Uterine Carcinosarcoma A Rare and Challenging Cancer

Volume 6, Issue 5, May – 2021 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Uterine Carcinosarcoma:
A Rare and Challenging Cancer
Hassani Wissal,Farhan Fatim-zahra,Alami Zenab,Bouhafa Touria
HASSAN II hospital,
Fez, Morocco
Abstract:- Uterine carcinosarcoma is a rare and highly III. RESULTS

aggressive malignancy.[1] The prognosis is often poor.
The clinical presentation of the uterine carcinosarcomas is A total of 13 patients were carried for a uterine
nonspecific, and imaging and pathology studies play an carcinosarcoma in the radiotherapy department of the Hassan
important role in diagnosis.[2] In this study, we are II hospital in Fez between January 2017 and December 2020.
exposing the clinical, paraclinical and therapeutic aspects The median age was 62 year-old [56-80]. Great multiparity
of patients with uterine carcinosarcoma treated in the was found in 75% of cases. All of our patients were
radiotherapy department of Hassan II university hospital postmenopausal and the median time from menopause to
center, and discuss our results with literature data. diagnosis was 13 years. The most common medical issues
were diabetes and blood pressure. 89% of our patients had a
Keywords:- Carcinosarcoma, Diagnosis, Management. body mass index (BMI) ≥30.
I. INTRODUCTION The median delay for condultation was 6 months. Post-

menopausal bleeding was major symptom for consultation.
Uterine carcinosarcomas is considered as rare tumor. It The gynecological examination found an increased in uterus
counts for less than 5% of uterine malignancies. It is size in 80% of cases. A Magnetic resonance imaging (MRI)
considered as high-risk form of endometrial was performed and found a bulky endocavitary mass in hypo-
adenocarcinoma[1]that got similitudes with endometrial intense in the T1 and T2-weighted sequences.
carcinoma more than with uterine sarcomas(epidemiology,
risk factors, clinical behavior).[1] The standard management A diagnostic hysteroscopy with biopsy dissection was
of carcinosarcomas consist in surgical staging [2] the performed in 80% of cases that found out carcinomatous or
indication of adjuvant treatment (chemotherapy, radiotherapy sarcomatous process with a heterologous component in 75%
and brachytherapy), depends on histological stage.[4] of cases. After the confirmation of the diagnosis, patients
went CT to eliminate the presence of metastases. 40% of the
We aimed in our study to expose clinical, paraclinical patients were classified as stage IB, stage II in 20% of cases,
and therapeutic aspects of patients with uterine stage IIIC1 and IVB in 20% of cases.
carcinosarcoma treated in the radiotherapy department of
Hassan II university hospital center. The surgical management consisted on total abdominal
hysterectomy, bilateral salpingo-oophorectomy and
II. PATIENTS AND METHOD retroperitoneal lymph node dissection. 40% of the patients
were classified as stage IB, stage II in 20% of cases, stage
It is a retrospective study carried out in the radiotherapy IIIC1 and IVB in 20% of cases.
department of Hassan II hospital in Fez between January
2017 and December 2020 on women presenting an uterine Adjuvant therapy was offered for all patients. They all
carcinosarcomas. All of our patients were over 18 years old went through chemotherapy (cisplatin regimen and taxanes),
and had a diagnosis of carcinosarcoma confirmed by External beam radiotherapy (EBRT) and received 50Gy in
pathological examination. The patients were listed via the 28 fractions and endocavitary HDR brachytherapy.
service register and the data collected on the basis of hospital
network [HOSIX] and paper file of each patient. The data After a median follow-up of 18 months, 70% of our
was entered and analyzed by the epi-info software version women were in remission, 10% in recurrence, and 10% in
3.5.2011. metastatic event.
IJISRT21MAY714 www.ijisrt.com 1356

ISSN No:-2456-2165
IV. DISCUSSION Uterine carcinosarcoma usually requires combined
modality approach which includes surgery, chemotherapy,
Uterine carcinosarcoma accounts for 4.3% of all uterine radiotherapy and sometimes hormonal therapy. Surgery
corpus cancers. The worldwide annual incidence is 0.5–3.3 includes hysterectomy, bilateral salpingoophrectomy, lymph
cases per 100,000 women[5]. This incidence is increasing at node dissection and resection of all gross disease. The
approximately 50 years of age and reaches a maximum at the decision of an adjuvant treatment after surgery has to be
age of 75 years[6]. The median age at the time of diagnosis is individualized depending on the staging at diagnosis and
62-67 years[2] which corresponds to the results found in our condition of the patient. Patients with stage I and II are
series. usually treated by total abdominal hysterectomy, bilateral
salpingoophrectomy and omentectomy also performed
The most commonly associated etiological factors of because of the probability of abdominal dissemination.
carcinosarcoma are previous exposure to radiation. [10] The Patients may need adjuvant radiotherapy and chemotherapy.
frequency of carcinosarcoma after radiation exposure For patients with advanced stages (III, IV), they can be
increased from a baseline rate as expected. It has been offered debulking surgery, chemotherapy, and adjuvant
suggested that post-irradiation carcinosarcoma occur at a radiation.
younger age than those arising de novo. [11] The common
risk factors associated with the development of Adjuvant irradiation is usually associated to a better
carcinosarcoma are exposure to tamoxifen, exogenous local control, and is indicated for women with early-stage
estrogen and obesity.[3].In our series 89% of the patients had carcinosarcoma completely resected.[4] A randomized trial
a BMI corresponding to a state of obesity. demonstrated that adjuvant radiotherapy on the pelvis (total
dose of 50.4 Gy) in early stage disease ( I or II ) improved
The common symptoms of uterine carcinosarcomas are local control in the subgroup for women with
vaginal bleeding and pain associated to rapidly growing carcinosarcoma.[12]
uterus. Vaginal bleeding is the most frequent symptom.[3]
Usually, pelvis examination finds a growth that can be Patients presenting a carcinosarcoma of the uterus
palpated or seen through the cervical os. Almost 15% of should be closely followed up considering the state of
patients present an involvement of the cervix identified disease, in fact, a high risk of local recurrence (60%) and
through cervical biopsy, endocervical curettage, or both [7] distant metastasis has been reported; [1] Guidelines for the
A computed tomography (CT) scan or gadolinium- follow up are identical to those for women treated for
enhanced magnetic resonance imaging (MRI) are requested endometrial adenocarcinoma. Clinical follow-up should be
for evaluating extention of disease locally. It usually finds an performed with a physical exam, and vaginal cytology i every
heterogeneous bulky polypoid prolapsing into the 3 months for 2 years, then every 6 months for 5 years[13]
endocervical canal and can also find a prolonged intense
enhancement .[8]. The behavior of carcinosarcomas is Due to its aggressive behavior, the overall prognosis of
governed by the carcinomatous element. Carcinoma usually uterine carcinosarcoma is poor, even with the best of care,
metastasizes through the lymphatic channels to nearby lymph [14]Staging is considered as the most important prognostic
nodes, while sarcoma usually metastasizes to peritoneal factor. Other factors described are patient age, and presence
cavity or to the lungs. In sarcoma, lymph node metastasis is of gross residual disease[15]
very uncommon. The patients of carcinosarcomas behave
much like as high grade endometrial adenosarcoma and V. CONCLUSION
commonly metastasize to pelvic or par aortic lymph nodes[9]
Carcinosarcoma is considered as a rare but particularly
The histological examination allows confirming the aggressive uterine cancer. A multidisciplinary management
diagnosis. It finds 2 populations: carcinomatous and is useful including complete surgical staging and multimodal
sarcomatous cells with invasion of the stroma. Thus, the therapy combining external beam irradiation or vaginal
diagnosis is based on histopathology of the hysterectomy brachytherapy and systematic chemotherapy in patients with
piece. In fact, surgery is considered as primary management both early and advanced stage disease. However, the rarity of
for carcinosarcoma. It allows staging and initial treatment[10] this disease is an obstacle to the implementation of large
Uterine carcinosarcoma staging is as stated on 2017 randomized trials to allow adequate assessment and better
International Federation of Gynecology and Obstetrics management.
(FIGO)/Tumor, Node, Metastasis (TNM) classification
system.
Because this cancer is aggressive compared to other

uterine cancers, screening for an early efficient diagnosis and
choosing the correct management strategy have an extreme
significance. Treatments of this neoplasm usually use
surgery, irradiation therapy, and chemotherapy.

ISSN No:-2456-2165
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Uterine Carcinosarcoma A Rare and Challenging Cancer

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Volume 6, Issue 5, May – 2021 International Journal of Innovative Science and Research Technology

Abstract:- Uterine carcinosarcoma is a rare and highly III. RESULTS

I. INTRODUCTION The median delay for condultation was 6 months. Post-

IJISRT21MAY714 www.ijisrt.com 1356

Because this cancer is aggressive compared to other

IJISRT21MAY714 www.ijisrt.com 1357

IJISRT21MAY714 www.ijisrt.com 1358

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