--- a
+++ b/processing/MACCROBAT/24898994.txt
@@ -0,0 +1,17 @@
+A woman in her 60s was found to have screen detected invasive lobular breast carcinoma of the right breast and invasive ductal carcinoma, no special type, of the left breast.
+Staging CT imaging prior to mastectomy showed a 12 cm pelvic mass which on initial impression was thought to be a fibroid uterus.
+Associated postmenopausal bleeding led to pelvic ultrasound, hysteroscopy and biopsy.
+The biopsy showed undifferentiated sarcoma, unclassifiable with immunohistochemistry.
+Following discussion at a multidisciplinary team meeting it was felt that the uterine tumour was a separate primary malignancy rather than metastasis from the breast.
+Hysterectomy and bilateral salpingo-oophorectomy was performed for both treatment purposes and to fully categorise the malignancy to guide further adjuvant therapy.
+Histological examination of the resection specimen showed a partially necrotic tumour with a discrete outline located within and extending throughout the myometrium.
+The tumour was composed of malignant spindle cells (figure 1A), with an intermittent component of pleomorphic cells with abundant eosinophilic cytoplasm.
+Plentiful osteoclast-like giant cells were present (figure 1B).
+Mitoses were numerous and structurally abnormal forms were common.
+Neoplastic cells were surrounded by hyaline osteoid matrix and foci of coarse neoplastic woven bone (figure 1C).
+Generous sampling of the tumour showed no admixed neoplastic epithelial elements, thus ruling out the more common carcinosarcoma (malignant mixed Müllerian tumour).
+Tumour cells showed immunohistochemical expression for vimentin, smooth muscle actin (SMA), desmin (focally) and CD99.
+Epithelial markers were not expressed.
+The morphological and immunohistochemical appearances were in keeping with primary uterine osteoblastic variant of osteosarcoma.
+Unfortunately, despite treatment, further CT imaging showed the development of multiple peritoneal and pulmonary deposits, confirmed on biopsy to be metastatic osteosarcoma.
+The patient received palliative chemotherapy and died several months later.