Biphasic tumor of uterine origin – a case report and literature review
DOI:
https://doi.org/10.12775/QS.2026.53.70221Keywords
uterine neoplasm, uterine carcinosarcoma, gynecological malignancyAbstract
Background: Uterine carcinosarcoma represents a rare subtype of the primary tumors of the uterus, consisting of less than 5% of uterine neoplasms. The most common symptom is abnormal vaginal bleeding. Most frequently, this type of cancer occurs in women over the age of 70.
Aim: The aim of the paper is to present the significance of early diagnosis and treatment of uterine carcinosarcoma and to compare treatment methods among patients with different stages of this type of cancer.
Materials and methods: This paper presents a case report of a 56 yeras old patient who was admitted to the hospital due to postmenopausal bleeding. During examination, an echogenic heterogeneous tumor was spotted in the uterine cervix. The materials obtained during the uterine dilation and curettage (D&C) revealed sarcoma stromale. During the second admission, laparoscopic hysterectomy was performed. Histopathological analysis of the material recognised neoplasm as carcinosarcoma not otherwise specified (NOS). According to the decision made during consultation, the patient was qualified for chemotherapy (6 cycles), followed up with radiotherapy.
Results: Uterine carcinosarcoma is characterized by its unique, bi-phasic structure, aggressive, high-grade character and poor prognosis, which all create diagnostic and therapeutic difficulties. Due to its rare occurrence, precise histopathological examination is crucial in the diagnostic process and further treatment administration.
Conclusions: Carcinosarcoma is an uncommon and distinctive form of uterine tumor. Its unusual morphology can complicate the diagnostic process and histopathological evaluation, potentially delaying the final diagnosis. Furthermore, because of its biphasic nature, its treatment approach differs from that used for more typical uterine cancers.
References
Kurnit KC, Previs RA, Soliman PT, Westin SN, Klopp AH, Fellman BM, et al. Prognostic factors impacting survival in early stage uterine carcinosarcoma. Gynecol Oncol. 2019;152(1):31-37.
Arend R, Doneza JA, Wright JD. Uterine carcinosarcoma. Curr Opin Oncol. 2011;23(5):531-536.
Bansal N, Herzog TJ, Seshan VE, Schiff PB, Burke WM, Cohen CJ, et al. Uterine carcinosarcomas and grade 3 endometrioid cancers: evidence for distinct tumor behavior. Obstet Gynecol. 2008;112(1):64-70.
Gotoh O, Sugiyama Y, Takazawa Y, Kato K, Tanaka N, Omatsu K, et al. Clinically relevant molecular subtypes and genomic alteration-independent differentiation in gynecologic carcinosarcoma. Nat Commun. 2019;10(1):4965.
Cherniack AD, Shen H, Walter V, Stewart C, Murray BA, Bowlby R, et al. Integrated Molecular Characterization of Uterine Carcinosarcoma. Cancer Cell. 2017;31(3):411-423.
Zhao S, Bellone S, Lopez S, Thakral D, Schwab C, English DP, et al. Mutational landscape of uterine and ovarian carcinosarcomas implicates histone genes in epithelial-mesenchymal transition. Proceedings of the National Academy of Sciences of the United States of America. 2016;113(43):12238-12243.
Amant F, Cadron I, Fuso L, Berteloot P, de Jonge E, Jacomen G, et al. Endometrial carcinosarcomas have a different prognosis and pattern of spread compared to high-risk epithelial endometrial cancer. Gynecol Oncol. 2005;98(2):274-280.
Vaidya AP, Horowitz NS, Oliva E, Halpern EF, Duska LR. Uterine malignant mixed mullerian tumors should not be included in studies of endometrial carcinoma. Gynecol Oncol. 2006;103(2):684-687.
Zhang C, Hu W, Jia N, Li Q, Hua K, Tao X, et al. Uterine carcinosarcoma and high-risk endometrial carcinomas: a clinicopathological comparison. Int J Gynecol Cancer. 2015;25(4):629-636.
Yahya JB, Zhu S, Burmeister C, Hijaz MY, Elshaikh MA. Matched-pair Analysis for Survival Endpoints Between Women With Early-stage Uterine Carcinosarcoma and Uterine Serous Carcinoma. Am J Clin Oncol. 2021;44(9):463-468.
Matsuzaki S, Klar M, Matsuzaki S, Roman LD, Sood AK, Matsuo K. Uterine carcinosarcoma: Contemporary clinical summary, molecular updates, and future research opportunity. Gynecol Oncol. 2021;160(2):586-601.
Ravishankar P, Smith DA, Avril S, Kikano E, Ramaiya NH. Uterine carcinosarcoma: a primer for radiologists. Abdom Radiol. 2019;44(8):2874–2885.
Cantrell LA, Blank SV, Duska LR. Uterine carcinosarcoma: A review of the literature. Gynecol Oncol. 2015;137(3):581-588.
Singh R. Review literature on uterine carcinosarcoma. J Cancer Res Ther. 2014;10(3):461-468.
Schiavone MB, Zivanovic O, Zhou Q, Leitao MM Jr, Levine DA, Soslow RA, et al. Survival of Patients with Uterine Carcinosarcoma Undergoing Sentinel Lymph Node Mapping. Ann Surg Oncol. 2016;23(1):196-202.
Akahira J, Tokunaga H, Toyoshima M, Takano T, Nagase S, Yoshinaga K, et al. Prognoses and prognostic factors of carcinosarcoma, endometrial stromal sarcoma and uterine leiomyosarcoma: a comparison with uterine endometrial adenocarcinoma. Oncology. 2006;71(5-6):333-340.
El-Nashar SA, Mariani A. Uterine carcinosarcoma. Clin Obstet Gynecol. 2011;54(2):292-304.
Gonzalez Bosquet J, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol. 2010;116(3):419-423.
Galaal K, Kew FM, Tam KF, Lopes A, Meirovitz M, Naik R, et al. Evaluation of prognostic factors and treatment outcomes in uterine carcinosarcoma. Eur J Obstet Gynecol Reprod Biol. 2009;143(2):88-92.
Major FJ, Blessing JA, Silverberg SG, Morrow CP, Creasman WT, Currie JL, et al. Prognostic factors in early-stage uterine sarcoma. A Gynecologic Oncology Group study. Cancer. 1993;71(S4):1702-1709.
Matsuo K, Ross MS, Machida H, Blake EA, Roman LD. Trends of uterine carcinosarcoma in the United States. J Gynecol Oncol. 2018;29(2):e22.
Sherman ME, Devesa SS. Analysis of racial differences in incidence, survival, and mortality for malignant tumors of the uterine corpus. Cancer. 2003;98(1):176-186.
McCluggage WG, McManus DT, Lioe TF, Hill CM. Uterine carcinosarcoma in association with tamoxifen therapy. Br J Obstet Gynaecol. 1997;104(6):748-750.
Zelmanowicz A, Hildesheim A, Sherman ME, Sturgeon SR, Kurman RJ, Barrett RJ, et al. Evidence for a common etiology for endometrial carcinomas and malignant mixed mullerian tumors. Gynecol Oncol. 1998;69(3):253-257.
Schwartz SM, Weiss NS, Daling JR, Gammon MD, Liff JM, Watt J, et al. Exogenous sex hormone use, correlates of endogenous hormone levels, and the incidence of histologic types of sarcoma of the uterus. Cancer. 1996;77(4):717-724.
McCluggage WG, Abdulkader M, Price JH, Kelehan P, Hamilton S, Beattie J, et al. Uterine carcinosarcomas in patients receiving tamoxifen. A report of 19 cases. Int J Gynecol Cancer. 2000;10(4):280-284.
Friedrich M, Villena-Heinsen C, Mink D, Bonkhoff H, Schmidt W. Carcinosarcoma, endometrial intraepithelial carcinoma and endometriosis after tamoxifen therapy in breast cancer. Eur J Obstet Gynecol Reprod Biol. 1999;82(1):85-87.
Zwierzchowska A, Panek G, Gajewska M. Postradiation carcinosarcoma of the corpus uteri--a case report. Eur J Gynaecol Oncol. 2015;36(6):746-749.
Zhao F, Xu Y, Zhang H, Ren Y. Ultrasonographic Findings of Uterine Carcinosarcoma. Gynecol Obstet Invest. 2019;84(3):277-282.
Sagebiel TL, Bhosale PR, Patnana M, Faria SC, Devine CE. Uterine Carcinosarcomas. Semin Ultrasound CT MR. 2019;40(4):295-301.
Pezzicoli G, Moscaritolo F, Silvestris E, Silvestris F, Cormio G, Porta C, et al. Uterine carcinosarcoma: An overview. Crit Rev Oncol Hematol. 202;163:103369.
Yilmaz U, Alanyali S, Aras AB, Ozsaran Z. Adjuvant radiotherapy for uterine carcinosarcoma: A retrospective assessment of treatment outcomes. J Cancer Res Ther. 2019;15(6):1377-1382.
An Y, Wang Q, Sun F, Zhang G, Wang F, Zhang L, et al. OSucs: An Online Prognostic Biomarker Analysis Tool for Uterine Carcinosarcoma. Genes 2020;11:1040.
Callister M, Ramondetta LM, Jhingran A, Burke TW, Eifel PJ. Malignant mixed Müllerian tumors of the uterus: analysis of patterns of failure, prognostic factors, and treatment outcome. Int J Radiat Oncol Biol Phys. 2004;58(3):786-796.
Gonzalez Bosquet J, Terstriep SA, Cliby WA, Brown-Jones M, Kaur JS, Podratz KC, et al. The impact of multi-modal therapy on survival for uterine carcinosarcomas. Gynecol Oncol. 2010;116(3):419-423.
Chiang CY, Huang HJ, Chang WY, Yang LY, Wu RC, Wang CC, et al. Adjuvant therapy and prognosis in uterine carcinosarcoma. J Formos Med Assoc. 2021;120(11):1977-1987.
Danska-Bidzinska A, Nasierowska-Guttmejer A, Bakula-Zalewska E, Bidzinski M, Wierzba W. Prognosis of the patients suffered from uterine carcinosarcoma from rural and urban areas. Ginekol Pol. 2021;92(11):774-777.
Terblanche L, Botha MH. Uterine carcinosarcoma: A 10-year single institution experience. PLoS One. 2022;17(7):e0271526.
Rauh-Hain JA, Starbuck KD, Meyer LA, Clemmer J, Schorge JO, Lu KH, et al. Patterns of care, predictors and outcomes of chemotherapy for uterine carcinosarcoma: a National Cancer Database analysis. Gynecol Oncol. 2015;139(1):84-89.
Matsuo K, Takazawa Y, Ross MS, Elishaev E, Podzielinski I, Yunokawa M, et al. Significance of histologic pattern of carcinoma and sarcoma components on survival outcomes of uterine carcinosarcoma. Ann Oncol. 2016;27(7):1257-1266.
van Weelden WJ, Reijnen C, Eggink FA, Boll D, Ottevanger PB, van den Berg HA, et al. Impact of different adjuvant treatment approaches on survival in stage III endometrial cancer: A population-based study. Eur J Cancer. 2020;133:104-111.
Matsuo K, Omatsu K, Ross MS, Johnson MS, Yunokawa M, Klobocista MM, et al. Impact of adjuvant therapy on recurrence patterns in stage I uterine carcinosarcoma. Gynecol Oncol. 2017;145(1):78-87.
Seagle BL, Kanis M, Kocherginsky M, Strauss JB, Shahabi S. Stage I uterine carcinosarcoma: Matched cohort analyses for lymphadenectomy, chemotherapy, and brachytherapy. Gynecol Oncol. 2017;145(1):71-77.
Powell MA, Filiaci VL, Hensley ML, Huang HQ, Moore KN, Tewari KS, et al. Randomized Phase III Trial of Paclitaxel and Carboplatin Versus Paclitaxel and Ifosfamide in Patients With Carcinosarcoma of the Uterus or Ovary: An NRG Oncology Trial. J Clin Oncol. 2022;40(9):968-977.
Engerud H, Berg HF, Myrvold M, Halle MK, Bjorge L, Haldorsen IS, et al. High degree of heterogeneity of PD-L1 and PD-1 from primary to metastatic endometrial cancer. Gynecol Oncol. 2020;157(1):260-267.
Chan TA, Yarchoan M, Jaffee E, Swanton C, Quezada SA, Stenzinger A, et al. Development of tumor mutation burden as an immunotherapy biomarker: utility for the oncology clinic. Ann Oncol. 2019;30(1):44-56.
Uterine Neoplasm. NCCN Guidelines Version 1.2020. National Comprehensive Cancer Network. https://www.nccn.org/professionals/physician_gls/default.aspx (accessed 9/7/2024),
Dwivedi SK, McMeekin SD, Slaughter K, Bhattacharya R. Role of TGF-β signaling in uterine carcinosarcoma. Oncotarget. 2015;6(16):14646-14655..
Osakabe M, Fukagawa D, Sato C, Sugimoto R, Uesugi N, Ishida K, et al. Immunohistochemical analysis of the epithelial to mesenchymal transition in uterine carcinosarcoma. Int J Gynecol Cancer. 2019;29(2):277-281.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2026 Jakub Oberda, Anna Rudzińska, Kacper Ponikowski, Paulina Gumółka, Natalia Kowalczyk, Eliza Kuchta, Zuzanna Kowalczyk, Piotr Kowalewski, Keli Jabłońska, Jolanta Wiśniewska, Katarzyna Szklener
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Stats
Number of views and downloads: 17
Number of citations: 0
