Recidiva cerebral precoz, tras resección quirúrgica de metástasis por carcinosarcoma uterino: reporte de caso
Abstract
Introduction: Uterine carcinosarcoma, also known as malignant mixed Müllerian tumor, is a rare and highly aggressive malignancy. Central nervous system involvement is exceptional, with very few cases of brain metastases reported in the literature. In this context, individualized evaluation with emphasis on immunohistochemical profiling is essential to characterize tumor biology and guide therapeutic decision-making. Case presentation: A 67-year-old woman with a history of uterine carcinosarcoma treated with total hysterectomy and bilateral adnexectomy received multiple lines of systemic chemotherapy due to poor tolerance and Progressive pulmonary metastatic disease. The pulmonary metastatic lesión was undergoing palliative radiotherapy at the time of neurological symptom onset. She presented with progressive language disturbance, transient aphasia, dysarthria, and writing apraxia. Brain computed tomography and magnetic resonance imaging revealed a solid intra-axial lesion in the left middle temporal gyrus measuring approximately 15 x 15 x 18 mm, associated with vasogenic edema and mild mass effect. Surgical resection achieved gross total removal; however, the procedure was complicated by sigmoid sinus injury and massive venous bleeding. Outcome: The patient initially showed favorable postoperative neurological recovery with improvement of language symptoms. She was subsequently readmitted due to worsening respiratory symptoms related to pulmonary metastatic disease. During hospitalizaron, follow-up brain computed tomography revealed a large tumor recurrence at the surgical site, occurring in an extremely early interval after surgery. Conclusión: This case illustrates the aggressive biological behavior of metastatic uterine carcinosarcoma and highlights that extremely early tumor recurrence represents a marker of poor prognosis and limited effectiveness of surgical treatment in the setting of active systemic disease, even after gross total resection