G. El Hachem MD, C. Jungels MD, R. De Wind , J. Kerger MD
Uterine carcinosarcomas or mixed malignant mullerian tumours (MMMT) are rare gynaecological tumours with mixed carcinomatous and sarcomatous components. They are aggressive with a high risk of loco-regional and distant recurrence. Central nervous system (CNS) invasion by gynaecological malignancies is unusual and is exceptional in MMMT. There are eight reported cases of CNS metastases secondary to uterine MMMT with six cases of brain and two cases of spinal cord metastases. Here we report the case of a 50 year old woman, previously healthy, who was diagnosed with an aggressive heterologous 17x14x10 cm MMMT of the uterus, invading the whole endometrial wall, with lympho-vascular invasion and associated rhabdomyosarcoma elements. She underwent radical surgical resection followed by adjuvant radiation and chemotherapy. She recurred for the first time locally, and was treated with wide surgical resection. Six months later, she developed metastases in supra and infra-diaphragmatic lymph nodes, peritoneum and lungs. While being on palliative chemotherapy for her disseminated disease, she suffered from headache, and unfortunately 4 brain metastatic lesions were seen on brain MRI. Clinicians must be aware of this exceptional metastatic location of MMMT. However, there are no guidelines to screen, prevent or treat CNS metastases secondary to MMMT.