Carcinosarcoma of the uterus: MR findings

To clarify the imaging characteristics of carcinosarcomas, which are the most common malignant mixed epithelial and mesenchymal tumors (MEMTs) of the uterus.

We retrospectively reviewed MR findings of 17 histopathologically confirmed cases with carcinosarcomas, including the size, growth pattern, signal intensity, contrast enhancement, and extrauterine spread in each case.

The maximum tumor diameter was 11-165 mm (mean 88 mm). Nine cases (53%) showed exophytic with a stalk and eight cases (47%) showed broad-based exophytic growth. None of them showed invasive growth. Fourteen cases (82%) were isointense and three cases (18%) were hyperintense to myometrium on T1-weighted images (T1WI). An extremely high intensity area suggesting intratumoral hemorrhage was seen in only two cases. In 15 cases (88%), more than half of the tumor showed higher signal intensity than the outer myometrium on T2WI. Eight of the 16 cases (50%) had an unenhanced area, whereas 13 cases (81%) had a strongly enhanced area. Extrauterine extension was observed in only two cases (12%) at initial presentation.

Uterine carcinosarcomas reveal a spectrum of imaging findings with a high signal on T2WI, with a prolonged intense enhancement being the most common imaging feature.