Endometrial carcinosarcoma with multi-classifier molecular signature (MMRd-p53abn): A case report

The uterine carcinosarcoma is a rare biphasic Malignant Mixed Mullerian Tumour (MMMT). It is a highly aggressive endometrial cancer phenotype, consisting of both epithelial and mesenchymal components. The presented case refers to a 65-year-old, P6L3 postmenopausal woman with postmenopausal bleeding and white discharge per vagina for one month with vulval leukoplakia. The ultrasound showed a thickened endometrium measuring 15 mm, and the Magnetic Resonance Imaging showed the uterus measuring 7.4 × 4.5 × 6 cm. The endometrium appeared heterogeneous, with a hyperintense lesion measuring 4.8 × 2.3 cm on T2W1. The myometrium appeared normal, and neither of the ovaries was visualized. The patient underwent surgery. The histopathological and immunohistochemical analysis suggested that high-grade Endometrial Carcinosarcoma with dual classifier positivity (MMRd-p53abn) more closely resembled single-classifier MMRd (Mismatch repair deficiency) than p53abn, with a good prognosis. Post-surgery, the patient was followed up on every three months. The patient received 6 cycles of adjuvant chemotherapy. Considering the highly invasive nature of uterine carcinosarcomas, the timely detection of this cancer by imaging, pathology findings and molecular classification is of extreme importance to improve the patient's survival and for management outcome.