Undifferentiated uterine sarcoma metastatic to the brain
A 65-year-old gravida 3, para 3-0-0-3, female presented with postmenopausal bleeding in July 2008. The patient sought medical attention from her gynecologist who performed a D and C, which revealed high-grade sarcoma of the uterus. Subsequent computed tomography (CT) scan of the chest, abdomen, and pelvis noted 9.5 × 6 cm irregular low density mass in the uterus with no extrauterine disease. She underwent a total abdominal hysterectomy, bilateral salpingo-oophorectomy, and omentectomy. The tumor measured 10 × 8 cm and demonstrated extensive necrosis. The margins were negative although the posterior wall of the myometrium was extensively involved. The final pathologic evaluation was consistent with undifferentiated endometrial sarcoma. She subsequently underwent pelvic radiation receiving 45 Gy in 25 fractions.\nOne year follow up imaging revealed multiple lung metastases for which she underwent a needle biopsy, consistent with metastatic undifferentiated uterine endometrial sarcoma. She completed six doses of a single chemotherapy agent, Adriamycin, with good radiographic response on interval CT and positron emission tomography (PET) scan. Three months later she began complaining of headaches and visual complaints. Magnetic resonance imaging (MRI) of the brain showed a homogenous enhancing occipital dural-based mass measuring 1.6 × 1.8 × 1.7 cm with a small amount of surrounding edema []. Due to the rarity of uterine sarcoma metastasizing to the brain, this was believed to represent a meningioma. Interval MRI scan revealed a significant increase in size of the right occipital mass to 2.3 cm with increased edema and mass effect. She underwent right occipital image guided craniotomy for resection of the mass. Postoperative imaging revealed complete resection of the dural-based mass []. Histopathology confirmed UUS metastases [Figures and ]. The patient was discharged on postoperative day one and started on taxol and carboplatin chemotherapy, as well as Gamma Knife stereotactic radiosurgery to the tumor bed.