Sarcomatoid carcinoma of the cervix with foci of malignant melanoma
Mrs. SRD, 42-year-old, P5 L3 D1 A1 , came to our hospital on 16th July 2012 with complaints of irregular bleeding per vaginum since 3 years. She had severe pain in the right lower limb since 1 month, because of which she was unable to walk and restricted to the bed. On examination, her general condition was fair, she was anemic. She had right sided unilateral lower limb edema. There was no evidence of any melanocytic lesion on her body.\nOn local examination, she had proliferative growth on the cervix that bleeds on touch. Both anterior and posterior fornix was involved with infiltration of upper 1/3rd of the vagina. On per rectal examination the right parametrium was involved up to the pelvic side wall and half of the left para was involved; the rectal mucosa was free. A clinical diagnosis of cervical cancer stage III B was made. Cervical biopsy was taken. On cystoscopic examination, proliferative growth was seen on the posterior wall of the bladder. Biopsy was taken from the bladder growth for histopathological confirmation.\nHer hemoglobin was 7.6 g%, liver and renal functions were within the normal limit. Chest X-ray was normal. Contrast enhanced magnetic resonance imaging (MRI) of pelvis showed large T2 hyperintense and T1 isointense cervical mass lesion with right parametrial extension. The mass was abutting the postero-lateral wall of the bladder with invasion of the right ureter, and contiguous bilateral pelvic nodes causing hydroureteronephrosis. There were multiple lesion in the left femur. MRI impression was Ca Cervix International Federation of Gynecology and Obstetrics (FIGO) IV-A with bone mets and bladder invasion [Figures –]. Histopathology was suggestive of sarcomatoid carcinoma of the cervix. Immunohistochemistry was positive for cytokeratin, vimentin, HMB45. Hence the final histo-pathological impression was spindle cell carcinoma with aberrant melanocytic differentiation/malignant melanoma [Figures and –]. The histology of bladder growth was similar to that of cervix.\nThe case was discussed in tumor board meeting with radiation and medical oncologists. In view of advanced stage and poor general condition of the patient, decision of only palliative radiation was taken. Single fraction of pelvic radiation with a dose of 10 Gy was given, covering the soft-tissue tumor and the bony metastasis. The unilateral lower limb edema was managed conservatively by keeping the left lower limb elevated. Patient didn′t respond well to the treatment; she had residual disease and succumbed to her disease after 5 months of the diagnosis of the disease.