Uterine carcinosarcoma, also known as malignant mixed Müllerian tumor (MMMT), is a rare and aggressive neoplasm that combines carcinomatous and sarcomatous components. Previously classified among uterine sarcomas, it is now recognized as an endometrial epithelial tumor, with prognosis primarily determined by the carcinomatous component. This pathology predominantly affects postmenopausal women and typically presents with postmenopausal bleeding. Initial clinical and radiological evaluations often underestimate the disease’s extent. In the case presented, a patient initially diagnosed with FIGO stage II high-grade serous carcinoma was reclassified as FIGO stage IIIB after surgery revealed carcinomatosis. Pathological analysis of surgical specimens confirmed a carcinosarcoma, accounting for the rapid progression despite management, including surgery and chemotherapy. This case highlights the exceptionally aggressive nature of carcinosarcomas and underscores the importance of a multidisciplinary approach to optimize patient care.
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