Rupture is a rare complication of uterine sarcoma. We report a case of a ruptured leiomyosarcoma with heterologous components, which was diagnosed after colonoscopy. A 48-year-old woman was referred to our department for anemia. Upon magnetic resonance imaging (MRI), a 48×50-mm mass was found on the anterior wall of her uterus and diagnosed as a uterine fibroid. After 8 years of regular visits to the hospital once or twice a year, she experienced abdominal pain after a colonoscopy for occult blood in her stool. Computed tomography revealed an enlarged uterine mass of 90×69 mm. MRI showed mixed signal on T2-weighted images, decreased diffusion, and high signal on T1-weighted images, indicating bleeding. The outline of the uterine mass was disrupted, and rupture of a malignant tumor in the uterus was suspected. Total hysterectomy, bilateral adnexal resection, and partial resection of the ileum and omentum were performed. Pathological findings comprised an irregular, bundle-like proliferation of spindle-shaped cells with prominent nuclear atypia, high mitotic count, coagulative necrosis, and infiltration of multinucleated giant cells with heterologous components of osteosarcoma and chondrosarcoma. A diagnosis of leiomyosarcoma with heterologous components was made. Postoperative chemotherapy was administered, but the tumor recurred with a lung metastasis one year after the surgery.

Ocular metastasis, particularly iris metastasis, is extremely rare. We report a case of iris metastasis from recurrent ovarian carcinosarcoma. A 63-year-old woman developed peritoneal dissemination and pulmonary metastases, 10 months after complete remission following initial treatment of stage IIIB ovarian carcinosarcoma with primary debulking surgery, followed by paclitaxel/carboplatin chemotherapy. Although she received gemcitabine/carboplatin + bevacizumab (Bev) chemotherapy for platinum-sensitive recurrent cancer, she showed cranial bone metastasis during maintenance Bev therapy. She underwent surgery and radiotherapy for the cranial bone lesions and was subsequently administered systemic liposomal doxorubicin. During suspension of chemotherapy, she visited the ophthalmologist for evaluation of decreased vision, blurring, and pain in her left eye. Slit-lamp examination showed a soft, white irregular tumor in the anterior segment, in her left iris with elevated intraocular pressure only in the left eye. The iris tumor was clinically diagnosed as metastases from ovarian carcinosarcoma. The patient was administered external radiotherapy (30 Gy), which led to tumor regression and gradual improvement in all ocular symptoms. Patients with iris metastasis tend to show extremely poor prognosis; however, prompt treatment can minimize ocular symptoms and prevent blindness to maintain patients' quality of life.