Post-radiation Uterine Carcinosarcoma: A Case Report

Uterine carcinosarcoma is a rare, malignant tumor of the endometrium composed of both high-grade epithelial (carcinomatous) and mesenchymal (sarcomatous) components, representing one of the most aggressive histological subtypes of endometrial carcinoma. Prior pelvic radiotherapy has been associated with an increased risk of subsequent aggressive endometrial malignancies, although the latency between irradiation and tumor development may vary considerably. Diagnosis may be delayed because early symptoms can mimic benign post-radiation sequelae. We report a woman in her 60s who, seven years after chemoradiotherapy for cervical squamous cell carcinoma, developed a three-month history of intermittent pelvic pain and mild vaginal bleeding. Pelvic MRI showed marked hematometra and a polypoid endometrial tumor invading the outer half of the myometrium. Histology after hysterectomy confirmed uterine carcinosarcoma with heterologous sarcomatous elements. Six months after diagnosis, biopsy-confirmed pleural metastases developed, and palliative chemotherapy was initiated. This case highlights hematometra as a nonspecific but potentially concerning radiological finding when associated with a suspicious endometrial mass in a previously irradiated patient, emphasizing the importance of timely investigation of new pelvic symptoms.