Cervical carcinosarcoma: Case report and review of the literature

Abstract

Objective: To report the case of a patient with cervical carcinosarcoma and intra-abdominal bleeding, and to review the available literature on the treatment and prognosis of this condition. Materials and methods: Case report of an 84-year-old patient who presented with an abdominal mass and urinary tract obstruction. During hospital stay, she developed intra-abdominal bleeding with signs of shock, requiring total abdominal hysterectomy with bilateral salpyngo-oophorectomy, hypogastric artery ligation and pelvic packing as interventions to control bleeding. Histology reported a diagnosis of carcinosarcoma of the uterine cervix. The patient evolved adequately and was referred for oncologic management. The search in the literature was conducted in the Medline vía PubMed, Sci- ELO and Ovid databases, using the terms "uterine carcinosarcoma" "treatment" "cancer treatment" "treatment review" and "treatment outcome". The search was limited by language type but not by year of publication. Results: A total of 19 studies met the inclusion and exclusion criteria, and they were predominantly case reports. The clinical stage most frequently reported was FIGO IB in close to 53% of cases, and the most frequent presentation was genital bleeding associated with a pelvic mass. With an average follow-up of 15 months, survival for this tumour is 17% for the patients receiving radiotherapy. Of the patients taken to surgery as primary treatment, 63% remained disease-free during the first two years of follow-up, with a frequency of nearly 100% during the same period when radiotherapy was given after surgery. Conclusions: Cervical carcinosarcoma is an infrequent condition whose most common clinical manifestation is the presence of genital bleeding accompanied by a pelvic mass. Surgery, radiotherapy and chemotherapy are therapeutic options available for the treatment of this entity. However, regardless of the treatment provided, survival prognosis in women with this disease is lower than in women with squamous cell carcinoma or adenocarcinoma. Further studies of high methodological quality are required to assess the safety and effectiveness of the various interventions used as therapeutic approach to this entity.