Uterine carcinosarcoma – rare tumor– report of 4 cases and review of the literature

Abstract

Abstract–The common histological type of uterine            malignancy is endometrial adenocarcinoma. Malignant mixed mullerian tumor is rare malignant tumor of uterus and it has poor prognosis. We review the four cases that were          presented at cancer institute from January 2015-december 2016 with histology of carcinosarcoma uterus, clinically     operable stage. All 4 patients were undergone proper surgical staging in form of TAH +BSO+BPLND+/- Para aortic node dissection, omental biopsy with peritoneal wash cytology. Based on final pathology reports patients received adjuvant RT, chemo RT and palliative chemotherapy.Key word-TAH +BSO- total abdominal hysterectomy with bilateral salpingo oophorectomy, BPLND- bilateral pelvic lymph nodes dissection, Malignant mixed mullerian tumor.Introduction   Malignant  mixed mullerian tumor are rare tumor of uterus and accounting for only 2-5 % of all uterine malignancy (1-4).This tumor is highly aggressive, are composed of   epithelial and mesenchymal element(5).This is predominantly in post menopause women (23). Risk factors for developed of this tumor are similar to endometroid carcinoma and include nulli parous, advanced age, obesity, exposure of exogenous estrogen and long term use of  tamoxifan (21). It has          aggressive nature. It spread and grows rapidly and usually found in later stage (beyond stage)

.2).Treatment of carcinosarcoma for localized or locally   advance stage is primarysurgery. It includes surgical staging(TAH+BSO+BPLND+Para aortic nodes  dissection + omental biopsy). Adjuvant treatment based in post operative histology and stage.It includes  vaginal radiotherapy/ chemo radio therapy/ chemo therapy. There is no defined evidence for adjuvant treatment as there is no RCT because it is rare tumor. Evidence  available based on case series or case reports (14,15,16).