Abstract
Uterine carcinosarcoma (UCS) is a rare aggressive neoplasm.We present a clinical case with UCS, developed during along-term five years adjuvant tamoxifen treatment and ovarian suppression with LHRH agonist on the occasion of invasive ductal breast carcinoma. Crucial for obtaining diagnosis of this rare aggressive neoplasm is the strict pathohistological and immunohistochemical analysis, carried out by an experienced pathologist. Every patient with a history of breast carcinoma is a subject for periodic monitoring. Genital bleeding is required to perform a separated endometrial abrasion with a precise histological study. For UCS / III C2 FIGO stage without distant metastases is necessary to conduct a maximal surgical tumor reduction, involving ever total abdominal hysterectomy, bilateral salpingo-oophorectomy, pelvic and para-aortic lymphadenectomy, peritoneal cytology, and omentectomy, followed by a combined simultaneous chemo-radiotherapy of tumor bed and pelvic lymph nodes, definitive radiotherapy of para-aortical lymph nodes, as well as adjuvant chemotherapy.
Highlights
Malignant uterine neoplasms containing both carcinomatous and sarcomatous elements are designated in the World Health Organisation (WHO) classification of uterine neoplasms as carcinosarcomas [1]
Carcinosarcoma /malignant mixed Mullerian tumor (MMMT) of the endometrium accounts for only 1%−2% of all gynecological malignancies [14]
Carcinosarcomas are biphasic malignant tumors composed of 2 distinct neoplastic cell populations: epithelial cells, and mesenchymal cells [15]
Summary
Malignant uterine neoplasms containing both carcinomatous and sarcomatous elements are designated in the World Health Organisation (WHO) classification of uterine neoplasms as carcinosarcomas [1]. Uterine carcinosarcomas (UCS) are characterized with a rare occurrence, accounting for only 2–5% of all uterine malignancies [2,3,4,5] They are aggressive undifferentiated carcinomas which include both carcinomatous and sarcomatous elements, arising from a single malignant epithelial clone [6,7,8,9]. From pathohistological and immunohistochemical analysis an uterine carcinosarcoma (UCS) with cervical tumor infiltration was confirmed. Immunohistochemical analysis reports positive expression of tumor cells to CKAE 1/3 and negative to GATA 3, Mammaglobin and GCDFP. Control CT and PET/CT from May 2021 reports disease progression with metabolic active bone marrow engagement zones in the vertebra C1 and L3, a pathological fracture of L1 and a metabolic active area on the right para-aortic lymph nodes at level L2-L3 (Fig.). We conducted palliative re-irradiation in the area of metastatic vertebrae and metastatic para-aortic lymph nodes at L2-L3 level in June 2021 (Fig.15)
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