinoma showing radiological differentiation on MRI: A case report and diagnostic challenges

• DOI: 10.5348/100196z08hk2025cr
• Publication Date: 2025-02-19T15:01:27Z
• Authors: Hirofumi Koike; Hirokazu Kurohama; Takaaki Nakamura; Shintaro Takenoshita; Miyuki Koga; Taiga Oka; Minoru Morikawa; Ayumi Harada; Ryo Toya

Introduction: Synchronous cancer, which is when a secondary cancer occurs simultaneously or within six months of a primary cancer diagnosis, is rare for malignant female genital tract neoplasms. Despite cervical and endometrial cancers being very common gynecologic malignancies, they do not frequently occur synchronously.

Case Report: Here, we report a case of a 49-year-old female patient with a synchronous occurrence of endometrial adenocarcinoma and cervical carcinosarcoma (CCS), an extremely rare and aggressive cervical cancer subtype. Transvaginal ultrasonography showed two non-contiguous masses: one in the cervical canal and one in the uterine cavity. Magnetic resonance imaging (MRI) was then used for further examination. The two masses showed similar high signal intensity on the T2-weighted images and low apparent diffusion coefficient values. T2-weighted images suggested that they were contiguous at the cervix. However, retrospective analysis indicated that the cervical mass showed a relatively higher signal intensity on the T2-weighted images and a stronger, more heterogenous enhancement on the early-phase contrast fat-suppressed T1-weighted images. Additionally, constricted morphology was observed in the cervix, which is not consistent with what is typically observed with invasive endometrial or cervical cancer. Further analysis using histopathology and immunohistochemistry methods indicated a synchronous occurrence of CCS and endometrial adenocarcinoma, which is very rare.

Conclusion: This case effectively demonstrates the diagnostic challenges associated with magnetic resonance imaging (MRI)-based interpretation of synchronous gynecologic cancers, as well as highlights the key imaging features that may help facilitate differentiation of the two pathological types.