Advanced Primary Cervical Carcinosarcoma With Ovarian and Peritoneal Metastases in a Premenopausal Woman: A Rare Case...

Cervical carcinosarcoma (CCS), also known as malignant mixed Müllerian tumor (MMMT) of the cervix, is an exceptionally rare and aggressive biphasic neoplasm composed of both epithelial and mesenchymal malignant components. Due to its rarity, optimal management strategies are not well established, particularly in low-resource settings. Most reported cases present at an advanced stage and are associated with poor prognosis. To our knowledge, this represents the first reported metastatic case of CCS from Sub-Saharan Africa. We report a case of advanced CCS in a 33-year-old woman who presented to a tertiary referral center in Northern Tanzania with a five-month history of heavy and prolonged vaginal bleeding, lower abdominal pain, headaches, palpitations, and generalized weakness. Clinical examination revealed a large vaginal mass with restricted uterine mobility and rectal involvement. Imaging demonstrated a heterogeneously enhancing cervical mass measuring 10 × 9 × 14 cm with parametrial invasion, recto-sigmoid infiltration, bilateral ovarian enlargement, peritoneal dissemination, lymphadenopathy, and ascites, consistent with FIGO stage IVB disease. Exploratory laparotomy revealed omental caking, bilateral ovarian masses, liver surface nodules, and extensive pelvic adhesions. A total abdominal hysterectomy (TAH) with bilateral salpingo-oophorectomy (BSO) was performed. Histopathological examination demonstrated a biphasic malignant tumor composed of carcinomatous elements arranged in nests and cords and sarcomatous pleomorphic spindle cells. Immunohistochemistry showed epithelial differentiation with p16 positivity and mesenchymal differentiation highlighted by desmin. Intraoperative findings and imaging confirmed ovarian and peritoneal metastases, consistent with advanced disease. Multidisciplinary review recommended systemic chemotherapy with carboplatin and paclitaxel followed by radiotherapy. Treatment was not initiated, however, due to financial constraints. The patient was subsequently lost to follow-up.