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Case Report
First reported case of a synchronous occurrence of cervical carcinosarcoma and endometrial adenocarcinoma showing radiological differentiation on MRI: A case report and diagnostic challenges
1 Department of Radiology, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
2 Department of Tumor and Diagnostic Pathology, Atomic Bomb Disease Institute, Nagasaki University, 1-12-4 Sakamoto, Nagasaki 852-8523, Japan
3 Department of Radiology, Sasebo Central Hospital, Sasebo, Nagasaki, Japan
4 Department of Radiology, Sasebo City General Hospital, Sasebo, Nagasaki, Japan
5 Department of Obstetrics and Gynecology, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki 852-8501, Japan
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Hirofumi Koike
Department of Radiology, Nagasaki University School of Medicine, 1-7-1 Sakamoto, Nagasaki 852-8501,
Japan
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Article ID: 100196Z08HK2025
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Koike H, Kurohama H, Nakamura T, Takenoshita S, Koga M, Oka T, Morikawa M, Harada A, Toya R. First reported case of a synchronous occurrence of cervical carcinosarcoma and endometrial adenocarcinoma showing radiological differentiation on MRI: A case report and diagnostic challenges. J Case Rep Images Obstet Gynecol 2025;11(1):35–41.ABSTRACT
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.
Keywords: Carcinosarcoma, Cervical cancer, Endometrial cancer, Magnetic resonance imaging
SUPPORTING INFORMATION
Acknowledgments
We thank J. Iacona, Ph.D., from Edanz (https://jp.edanz.com/ac), for editing a draft of this manuscript.
Author ContributionsHirofumi Koike - Acquisition of data, Analysis of data, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Hirokazu Kurohama - Acquisition of data, Analysis of data, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Takaaki Nakamura - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Shintaro Takenoshita - Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Miyuki Koga - Acquisition of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Taiga Oka - Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Minoru Morikawa - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ayumi Harada - Acquisition of data, Analysis of data, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Ryo Toya - Conception of the work, Design of the work, Acquisition of data, Analysis of data, Drafting the work, Revising the work critically for important intellectual content, Final approval of the version to be published, Agree to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2025 Hirofumi Koike et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
