Presentation
Large volume post-menopausal per vaginal bleeding.
Patient Data
enlarged uterus with a heterogeneously hypodense mass occupying the endocervical canal and extending into the uterine cavity with minor heterogeneous contrast enhancement
preserved fat plane surrounding the uterus with no direct invasion into the rectum or bladder demonstrated
no visceral metastases
lytic lesions in the lower thoracic and lumbar vertebral bodies, suspicious for metastases, as well as degenerative changes throughout the vertebral column
mildly fatty liver, borderline enlarged spleen and diverticulosis
Case Discussion
The lesion in the endocervical canal and uterine cavity had been biopsied via hysteroscopy prior to this CT and was confirmed on histology to be a malignant mixed Mullerian tumor of the uterus (carcinosarcoma).
Post-menopausal per vaginal bleeding is the most common clinical presentation for malignant mixed Mullerian tumor of the uterus, which is typically highly aggressive with poor prognosis.