Late Isolated Abdominal Wall Recurrence of Uterine Carcinosarcoma: A Favourable Outcome in a Case Report Treated with Wide Surgical Excision and Prosthetic Reconstruction

Abstract

Introduction: Uterine carcinosarcoma is a rare and highly aggressive malignancy associated with a high risk of recurrence. Relapse usually involves the pelvis or distant organs, whereas isolated abdominal wall recurrence is exceptional. This report describes a late isolated abdominal wall recurrence and its surgical management, highlighting the need for prolonged surveillance in affected patients. Case Report: A 71-year-old postmenopausal woman presented with metrorrhagia. Diagnostic curettage revealed grade 2 endometrioid adenocarcinoma, and pelvic magnetic resonance imaging suggested stage IA disease. She underwent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymphadenectomy in July 2021. Final histopathological examination confirmed uterine carcinosarcoma with myometrial invasion greater than 50%, cervical stromal involvement, lymphovascular space invasion, negative pelvic lymph nodes, and clear vaginal margins. Adjuvant external beam pelvic radiotherapy, vaginal brachytherapy, and six cycles of paclitaxel-carboplatin chemotherapy were completed in April 2022. After more than two years of complete remission, routine surveillance imaging in March 2025 identified an isolated median subumbilical abdominal wall mass. Magnetic resonance imaging showed features suggestive of abdominal wall metastasis. Core needle biopsy demonstrated a poorly differentiated carcinoma, and immunohistochemistry showed CK7 and PAX8 positivity with oestrogen and progesterone receptor negativity, supporting recurrence of the known gynaecological malignancy. Wide en bloc resection of the abdominal wall lesion was performed, followed by reconstruction using a 30 × 30 cm dual-layer intraperitoneal mesh. No peritoneal carcinomatosis or ascites was observed intraoperatively. Final histopathological examination confirmed abdominal wall localisation of spindle cell sarcoma with heterologous osteosarcomatous differentiation, complete resection, and R0 margins. The postoperative course was uneventful. Conclusion: This case illustrates that, in selected patients with isolated abdominal wall recurrence of uterine carcinosarcoma, complete surgical excision with prosthetic reconstruction may provide effective local control. Long-term surveillance remains essential because atypical late recurrence may occur after an apparently sustained remission.