Coexistent uterine choriocarcinoma and carcinosarcoma with lung metastases

We report a 55-year-old woman with a lung metastasis and a uterine carcinosarcoma coexisting with uterine choriocarcinoma, and we discuss the management of choriocarcinoma or soft-tissue sarcoma lung metastases. We reviewed the patient's clinical course and the microscopic examination of her polypoid tumor, and we performed a Medline search of the literature. Pathologists concluded that 2 tumors coexisted in the uterus: one with a double quota, ie, a uterine carcinosarcoma and a uterine choriocarcinoma. Initially, the multiple lung metastases were tentatively thought to constitute choriocarcinoma because of their high β human chorionic gonadotropin (hCG) level and their distribution. Chemotherapy for choriocarcinoma was undertaken, comprising 5 courses of cisplatin 75 mg/m² on day 1, actinomycin 0.3 mg/m²/day on days 1-3, and etoposide 100 mg/m²/day on days 1-3. A total abdominal hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and pelvic lymph node dissection were also performed, followed by pelvic radiation therapy and brachytherapy. Four months after the end of treatment, a checkup revealed a serum hCG level < 2 IU/L, normal results for an abdominal and pelvic computed tomography (CT) scan, and only 2 small pulmonary metastases in regression according to a CT scan of the chest. A search of the literature revealed that in cases of choriocarcinoma lung metastases, the residual tumors usually show necrosis or fiberization. Therefore, these patients should be considered to be in complete remission, and further treatments such as pulmonary resection should not be necessary. On the contrary, several reports indicated prolonged survival after the surgical treatment of sarcoma lung metastases. Three histologic patterns at the same time in a uterus are quite uncommon. In our patient, a choriocarcinoma coexisted with a carcinosarcoma, with metastatic choriocarcinoma or sarcoma to the lungs. The treatment of such metastases depends on their etiology, and the follow-up of such patients is very important.