2020 Volume 55 Issue 4 Pages 421-426
We report a patient in her 50s with uterine carcinosarcoma that occurred after renal transplantation (RTx). She had a history of right breast cancer before RTx and left breast cancer after RTx as well as uterine fibroids diagnosed by the gynecologist. Since she underwent ABO compatible live related RTx from her father her graft function had been stable with serum creatinine (Cr) of around 1.0 mg/dL. She was admitted due to acute renal failure with Cr of 8.49 mg/dL about 13 years after RTx. She was on everolimus, mycophenolate mofetil and methylprednisolone. As abdominal CT revealed severe compression of transplanted ureter due to an enlarged uterus, the ureteral stent was inserted under the cystoscope. Bladder mucosal biopsy suspected undifferentiated round-cell sarcoma. MRI and CT confirmed the invasion of the uterine tumor into the bladder as well as lymph nodes and lung metastases. A radical hysterectomy and cystectomy with ureterocutaneostomy were performed. Pathological finding revealed uterine carcinosarcoma (malignant mixed epithelial and mesenchymal tumor, carcinosarcoma, heterologous). As she developed renal failure due to residual tumor progression, it was decided not to give her follow-up chemotherapy, and she succumbed three weeks after surgery. To the best of our knowledge this is the first case of uterine carcinosarcoma after RTx. Despite close follow-up by a multidisciplinary approach it was considered that early diagnosis was extremely difficult due to rapid progression of this malignancy.
