Carcinosarcoma of the uterus associated with a nongestational choriocarcinoma

Choriocarcinoma has been reported in association with endometrial carcinoma and as a metaplastic change in multiple carcinomas, including liver, urina ry bladder, lung, and the gastrointestinal tract. We report choriocarcinoma in conjunction with a carcinosarcoma (also called malignant mullerian mixe d tumor) in a 71-year-old woman whose hysterectomy specimen revealed two po lypoid lesions of the endometrium, one arising from the anterior endometriu m and one arising from the posterior endometrium. Histologic examination re vealed three histologic patterns. The anterior endometrial lesion showed a FIGO grade 2 endometrioid endometrial adenocarcinoma. The posterior endomet rial lesion showed a carcinosarcoma composed of a high-grade adenocarcinoma and scant homologous stromal sarcoma. In addition, a choriocarcinoma was i dentified intermixed with the adenocarcinoma. The synctiocytotrophoblasts a nd cytotrophoblasts stained strongly with beta human chorionic gonadotropin (beta-hCG) and human placental lactogen (hPL). The patient's beta-hCG leve ls on postoperative days 14, 27, and 42 were 283, 32, and 7 mIU/mL, respect ively. This unusual case suggests the importance of identifying the chorioc arcinomatous component, since the serum beta-hCG can serve as a marker of t umor recurrence postoperatively.