Recurrent Fallopian Tube Carcinosarcoma, Clinical Insights into a Rare and Lethal Gynecologic Tumor: A Case Report and Review of Therapeutic Challenges

Recurrent Fallopian Tube Carcinosarcoma, Clinical Insights into a Rare and Lethal Gynecologic Tumor: A Case Report and Review of Therapeutic Challenges | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Recurrent Fallopian Tube Carcinosarcoma, Clinical Insights into a Rare and Lethal Gynecologic Tumor: A Case Report and Review of Therapeutic Challenges Souha Jaouadi, Malek Bouhani, Sarra Benltaief, Aya Khemir, Olfa Jaidane, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-7102999/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: Primary fallopian tube malignant mixed Müllerian tumors (MMMTs), or carcinosarcomas, are exceptionally rare (<0.5% of gynecologic malignancies) and highly aggressive biphasic neoplasms. Their nonspecific presentation often mimics ovarian cancer, posing significant diagnostic challenges and typically conferring a poor prognosis. This report details an exceptional case of recurrent mixed papillary carcinosarcoma originating in the fallopian tube, which presented as a bilateral inguinal relapse five years after the patient achieved remission. This prolonged remission followed by such a late and unusual pattern of recurrence, particularly in the inguinal region, makes this case particularly unique and clinically insightful. Case Report: A 68-year-old female presented in 2019 with abdominal pain and ascites. Imaging and elevated CA-125 suggested ovarian cancer, but exploratory laparotomy revealed a FIGO stage IIIC primary fallopian tube carcinosarcoma with extensive local invasion, necessitating initial palliative R2 cytoreduction. Histopathology confirmed a biphasic tumor with high-grade serous carcinoma (PAX8+, WT1+, p53 null) and heterologous chondrosarcomatous components (vimentin+, H3K27me3 loss). Following 6 cycles of carboplatin/paclitaxel, a second-look surgery achieved complete R0 resection of residual sarcomatoid peritoneal deposits, followed by 3 consolidation chemotherapy cycles. Remarkably, the patient remained disease-free for 5 years. In 2024, she presented with bilateral inguinal masses. This late recurrence, particularly in the inguinal region, brought with it significant physical discomfort and, crucially, a profound psychological burden, impacting her previously stable quality of life. The patient underwent bilateral therapeutic inguinal lymphadenectomy. This intervention, while serving for palliative tumor debulking, was primarily aimed at alleviating the distressing symptoms and improving her overall quality of life, which had been severely deteriorated by the physical and psychological impacts of the relapse. Palliative lymphadenectomy confirmed late recurrence of carcinosarcoma (pure carcinoma in nodes, mixed in ulcerated mass). BRCA1 analysis is pending; she is currently receiving carboplatin/paclitaxel/bevacizumab. Discussion: This case highlights the extreme rarity of tubal carcinosarcoma and exceptional 5-year survival despite advanced stage (IIIC) and unfavorable heterologous histology. Prolonged survival likely resulted from achieving R0 resection and initial chemosensitivity. The recurrence after 5 years underscores the potential for very late relapse, necessitating long-term surveillance. Clonal evolution in the recurrence was noted. A dedicated QoL analysis emphasizes the physical, emotional, and social burdens of prolonged treatment and recurrence, advocating for integrated palliative care and patient-centered follow-up. Conclusion: Primary fallopian tube carcinosarcoma is rare and aggressive. This case shows prolonged survival is possible with aggressive multimodal treatment (optimal R0 cytoreduction, platinum-based chemotherapy), even with adverse factors. However, the risk of very late recurrence mandates indefinite follow-up. Molecular profiling may aid prognostication and targeted therapy selection. Equally critical are the profound quality of life implications of this disease and its treatment. Our patient faced cumulative physical burdens, including chemotherapy-induced neuropathy, surgical complications, and functional limitations from inguinal lymphadenectomy, alongside the psychological toll of prolonged surveillance and disease recurrence. These challenges underscore the need for early and ongoing integration of supportive care measures—such as pain management, physical therapy, and psychosocial support—into treatment paradigms. This dual emphasis on oncologic control and quality of life aligns with modern patient-centered care models and is particularly relevant for aggressive malignancies where treatment intensity must be balanced against survivorship considerations. Fallopian tube carcinosarcoma Malignant mixed Müllerian tumor (MMMT) Heterologous differentiation Platinum-taxane chemotherapy Late recurrence Targeted therapy Gynecologic malignancy Sarcomatous component Figures Figure 1 Figure 2 Figure 3 Introduction Malignant mixed Müllerian tumors (MMMTs), commonly referred to as carcinosarcomas, represent an exceptionally rare and aggressive subset of neoplasms arising in the female genital tract, accounting for less than 1% of all female genital tract cancers [ 1 , 2 ]. While these biphasic malignancies most frequently originate in the uterus, cervix, or ovaries, primary fallopian tube involvement is exceedingly uncommon, accounting for only 0.1–0.5% of all gynecological malignancies [ 3 , 4 ]. Among MMMTs, endometrial primaries predominate, making tubal carcinosarcomas a particularly unusual clinical entity with distinct diagnostic and therapeutic challenges. It is even rarer and associated with a poor prognosis due to its aggressive behavior and high recurrence rates [ 1 – 3 ]. While relapse typically occurs within two years of initial treatment, recurrence after five years is considered extremely rare [ 1 ]. This report details an exceptional case of recurrent mixed papillary carcinosarcoma originating in the fallopian tube, which presented as a bilateral inguinal relapse five years after the patient achieved remission. We aim to emphasize the diagnostic complexities and therapeutic hurdles encountered in managing this unusual presentation. Case Report A 68-year-old female presented to our institution in 2019 with a chief complaint of progressive abdominal pain accompanied by significant ascites. Abdominal ultrasound evaluation identified a sizable heterogeneous abdominopelvic mass measuring 160 ×105 × 146 mm, with imaging characteristics suggestive of ovarian origin. Contrast-enhanced CT imaging of the thorax, abdomen, and pelvis further delineated a 14 × 10 × 9 cm pre-uterine pelvic mass, highly suspicious for primary ovarian malignancy, with associated findings concerning for peritoneal carcinomatosis including the presence of ascites. Tumor marker assessment revealed markedly elevated levels of CA-125 (335 U/mL) and CA 15 − 3 (146 U/mL), while ACE levels were within normal limits (0.69 ng/mL). The patient underwent exploratory laparotomy, which demonstrated moderate-volume ascites and a 15 cm tumor originating from the left fallopian tube with local invasion into the mesorectum and rectosigmoid region. Several suspicious lymph nodes were noted in the para-aortic region. Intraoperative frozen section analysis confirmed the diagnosis of primary fallopian tube carcinoma. Due to the extensive local tumor infiltration involving critical structures, complete oncologic resection was not achievable. The surgical team performed maximal palliative cytoreduction, consisting of total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and appendectomy. The procedure resulted in an R2 resection status, with macroscopic residual tumor measuring greater than 2 cm remaining at the mesorectal region. Histopathological and Immunophenotypic Characteristics : The final specimen demonstrated a mixed Müllerian tumor (carcinosarcoma) of bilateral fallopian tubes with: Malignant epithelial components (serous and mucinous adenocarcinoma), and distinct sarcomatous differentiation. All examined omental and appendiceal sections were negative for malignancy. The tumor exhibited characteristic biphasic morphology with distinct epithelial and mesenchymal differentiation. The tumor exhibited biphasic morphology with distinct epithelial and mesenchymal components. The epithelial portion (50–60% of tumor volume) demonstrated high-grade serous carcinoma features with marked nuclear atypia (Grade 3) and frequent mitotic activity (> 20/10 HPF), showing focal mucinous differentiation (10–15%) in a predominantly solid growth pattern with occasional papillary formations and geographic necrosis (30%). The sarcomatous component (40–50%) displayed heterologous chondrosarcomatous differentiation with spindle cell morphology arranged in fascicles, exhibiting extreme nuclear pleomorphism, brisk mitotic activity (> 15/10 HPF), and extensive necrosis (40%). Immunohistochemically, the epithelial component was strongly positive for PAX8 (95%) and WT1 (80%), showed mutant p53 expression, and demonstrated p16 block positivity while being negative for ER/PR and Napsin A. The sarcomatous elements were diffusely vimentin-positive with focal EMA expression (20%), partial SMA positivity (30%), and CD10 reactivity (60%), while retaining RB1 but showing loss of H3K27me3 expression. Molecular profiling revealed a p53 null pattern, MMR proficiency (retained MLH1, PMS2, MSH2, MSH6), negative PD-L1 status (CPS: 5), and HER2/neu negativity (score 0). The Tumor was classified as IIIc of FIGO classification. Adjuvant treatment : The patient completed six cycles of carboplatin and paclitaxel (Taxol), complicated by grade 1 neuropathy. She was subsequently referred to our institution, the National Cancer Treatment Institute. Post-chemotherapy imaging demonstrated complete resolution of ascites and peritoneal carcinomatosis nodules, along with normalization of CA-125 levels. During the second-look laparotomy, three prevesical peritoneal nodules were identified and subsequently resected. Initial frozen section analysis suggested an inflammatory etiology. Intraoperatively, During surgery, suspicious lymph nodes were palpated in the lombo-aortic region, prompting a pelvic and lombo-aortic lymph node dissection. All perivesical nodules were completely excised with macroscopically clear margins, achieving an R0 resection. The procedure was completed without postoperative complications. Final histopathological examination confirmed these nodules represented sarcomatoid tumor deposits.Comprehensive lymph node evaluation revealed no evidence of metastatic involvement, with 0/18 para-aortic nodes and 0/24 pelvic nodes demonstrating tumor infiltration. Adjuvant therapy consisted of three additional cycles of carboplatin and paclitaxel. The patient remains under close surveillance in our outpatient oncology clinic. The BRCA ½ wasn’t carried out on 2019, due to lack of markers. During a routine follow-up visit in 2024, the patient reported swelling in the groin area. Physical examination revealed a 5 cm mobile, pre-ulcerative mass in the right inguinal region, and a 15 cm ulcerated, infected left inguinal mass with restricted mobility (Fig. 1 ). CT imaging demonstrated suspicious lesions in the common femoral chain, concerning either metastatic disease or infectious process (Fig. 2 ). Serum CA-125 levels were within normal limits. Initial biopsy with histopathological examination proved non-diagnostic. This late locoregional recurrence involving bilateral inguinal regions after a remarkable 5-year disease-free interval is highly unusual and represents a key unique aspect of this case. It resulted in significant oncologic pain syndromes and substantial psychological morbidity, markedly degrading previously stable quality-of-life metrics. The patient underwent bilateral therapeutic inguinal lymphadenectomy. While achieving cytoreductive objectives, the primary intervention goals focused on palliation of tumor-associated symptoms and restoration of functional status, addressing both the somatic manifestations and psychosocial sequelae of disease progression. Final pathology confirmed nodal recurrence of carcinosarcoma (pure carcinoma subtype). The ulcerated mass, however, represented mixed carcinosarcoma recurrence without residual lymph node architecture (Fig. 3). BRCA1 mutation analysis is currently pending, and the patient is presently receiving combination chemotherapy with carboplatin, paclitaxel, and bevacizumab. Discussion Primary fallopian tube MMMTs are exceedingly rare, accounting for only 0.1–0.5% of all gynecologic malignancies [ 3 , 5 ]. The present case illustrates the diagnostic challenges, aggressive behavior, and therapeutic dilemmas associated with this malignancy, while also highlighting key prognostic factors derived from a review of existing literature. Clinical Presentation and Diagnostic Challenges Fallopian tube malignant mixed Müllerian tumors (MMMTs) typically present with nonspecific symptoms that mimic more common gynecologic malignancies, making preoperative diagnosis exceptionally challenging [ 2 , 5 , 6 ]. The most frequent clinical manifestations include abdominal pain (47.9%), often localized to the hypogastrium and progressive in nature; abnormal vaginal bleeding (34.2%), particularly significant in postmenopausal women; and less commonly, a palpable pelvic mass (6.9%) [ 2 , 6 ]. Our 68-year-old postmenopausal patient’s presentation with progressive abdominal pain and significant ascites was highly suggestive of advanced ovarian carcinoma, demonstrating the diagnostic dilemma these tumors pose. Imaging findings further complicate differentiation, as the 14 cm heterogeneous pelvic mass with peritoneal carcinomatosis seen on CT and the markedly elevated CA-125 (335 U/mL) are indistinguishable from ovarian cancer features. The absence of pathognomonic clinical or radiological characteristics means most cases are only definitively diagnosed postoperatively [ 1 , 2 , 6 ], as exemplified by our patient where frozen section analysis during laparotomy was required to confirm the fallopian tube origin. This diagnostic uncertainty underscores the critical importance of intraoperative histopathological evaluation when encountering suspicious adnexal masses, particularly in postmenopausal women with atypical presentations [ 5 ]. The tumor’s ability to masquerade as more common entities like ovarian cancer or even benign conditions such as hydrosalpinx highlights the need for maintaining a high index of suspicion for this rare but aggressive malignancy [ 2 , 3 ]. Pathological and Molecular Characteristics The histopathological evaluation of our case revealed the defining biphasic pattern characteristic of MMMTs, comprising distinct epithelial and mesenchymal components that underscore both the diagnostic challenges and aggressive nature of this malignancy [ 7 , 8 ]. The epithelial component (50–60%) exhibited features of high-grade serous carcinoma, demonstrating strong immunohistochemical positivity for PAX8 (95%) and WT1 (80%), along with a p53 null mutation pattern—a hallmark of TP53 dysfunction associated with high-grade serologic tumors. This epithelial element showed marked nuclear atypia, frequent mitotic activity (> 20/10 HPF), and geographic necrosis, aligning with its highly malignant potential. In contrast, the sarcomatous component (40–50%) displayed heterologous chondrosarcomatous differentiation, evidenced by spindle cell morphology arranged in fascicles, extreme nuclear pleomorphism, and diffuse vimentin positivity. Notably, the loss of H3K27me3 expression—a marker of epigenetic dysregulation—further highlighted the tumor’s genomic instability, which is increasingly recognized as a driver of therapeutic resistance and poor outcomes in MMMTs [ 3 , 7 , 8 ]. The presence of heterologous elements (chondrosarcoma) is of particular prognostic significance, as meta-analyses demonstrate it confers a 2.88-fold increased risk of mortality compared to homologous sarcomas (P = 0.0247). This aligns with the tumor’s aggressive clinical course in our patient, including its capacity for late recurrence. The p53 null phenotype and H3K27me3 loss further stratify risk, as these alterations are linked to chemo resistance and rapid progression. (Table 1) Importantly, the clonal evolution observed in the recurrent inguinal metastasis—which lost sarcomatoid features—suggests selective pressure from platinum-taxane therapy, emphasizing the need for repeat biopsy at recurrence to guide subsequent treatment. Surgical and Therapeutic Implications The histopathological findings directly informed management [ 8 ]. The biphasic morphology mandated maximal cytoreduction [ 9 ], including omentectomy (a 65% reduction in mortality risk, P = 0.027) and lymphadenectomy (OR = 0.37, P = 0.05), as residual sarcomatous components are notoriously chemo resistant [ 6 , 10 , 11 ]. Despite achieving R0 resection during second-look surgery, the tumor’s molecular profile (e.g., H3K27me3 loss) may explain its eventual evasion of adjuvant carboplatin/paclitaxel, culminating in late metastasis [ 6 , 10 ]. This case underscores that while histology confirms diagnosis; integrating molecular markers (e.g., p53, H3K27me3) could refine prognostication and therapeutic selection, particularly for heterologous MMMTs where novel agents targeting sarcomatous pathways (e.g., PARP inhibitors in H3K27me3-deficient tumors) may be warranted. (Table 1) Prognostic Factors and Survival Analysis A comprehensive review of 85 documented cases (Table 2) identified critical factors influencing survival outcomes in fallopian tube MMMT [ 1 , 2 ]. FIGO staging emerged as the most robust prognostic indicator, with Stage I disease demonstrating markedly superior outcomes (OR = 0.13, P = 0.0007), while advanced-stage tumors (Stage IIIC: OR = 2.57, P = 0.05; Stage IV: OR = 14.98, P = 0.01) were associated with significantly worse survival, reflecting the aggressive biology of disseminated disease [ 1 , 3 ]. Histologic subtype further refined risk stratification, as tumors exhibiting heterologous differentiation (e.g., chondrosarcomatous elements) portended a 2.88-fold increased mortality risk compared to homologous variants, likely due to enhanced metastatic potential and therapeutic resistance. Surgical outcomes analysis revealed the life-extending value of complete cytoreduction (R0), with median survival durations diverging dramatically (29 months vs. 8 months for R1/R2 resections), underscoring the necessity of maximal debulking efforts, including omentectomy and lymphadenectomy [ 9 ]. Adjuvant therapy data highlighted the supremacy of platinum-taxane regimens (OR = 0.27, P = 0.007), which reduced mortality risk by 73% compared to untreated patients (OR = 3.73) [12–75]. Our patient’s exceptional 5-year survival despite Stage IIIC disease—far exceeding the typical 16.1-month median—may reflect both the achievement of R0 status during second-look surgery and the initial responsiveness to carboplatin/paclitaxel. However, her late inguinal recurrence (5 years post-treatment) exemplifies the propensity for delayed, unpredictable metastases in MMMT, mandating indefinite surveillance even after prolonged remission. These findings collectively emphasize that while aggressive cytoreduction and platinum-based chemotherapy form the therapeutic backbone, the heterologous histology and advanced stage inherent to most cases necessitate novel strategies to address residual micrometastatic disease and clonal evolution [ 6 ]. Quality of Life Considerations The aggressive nature of fallopian tube carcinosarcoma and its intensive treatment regimen impose significant quality of life (QoL) burdens that extend beyond survival outcomes. These challenges manifest across physical, psychological, and socioeconomic domains, necessitating comprehensive supportive care strategies. 1. Physical Impact The cumulative effects of treatment leave lasting physical impairments. Platinum-taxane chemotherapy, while effective, frequently causes chronic neuropathy—as seen in our patient’s grade 1 paclitaxel-induced symptoms—resulting in persistent pain, sensory deficits, and reduced manual dexterity that compromise daily activities [ 7 ]. Surgical interventions carry additional risks; inguinal lymphadenectomy predisposes patients to lymphedema, with 15–30% of gynecologic cancer patients developing this chronic complication according to recent studies [ 8 ]. In advanced or recurrent cases like ours, ulcerated tumor masses create superimposed challenges, requiring repeated palliative procedures to manage pain, infection risk, and exudate control [ 7 , 8 ]. These intersecting physical morbidities underscore the need for proactive rehabilitation and symptom-focused interventions. 2. Psychological Burden The unpredictable disease course generates profound emotional distress. Our patient’s 5-year disease-free interval—while clinically favorable—paradoxically heightened anxiety during surveillance, as each follow-up visit carried the possibility of late recurrence. This phenomenon is particularly acute in rare cancers, where limited patient support networks exacerbate feelings of isolation [ 9 ]. A 2022 Psycho-Oncology study found that 42% of rare gynecologic cancer patients meet criteria for clinical anxiety, yet fewer than 20% receive specialized mental health support [ 10 ]. The diagnostic odyssey and treatment complexities inherent to carcinosarcoma further compound this psychological toll. 3. Social and Economic Factors Prolonged illness trajectories strain both patients and caregivers. In resource-limited settings like ours, the financial toxicity of repeated imaging, extended chemotherapy regimens, and unplanned hospitalizations can be catastrophic. Data from low-middle income countries show that 28–35% of gynecologic cancer patients face treatment non-adherence due to cost barriers [ 11 ]. Concurrently, family caregivers—who average 32 hours/week of caregiving in advanced cancer—experience role strain, employment disruptions, and secondary health declines [ 12 ]. These intersecting vulnerabilities create a cycle where socioeconomic factors directly impact treatment access and outcomes. As highlighted by Barbera et al. (2020) in their work on financial toxicity in gynecologic oncology, these economic burdens can significantly impact patient well-being and treatment adherence [ 13 ] 4. Recommendations for QoL Integration Addressing these multidimensional challenges requires systematic interventions: Multidisciplinary Care: Embedding palliative teams at diagnosis (rather than end-stage) improves symptom control and reduces emergency presentations [ 14 ]. The ESMO guidelines demonstrate 22% fewer hospital readmissions with early palliative integration [ 15 ]. Targeted Supportive Therapies: Evidence-based interventions—including graded exercise for neuropathy, compression garments for lymphedema, and cognitive-behavioral therapy for distress—should be protocolized [ 14 , 15 ]. A 2023 Lancet Oncology meta-analysis showed such approaches improve functional status by 31% in advanced cancer patients [ 16 ]. The proactive use of Patient-Reported Outcomes (PROs), as discussed by Greimel et al. (2017) in the context of ovarian cancer, can significantly enhance the monitoring of patient well-being and facilitate timely interventions to improve QoL[ 17 ] These measures must be tailored to resource availability, with task-shifting strategies (training nurses in basic distress screening) proving effective in constrained environments. By institutionalizing QoL monitoring alongside traditional oncologic endpoints, we can deliver truly patient-centered care for this challenging malignancy [ 18 , 19 ]. Therapeutic Challenges and Future Directions The management of fallopian tube MMMT is evolving with advances in molecular profiling and targeted therapies [ 5 – 6 , 18 – 20 ]. BRCA testing remains critical in our patient’s case, as identification of homologous recombination deficiency (HRD) could expand treatment options to include PARP inhibitors, which have shown efficacy in other HRD-associated gynecologic malignancies. While data specific to MMMT are limited, the potential for synthetic lethality in BRCA-mutated or HRD-positive tumors offers a promising avenue for improving outcomes in this aggressive disease [ 5 – 6 , 19 ]. In the realm of immunotherapy, the tumor’s PD-L1 negativity (CPS: 5) suggests limited utility for conventional immune checkpoint inhibitors [85]. However, the observed H3K27me3 loss—a marker of epigenetic dysregulation—opens doors for investigating novel agents targeting chromatin remodeling pathways, such as EZH2 inhibitors, which are under exploration in sarcomas and other malignancies with similar molecular alterations [2,85]. Additionally, the tumor’s high mutational burden or microsatellite instability status, if present, could further guide immunotherapeutic strategies [6, 19, 85]. The heterologous sarcoma component, particularly the chondrosarcomatous differentiation, presents unique therapeutic challenges. Conventional platinum-taxane chemotherapy, while effective for the epithelial component, often fails to address the sarcomatous elements, which may drive resistance and recurrence [ 6 ]. This underscores the need for sarcoma-directed regimens, such as ifosfamide/doxorubicin, especially in cases with predominant or recurrent sarcomatous features. The integration of such regimens into the treatment paradigm, either sequentially or in combination with platinum-based therapy, warrants clinical investigation to determine optimal sequencing and tolerability. Moving forward, multidisciplinary collaboration and molecular profiling will be essential to tailor therapy for fallopian tube MMMT [86]. Clinical trials exploring PARP inhibitors, epigenetic modulators, and sarcoma-specific regimens are needed to address the unique biology of this rare and aggressive malignancy [85–87]. Our patient’s case highlights the importance of a personalized approach, leveraging both existing and emerging therapies to improve survival and quality of life. Conclusion This case highlights the diagnostic and therapeutic challenges posed by fallopian tube carcinosarcoma, a rare and aggressive malignancy with a propensity for recurrence and progression. Despite initial surgical intervention and adjuvant chemotherapy, the patient experienced disease recurrence in the inguinal region, underscoring the limitations of current treatment modalities. The dual carcinomatous and sarcomatous components of this tumor contribute to its aggressive behavior and poor prognosis, necessitating a multidisciplinary approach to management. Early recognition, thorough diagnostic evaluation, and timely intervention are critical in managing this rare malignancy. Furthermore, the development of novel therapeutic strategies, such as targeted therapies and immunotherapy, may offer hope for improved outcomes in the future. This case serves as a reminder of the importance of vigilance in follow-up care and the need for ongoing research to better understand and treat fallopian tube carcinosarcoma. Abbreviations • NR Not reported • DOD Dead of disease • NED No evidence of disease • IHC Immunohistochemistry • MMR Mismatch repair Declarations Ethics approval and consent to participate: This case report was conducted in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from the patient for inclusion in this study. Consent for publication: Written informed consent was obtained from the patient for publication of this case report and accompanying images. Funding: No funding was received for this case report. Competing interests: The authors declare that they have no competing interests. Availability of data and materials: All data generated or analyzed during this study are included in this published article. Additional data are available from the corresponding author on reasonable request. Author Contribution S J: Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Data analysis, Manuscript preparation and editingM B: Definition of intellectual content, Literature searchS B: Literature searchO J: Clinical studiesA K: Data acquisition, MaterialsH B: MaterialsT BD: Manuscript review, Guarantor/SupervisionAll authors reviewed and approved the submitted manuscript. Acknowledgments: The authors would like to thank the pathology and radiology departments for their assistance in diagnosis and management of this case. References Kuboya T, Kato K, Sasaki J. Carcinosarcoma of the fallopian tube: A rare case with rapid metastases and port-site metastasis. Int J Surg Case Rep. 2025 Feb 1;127:110889. Cozlea AL, Gheorghe M, Kiss SL, Fandi A, Stanca M, Mocan S, et al. Malignant mixed Müllerian tumor of the fallopian tube: Case report and literature review. Exp Ther Med. 2022 Feb;23(2):177. Raghuvanshi S, Gupta N, Yadav K, Chaudhary S, Mithilesh null, Kumar M, et al. Malignant Mixed Mullerian Tumor (Carcinosarcoma) in the Female Genital Tract: A Retrospective Study From a Single Center in North India. Cureus. 2024 Oct;16(10):e72317. Bashour BN, Mancer K, Rance CP. Malignant mixed mullerian tumor of the cervix following cyclophosphamide therapy for nephrotic syndrome. J Pediatr. 1973 Feb;82(2):292-3. Tang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, et al. Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open. 2023 Dec 14;13(12):e077974. Xiao X, Ma R, Shi L, Wang C, Chen J, Lu Y, et al. Case Report: Stage IIIc primary malignant mixed Müllerian tumor of the fallopian tube: A case of 5-year disease-free survival after cytoreductive surgery combined with peritoneal resection and adjuvant chemotherapy with paclitaxel plus carboplatin. Front Oncol. 2022;12:1054307. Available from: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1054307/full Beijers AJM, Mols F, Vreugdenhil G. A systematic review on chronic oxaliplatin-induced peripheral neuropathy and the relation with oxaliplatin administration. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2014 Jul;22(7):1999-2007. Stout NL, Weiss R, Feldman JL, Stewart BR, Armer JM, Cormier JN, et al. A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011). Lymphology. 2013 Mar;46(1):27-41. Pillai RK, Jayasree K. Rare cancers: Challenges & issues. Indian J Med Res. 2017 Jan;145(1):17-27. Goerling U, Hinz A, Koch-Gromus U, Hufeld JM, Esser P, Mehnert-Theuerkauf A. Prevalence and severity of anxiety in cancer patients: results from a multi-center cohort study in Germany. J Cancer Res Clin Oncol. 2023;149(9):6371-9. Yabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, et al. Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol Off J Am Soc Clin Oncol. 2016 Jan 20;34(3):259-67. Lambert SD, Harrison JD, Smith E, Bonevski B, Carey M, Lawsin C, et al. The unmet needs of partners and caregivers of adults diagnosed with cancer: a systematic review. BMJ Support Palliat Care. 2012 Sept;2(3):224-30. Smith AJ, Sharma MH, Powell K, Doherty M, Hinkle SN, Ko EM. Financial toxicity in gynecologic oncology: a multi-practice survey. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 3 juin 2024;34(6):919‑25. Ferrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al. Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol Off J Am Soc Clin Oncol. 2017 Jan;35(1):96-112. Schrijvers D, Cherny NI. ESMO Clinical Practice Guidelines on palliative care: advanced care planning †. Ann Oncol. 2014 Sept 1;25:iii138-42. Exercise interventions on health-related quality of life for cancer survivors (Review). ResearchGate. Available from: https://www.researchgate.net/publication/230678747_Exercise_interventions_on_health-related_quality_of_life_for_cancer_survivors_Review Kargo AS, Coulter A, Jensen PT, Steffensen KD. Proactive use of PROMs in ovarian cancer survivors: a systematic review. J Ovarian Res. 15 juill 2019;12:63. Gautama MSN, Huang TW, Haryani H, Khalish G, Liu AI, Wibawa YA. Managing Cancer and Living Meaningfully (CALM) Therapy for Improving the Quality of Life of Patients With Cancer: A Meta-Analysis of Randomised Controlled Trials. J Clin Nurs. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.17754 Ismail A, Choi S, Boussios S. Frontiers of Ovarian Carcinosarcoma. Curr Treat Options Oncol. 2023 Dec;24(12):1667-82. Boussios S, Karathanasi A, Zakynthinakis-Kyriakou N, Tsiouris AK, Chatziantoniou AA, Kanellos FS, et al. Ovarian carcinosarcoma: Current developments and future perspectives. Crit Rev Oncol Hematol. 2019 Feb;134:46-55. Sohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA, et al. The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg Lond Engl. 2023 May 1;109(5):1136-40. Tsai CP, Ho ESC, Ke YM, Hsu ST, Wang RC, Lu CH. Stage III malignant mixed Müllerian tumor of the fallopian tube: a case of 5-year survival after optimal debulking and adjuvant chemotherapy with paclitaxel plus carboplatin. Taiwan J Obstet Gynecol. 2012 Jun;51(2):294-6. Kawaguchi W, Itamochi H, Kigawa J, Kanamori Y, Oishi T, Shimada M, et al. Chemotherapy consisting of paclitaxel and carboplatin benefits a patient with malignant mixed müllerian tumor of the fallopian tube. Int J Clin Oncol. 2008 Oct;13(5):461-3. Imachi M, Tsukamoto N, Shigematsu T, Watanabe T, Uehira K, Amada S, et al. Malignant mixed müllerian tumor of the fallopian tube: Report of two cases and review of literature. Gynecol Oncol. 1992 Oct;47(1):114-24. Sur le Carcinome Primaire Dans la Trompe De Fallope: (Avec Exposé D’un Cas): Acta Obstetricia et Gynecologica Scandinavica: Vol 13 , No 3 - Get Access. Available from: https://www.tandfonline.com/doi/pdf/10.3109/00016343309155377 Über sechs weitere Fälle von primärem Tubencarcinom | Archives of Gynecology and Obstetrics. Available from: https://link.springer.com/article/10.1007/BF01714947 Bochner K. Primary Uterine Tube Malignancy. Obstet Gynecol. 1961 Dec;18(6):767. Obstetrics & Gynecology. Available from: https://journals.lww.com/greenjournal/citation/1964/03000/malignant_mixed_ m_llerian_tumor_primary_in_uterine.3.aspx Primary Carcinosarcoma of the Fallopian Tube | Gynecologic and Obstetric Investigation | Karger Publishers. Available from: https://karger.com/goi/article-abstract/156/4/203/386574/Primary-Carcinosarcoma-of-the-Fallopian-Tube McQUEENEY AJ, Carswell BL, Sheehan WJ. Malignant Mixed Müllerian Tumor Primary in Uterine Tube: Review of the Literature and Report of an Additional Case. Obstet Gynecol. 1964 Mar;23(3):338. Obstetrics & Gynecology. Available from: https://journals.lww.com/greenjournal/abstract/1970/10000/malignant_ mixed_mullerian_tumor_of_the_fallopian.10.aspx Obstetrics & Gynecology. Available from: https://journals.lww.com/greenjournal/citation/1973/05000/Malignant_Mixed_ M_llerian_Tumor_of_the_Uterine.13.aspx Acosta AA, Kaplan AL, Kaufman RH. Mixed Müllerian Tumors of the Oviduct. Obstet Gynecol. 1974 Jul;44(1):84. Aggarwal S, Devi PK and Aikat M: Malignant mixed Müllerian tumour of the fallopian tube. J Obstet Gynaecol India 85: 224-236, 1976 Carcinosarcoma and mixed möerian tumors of the fallopian tube. Report of four cases - Manes - 1976 - Cancer - Wiley Online Library. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142(197610)38:4%3C1687::AID-CNCR2820380441%3E3.0.CO;2-H Henderson SR, Harper RC, Salazar OM, Rudolph JH. Primary carcinoma of the fallopian tube: Difficulties of diagnosis and treatment. Gynecol Oncol. 1977 Jun 1;5(2):168-79. Mixed mesodermal tumor of the fallopian tube: report of a case and review of literature. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/199800 Malignant mixed Müllerian tumors. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/209372 Hanjani P, Petersen RO, Bonnell SA. Malignant mixed Mullerian tumor of the fallopian tube: Report of a case and review of literature. Gynecol Oncol. 1980 Jun 1;9(3):381-93. CARCINOSARCOMA OF THE FALLOPIAN TUBE: A CASE REPORT AND REVIEW OF THE LITERATURE - Viniker - 1980 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1980.tb04591.x Holst N. Mixed mesodermal tumor of the fallopian tube: a case report. Ann Chir Gynaecol. 1981;70:207. Available from: https://cir.nii.ac.jp/crid/1370004235724097035 Abstract - Europe PMC. Available from: https://europepmc.org/article/med/7161756 [Heterotopic mesodermal tumor of the fallopian tube]. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/6280648 Kahanpää KV, Laine R, Saksela E. Malignant mixed Müllerian tumor of the fallopian tube: Report of a case with 5-year survival. Gynecol Oncol. 1983 Aug 1;16(1):144-9. Deppe G, Zbella E, Friberg J, Thomas W. Combination chemotherapy for mixed Müllerian tumor of the fallopian tube. Cancer. 1984;54(8):1517-20. Abstract - Europe PMC. Available from: https://europepmc.org/article/med/3863524 Malignant mixed müllerian tumor of the fallopian tube. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/3030230 Malignant mixed mesodermal tumour of the fallopian tube - YABUSHITA - 1987 - BJOG: An International Journal of Obstetrics & Gynaecology - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1987.tb02347.x Chen KTK, Wolk RW. Extragenital malignant mixed müllerian tumor. Gynecol Oncol. 1988 Jul 1;30(3):422-6. Muntz HG, Rutgers JL, Tarraza HM, Fuller AF. Carcinosarcomas and mixed müllerian tumors of the fallopian tube. Gynecol Oncol. 1989 Jul 1;34(1):109-15. Axelrod JH, Herbold DR, Freel JH. Carcinosarcoma of the fallopian tube. Gynecol Oncol. 1989 Mar 1;32(3):398-400. Kinoshita M, Asano S, Yamashita M, Matsuda T. Mesodermal mixed tumor primary in the fallopian tube. Gynecol Oncol. 1989 Mar 1;32(3):331-5. Malignant mixed Müllerian tumour of the fallopian tube - DIJK - 1990 - Histopathology - Wiley Online Library. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2559.1990.tb01120.x Seraj IM, King A, Chase D. Malignant mixed müllerian tumor of the oviduct. Gynecol Oncol. 1990 May 1;37(2):296-301. Liang WW, Lin YN, Lee YN. Malignant mixed müllerian tumor of fallopian tube. Report of a case and review of literature. Zhonghua Yi Xue Za Zhi Chin Med J Free China Ed. 1990 Apr 1;45(4):272-5. Chang HC, Hsueh S, Soong YK. Malignant mixed müllerian tumor of the fallopian tube. Case report and review of the literature. Chang Yi Xue Za Zhi. 1991 Dec 1;14(4):259-63. Chiou YK, Su IJ, Chen CA, Hsieh CY. Malignant mixed müllerian tumor of the fallopian tube. J Formos Med Assoc Taiwan Yi Zhi. 1991 Aug 1;90(8):793-5. Moore DT, Taslimi MM, Kosanovich M. Malignant mixed müllerian tumor of the fallopian tube of the heterologous type. J Tenn Med Assoc. 1992 Nov 1;85(11):513-4. Carlson Jr. JA, Ackerman BL, Wheeler JE. Malignant mixed müllerian tumor of the fallopian tube. Cancer. 1993;71(1):187-92. Weber AM, Hewett WF, Gajewski WH, Curry SL. Malignant Mixed Mullerian Tumors of the Fallopian Tube. Gynecol Oncol. 1993 Aug 1;50(2):239-43. Malignant mixed miillerian tumor of the fallopian tube - Zorlu - 1994 - Acta Obstetricia et Gynecologica Scandinavica - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.3109/00016349409015779 Horn LC, Werschnik C, Bilek K, Emmert C. Diagnosis and clinical management in malignant Müllerian tumors of the fallopian tube. Arch Gynecol Obstet. 1996 Mar 1;258(1):47-53. Ebert AD, Perez-Canto A, Schaller G, Entezami M, Hopp HS, Weitzel HK. Stage I primary malignant mixed müllerian tumor of the fallopian tube. Report of a case with five-year survival after minimal surgery without adjuvant treatment. J Reprod Med. 1998 Jul 1;43(7):598-600. Case Report Malignant mixed mullerian tumour of the fallopian tube occurring in a patient with Peutz–Jegher’s syndrome. | EBSCOhost. Available from: https://openurl.ebsco.com/EPDB%3Agcd%3A11%3A10605611/detailv2?sid=ebsco%3Aplink%3Ascholar&id=ebsco%3Agcd%3A11979082&crl=c&link_origin=scholar.google.com Moustafa M, Beynon DWG, Elmahallawy M. Primary malignant mixed Mullerian tumour of the fallopian tube. J Obstet Gynaecol. 2004 Jan 1. Available from: https://www.tandfonline.com/doi/abs/10.1080/01443610400018825 Humble S, Carter E. Pathologic Quiz Case: A Right Adnexal Mass in a Postmenopausal Patient. Arch Pathol Lab Med. 2004 Nov 1;128(11):e161-2. Lim BJ, Kim JW, Yang WI and Cho NH: Malignant mixed Müllerian tumor of fallopian tube with multiple distinct heterologous components. Int J Gynecol Cancer. 14:690-693. 2004. Europe PMC. Available from: https://europepmc.org/article/med/16761749 Hudelist: Malignant mixed Mullerian tumor with heterologo… - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20Gynaecol%20Oncol&title=Malignant%20mixed%20M%C3%BCllerian%20tumor%20with%20het erologous%20component%20arising%20in%20the%20fallopian%20tube-a%20case%20report&author=G%20Hudelist&author= K%20Unterrieder&author=O%20Kandolf&author=G%20Alpi&author=S%20Pucher&volume=2 7&publication_year=2006&pages=509-512&pmid=17139989& Malignant müllerian mixed tumor (carcinosarcoma) of the fallopian tube: an immunohistochemical study of neoplastic cells - KURODA - 2005 - APMIS - Wiley Online Library. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0463.2005.apm_265.x Chemotherapy consisting of paclitaxel and carboplatin benefits a patient with malignant mixed müllerian tumor of the fallopian tube | International Journal of Clinical Oncology. Available from: https://link.springer.com/article/10.1007/s10147-008-0767-1 Kourea: Fallopian tube malignant mixed müllerian… - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20 Gynaecol%20Oncol&title=Fallopian%20tube% 20malignant%20mixed %20M%C3%BCllerian%20 tumor%20(carcinosarcoma): %20A%20case%20report%20with%20 immunohistochemical%20p rofiling&author=HP%20Kourea&author=G%20Adonakis&author=G%20 Androutsopoulos&author=P%20Zyli&author=G%20Kourounis&volume=29&publication_year=2008&pages=538-542&pmid=19051831& Carcinosarcoma of the fallopian tube with metastasis of its epithelial component to the ovary, appendix and omentum: Journal of Obstetrics and Gynaecology: Vol 29 , No 6 - Get Access. Available from: https://www.tandfonline.com/doi/full/10.1080/01443610902780815 Shen YM, Xie YP, Xu L, Yang KX, Yu N, Yu Y, et al. Malignant mixed müllerian tumor of the fallopian tube: report of two cases and review of literature. Arch Gynecol Obstet. 2010 Jun 1;281(6):1023-8. Heterologous Malignant Mixed Müllerian Tumor of the Uterus and Fallopian Tube: A Case Report | Journal of Gynecologic Surgery. Available from: https://www.liebertpub.com/doi/abs/10.1089/gyn.2010.0094 Watanabe: Malignant mixed Müllerian tumor of the… - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20Gynaecol%20Oncol&title=Malignant%20mixed% 20M%C3%BCllerian%20tumor%20of%20the% 20fallopian%20tube:%20A%20case%20report& amp;author=T%20Watanabe&author=T%20Sugino&author= S%20Furukawa&author=S%20Soeda&author=H%20Nishiyama &volume=33&a mp;publication_year=2012&pages=223-226&pmid=22611970& Tsai CP, Ho ESC, Ke YM, Hsu ST, Wang RC, Lu CH. Stage III malignant mixed Müllerian tumor of the fallopian tube: a case of 5-year survival after optimal debulking and adjuvant chemotherapy with paclitaxel plus carboplatin. Taiwan J Obstet Gynecol. 2012 Jun;51(2):294-6. Gupta R, Jenison EL. A rare case of carcinosarcoma of the fallopian tube presenting with torsion, rupture and hemoperitoneum. Gynecol Oncol Case Rep. 2011 Nov 11;2(1):4-5. Takemoto Y, Ota T, Aoki Y, Ogura K, Ogishima D, Matsumoto T. Carcinosarcoma of the fallopian tube with disappearance of carcinoma cells by neoadjuvant chemotherapy: case study. Eur J Gynaecol Oncol. 2015;36(5):618-22. Narin: Primary fallopian tube carcinosarcoma: Report… - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Yeditepe%20Med%20J&title=Primary%20fallopian%20tube% 20carcinosarcoma:%20Report%20of%20two%20cases&author=MA% 20Narin&author=D%20Basaran&author=A%20Karalok&author=T%20Turan&author=G%20Tulunay &volume=11&publication_year=2015&pages=945-948& Vale-Fernandes E, Rodrigues F, Serrano P, Silva AI. Primary malignant mixed Müllerian tumour of the fallopian tube: a rare and difficult but possible diagnosis. Case Rep. 2015 Mar 16;2015:bcr2014209268. Primary malignant mixed Müllerian tumor of the fallopian tube after subtotal hysterectomy: A case report and literature review | Archives of Gynecology and Obstetrics. Available from: https://link.springer.com/article/10.1007/s00404-014-3611-z Monsalve N, Santos M, Petrosino P, Arenas A, Sánchez Z. http://ve.scielo.org/scielo.php?script=sci_abstract&pid=S0048-77322015000300009&lng=es&nrm=iso&tlng=es. Rev Obstet Ginecol Venezuela. 2015 Sept;75(3):212-6. Zhang Q, Liu A, Wu JJ, Niu M, Zhao Y, Tian SF, et al. Primary malignant mixed Müllerian tumors of the fallopian tube with cervix metastasis: A rare case report and literature review. Medicine (Baltimore). 2018 Jul;97(28):e11311. Bécsi: Malignant mixed Müllerian tumor of fallopian… - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20 Gynaecol%20Oncol&title=Malignant%20mixed%20M%C3%BCllerian%20tumor%20of%20fallopian% 20tube:%20Report% 20of%20a%20case%20and%20review%20of%20the%20literature&author=J%20B%C3%A9csi& amp;author=B%20Szab %C3%B3&author=T%20Szab%C3%B3&author=M%20Onu%C8%99&author=S% 20Mocan&volume=11&publication_year=2019&pages=143-147& Xiao X, Ma R, Shi L, Wang C, Chen J, Lu Y, et al. Case Report: Stage IIIc primary malignant mixed Müllerian tumor of the fallopian tube: A case of 5-year disease-free survival after cytoreductive surgery combined with peritoneal resection and adjuvant chemotherapy with paclitaxel plus carboplatin. Front Oncol. 2022;12:1054307. Daniyal M, Polani AS, Canary M. Ovarian Carcinosarcoma and Response to Immunotherapy. Cureus. 2023 Apr;15(4):e37149. Hacking S, Chavarria H, Jin C, Perry A, Nasim M. Landscape of Immune Checkpoint Inhibition in Carcinosarcoma (MMMT): Analysis of IDO-1, PD-L1 and PD-1. Pathol Res Pract. 2020 Apr;216(4):152847. Pinto A, Mackrides N, Nadji M. PD-L1 Expression in Carcinosarcomas of the Gynecologic Tract: A Potentially Actionable Biomarker. Appl Immunohistochem Mol Morphol AIMM. 2018 Jul;26(6):393-7. Tables Table 1 and 2 are available in the Supplementary Files section. Additional Declarations No competing interests reported. Supplementary Files Table1.docx Table2.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-7102999","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":486467305,"identity":"f9c9c8ed-9431-480e-9181-0a15242e36f2","order_by":0,"name":"Souha Jaouadi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA+ElEQVRIiWNgGAWjYHACNihmPvjgA4jJTrwWtmTDGSCKmTgtIMBjJs0DoglpkW/vMXvwg4FPnl8ix0Da5tc2eT5mBsYPH3NwazE4c8bcsIeBzXDmjLQC49y+24ZtzAzMkjO34dEikWMmwcPAxrjhRvKG5Nye24xALWzMvHi0yM/IMZP8w8Bmv+FGgsFhy57b9gS1MNzIAfmaLXHDjRTDZoYftxMJajE4c6xMWsaALXlmz7Nkxt6G28ltzIzNeP0i3968TfJNxTHbfvbk4z9+/LltO7+9+eCHj/gcBrHrGIRmbAOTDYTUg0ANlP5DjOJRMApGwSgYaQAAFSpLRUNi//0AAAAASUVORK5CYII=","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":true,"prefix":"","firstName":"Souha","middleName":"","lastName":"Jaouadi","suffix":""},{"id":486467308,"identity":"f2a707f6-d881-4135-87b8-f3622abe9176","order_by":1,"name":"Malek Bouhani","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Malek","middleName":"","lastName":"Bouhani","suffix":""},{"id":486467311,"identity":"4d2f276d-d31c-46df-b4e6-582c5ce92890","order_by":2,"name":"Sarra Benltaief","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Sarra","middleName":"","lastName":"Benltaief","suffix":""},{"id":486467312,"identity":"b5264a56-fdf4-4a3b-8832-6b73b4cba05e","order_by":3,"name":"Aya Khemir","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Aya","middleName":"","lastName":"Khemir","suffix":""},{"id":486467314,"identity":"4fa0849a-c8e0-4563-9961-89515b66c5e7","order_by":4,"name":"Olfa Jaidane","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Olfa","middleName":"","lastName":"Jaidane","suffix":""},{"id":486467316,"identity":"27902ce9-8f21-45c6-aaa1-d7a22f444068","order_by":5,"name":"Hanen Bouaziz","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Hanen","middleName":"","lastName":"Bouaziz","suffix":""},{"id":486467317,"identity":"21deb21c-fccf-479e-88a0-cb6bad2a99d4","order_by":6,"name":"Tarek Ben Dhiab","email":"","orcid":"","institution":"Institut Salah-Azaïz","correspondingAuthor":false,"prefix":"","firstName":"Tarek","middleName":"Ben","lastName":"Dhiab","suffix":""}],"badges":[],"createdAt":"2025-07-11 15:23:23","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-7102999/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-7102999/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":87380477,"identity":"63bb5f97-cb8d-471d-ad08-485086cb8ec4","added_by":"auto","created_at":"2025-07-23 08:34:39","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":81947,"visible":true,"origin":"","legend":"\u003cp\u003eClinical presentation of late bilateral inguinal recurrence of fallopian tube carcinosarcoma, five years after initial remission. Note the subcutaneous mass in the right inguinal region and the large, ulcerated, fungating mass in the left inguinal region.\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/ed6de079798d45f1dae2f629.jpeg"},{"id":87380492,"identity":"988d40eb-cb8f-4c3b-a8fa-1483c6b67a26","added_by":"auto","created_at":"2025-07-23 08:34:40","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":236154,"visible":true,"origin":"","legend":"\u003cp\u003eAxial contrast-enhanced CT scan demonstrating bilateral inguinal masses, consistent with metastatic recurrence of primary fallopian tube carcinosarcoma five years after initial treatment and remission.\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/c33554671aeae05e449b380b.png"},{"id":87380483,"identity":"d42d69c6-5701-4b91-bf3f-3e9d246db8a4","added_by":"auto","created_at":"2025-07-23 08:34:40","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":1190382,"visible":true,"origin":"","legend":"\u003cp\u003eHematoxylin \u0026amp; Eosin-stained section at x10 magnification showing infiltration of the dermis by a biphasic malignant proliferation; an epithelial component made of carcinomatous glands mixed with a sarcomatous component, (Insert): Hematoxylin \u0026amp; Eosin-stained section x200 showing tumor details; glands with highly atypical cells mixed with areas of heterologous elements (liposarcomatous)\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/a091cc3673757ab7292de171.jpeg"},{"id":90568558,"identity":"2b90156f-97d1-4719-8c43-76499cff232b","added_by":"auto","created_at":"2025-09-04 07:54:02","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2091842,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/16c9bc35-d268-4796-8be4-d722cead5b85.pdf"},{"id":87380487,"identity":"1ed0e7ec-1bd6-4354-8838-471b0fca265e","added_by":"auto","created_at":"2025-07-23 08:34:40","extension":"docx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":86884,"visible":true,"origin":"","legend":"","description":"","filename":"Table1.docx","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/10dbb1b48ba4e0b52ffa5c3b.docx"},{"id":87380481,"identity":"58adef2e-4bd1-495a-ad43-0b8d7ccab9ff","added_by":"auto","created_at":"2025-07-23 08:34:39","extension":"docx","order_by":5,"title":"","display":"","copyAsset":false,"role":"supplement","size":80340,"visible":true,"origin":"","legend":"","description":"","filename":"Table2.docx","url":"https://assets-eu.researchsquare.com/files/rs-7102999/v1/338f5a2b482bd40e455dfd2f.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Recurrent Fallopian Tube Carcinosarcoma, Clinical Insights into a Rare and Lethal Gynecologic Tumor: A Case Report and Review of Therapeutic Challenges","fulltext":[{"header":"Introduction","content":"\u003cp\u003eMalignant mixed Müllerian tumors (MMMTs), commonly referred to as carcinosarcomas, represent an exceptionally rare and aggressive subset of neoplasms arising in the female genital tract, accounting for less than 1% of all female genital tract cancers [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. While these biphasic malignancies most frequently originate in the uterus, cervix, or ovaries, primary fallopian tube involvement is exceedingly uncommon, accounting for only 0.1–0.5% of all gynecological malignancies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Among MMMTs, endometrial primaries predominate, making tubal carcinosarcomas a particularly unusual clinical entity with distinct diagnostic and therapeutic challenges. It is even rarer and associated with a poor prognosis due to its aggressive behavior and high recurrence rates [\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e–\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. While relapse typically occurs within two years of initial treatment, recurrence after five years is considered extremely rare [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. This report details an exceptional case of recurrent mixed papillary carcinosarcoma originating in the fallopian tube, which presented as a bilateral inguinal relapse five years after the patient achieved remission.\u003c/p\u003e\u003cp\u003eWe aim to emphasize the diagnostic complexities and therapeutic hurdles encountered in managing this unusual presentation.\u003c/p\u003e\u003cp\u003e\u003c/p\u003e"},{"header":"Case Report","content":"\u003cp\u003eA 68-year-old female presented to our institution in 2019 with a chief complaint of progressive abdominal pain accompanied by significant ascites. Abdominal ultrasound evaluation identified a sizable heterogeneous abdominopelvic mass measuring 160 ×105 × 146 mm, with imaging characteristics suggestive of ovarian origin. Contrast-enhanced CT imaging of the thorax, abdomen, and pelvis further delineated a 14 × 10 × 9 cm pre-uterine pelvic mass, highly suspicious for primary ovarian malignancy, with associated findings concerning for peritoneal carcinomatosis including the presence of ascites. Tumor marker assessment revealed markedly elevated levels of CA-125 (335 U/mL) and CA 15 − 3 (146 U/mL), while ACE levels were within normal limits (0.69 ng/mL).\u003c/p\u003e\u003cp\u003eThe patient underwent exploratory laparotomy, which demonstrated moderate-volume ascites and a 15 cm tumor originating from the left fallopian tube with local invasion into the mesorectum and rectosigmoid region. Several suspicious lymph nodes were noted in the para-aortic region. Intraoperative frozen section analysis confirmed the diagnosis of primary fallopian tube carcinoma.\u003c/p\u003e\u003cp\u003eDue to the extensive local tumor infiltration involving critical structures, complete oncologic resection was not achievable. The surgical team performed maximal palliative cytoreduction, consisting of total hysterectomy, bilateral salpingo-oophorectomy, omentectomy, and appendectomy. The procedure resulted in an R2 resection status, with macroscopic residual tumor measuring greater than 2 cm remaining at the mesorectal region.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eHistopathological and Immunophenotypic Characteristics\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eThe final specimen demonstrated a mixed Müllerian tumor (carcinosarcoma) of bilateral fallopian tubes with: Malignant epithelial components (serous and mucinous adenocarcinoma), and distinct sarcomatous differentiation.\u003c/p\u003e\u003cp\u003eAll examined omental and appendiceal sections were negative for malignancy.\u003c/p\u003e\u003cp\u003eThe tumor exhibited characteristic biphasic morphology with distinct epithelial and mesenchymal differentiation.\u003c/p\u003e\u003cp\u003eThe tumor exhibited biphasic morphology with distinct epithelial and mesenchymal components. The epithelial portion (50–60% of tumor volume) demonstrated high-grade serous carcinoma features with marked nuclear atypia (Grade 3) and frequent mitotic activity (\u0026gt; 20/10 HPF), showing focal mucinous differentiation (10–15%) in a predominantly solid growth pattern with occasional papillary formations and geographic necrosis (30%). The sarcomatous component (40–50%) displayed heterologous chondrosarcomatous differentiation with spindle cell morphology arranged in fascicles, exhibiting extreme nuclear pleomorphism, brisk mitotic activity (\u0026gt; 15/10 HPF), and extensive necrosis (40%). Immunohistochemically, the epithelial component was strongly positive for PAX8 (95%) and WT1 (80%), showed mutant p53 expression, and demonstrated p16 block positivity while being negative for ER/PR and Napsin A. The sarcomatous elements were diffusely vimentin-positive with focal EMA expression (20%), partial SMA positivity (30%), and CD10 reactivity (60%), while retaining RB1 but showing loss of H3K27me3 expression. Molecular profiling revealed a p53 null pattern, MMR proficiency (retained MLH1, PMS2, MSH2, MSH6), negative PD-L1 status (CPS: 5), and HER2/neu negativity (score 0).\u003c/p\u003e\u003cp\u003eThe Tumor was classified as IIIc of FIGO classification.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eAdjuvant treatment\u003c/span\u003e:\u003c/p\u003e\u003cp\u003eThe patient completed six cycles of carboplatin and paclitaxel (Taxol), complicated by grade 1 neuropathy. She was subsequently referred to our institution, the National Cancer Treatment Institute. Post-chemotherapy imaging demonstrated complete resolution of ascites and peritoneal carcinomatosis nodules, along with normalization of CA-125 levels.\u003c/p\u003e\u003cp\u003eDuring the second-look laparotomy, three prevesical peritoneal nodules were identified and subsequently resected. Initial frozen section analysis suggested an inflammatory etiology.\u003c/p\u003e\u003cp\u003eIntraoperatively,\u003c/p\u003e\u003cp\u003eDuring surgery, suspicious lymph nodes were palpated in the lombo-aortic region, prompting a pelvic and lombo-aortic lymph node dissection. All perivesical nodules were completely excised with macroscopically clear margins, achieving an R0 resection. The procedure was completed without postoperative complications.\u003c/p\u003e\u003cp\u003eFinal histopathological examination confirmed these nodules represented sarcomatoid tumor deposits.Comprehensive lymph node evaluation revealed no evidence of metastatic involvement, with 0/18 para-aortic nodes and 0/24 pelvic nodes demonstrating tumor infiltration.\u003c/p\u003e\u003cp\u003eAdjuvant therapy consisted of three additional cycles of carboplatin and paclitaxel. The patient remains under close surveillance in our outpatient oncology clinic.\u003c/p\u003e\u003cp\u003eThe BRCA ½ wasn’t carried out on 2019, due to lack of markers.\u003c/p\u003e\u003cp\u003eDuring a routine follow-up visit in 2024, the patient reported swelling in the groin area.\u003c/p\u003e\u003cp\u003ePhysical examination revealed a 5 cm mobile, pre-ulcerative mass in the right inguinal region, and a 15 cm ulcerated, infected left inguinal mass with restricted mobility (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003eCT imaging demonstrated suspicious lesions in the common femoral chain, concerning either metastatic disease or infectious process (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Serum CA-125 levels were within normal limits. Initial biopsy with histopathological examination proved non-diagnostic. This late locoregional recurrence involving bilateral inguinal regions after a remarkable 5-year disease-free interval is highly unusual and represents a key unique aspect of this case. It resulted in significant oncologic pain syndromes and substantial psychological morbidity, markedly degrading previously stable quality-of-life metrics. The patient underwent bilateral therapeutic inguinal lymphadenectomy. While achieving cytoreductive objectives, the primary intervention goals focused on palliation of tumor-associated symptoms and restoration of functional status, addressing both the somatic manifestations and psychosocial sequelae of disease progression.\u003c/p\u003e\u003cp\u003eFinal pathology confirmed nodal recurrence of carcinosarcoma (pure carcinoma subtype). The ulcerated mass, however, represented mixed carcinosarcoma recurrence without residual lymph node architecture (Fig.\u0026nbsp;3).\u003c/p\u003e\u003cp\u003eBRCA1 mutation analysis is currently pending, and the patient is presently receiving combination chemotherapy with carboplatin, paclitaxel, and bevacizumab.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003ePrimary fallopian tube MMMTs are exceedingly rare, accounting for only 0.1\u0026ndash;0.5% of all gynecologic malignancies [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The present case illustrates the diagnostic challenges, aggressive behavior, and therapeutic dilemmas associated with this malignancy, while also highlighting key prognostic factors derived from a review of existing literature.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eClinical Presentation and Diagnostic Challenges\u003c/span\u003e\u003c/p\u003e\u003cp\u003eFallopian tube malignant mixed M\u0026uuml;llerian tumors (MMMTs) typically present with nonspecific symptoms that mimic more common gynecologic malignancies, making preoperative diagnosis exceptionally challenging [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. The most frequent clinical manifestations include abdominal pain (47.9%), often localized to the hypogastrium and progressive in nature; abnormal vaginal bleeding (34.2%), particularly significant in postmenopausal women; and less commonly, a palpable pelvic mass (6.9%) [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. Our 68-year-old postmenopausal patient\u0026rsquo;s presentation with progressive abdominal pain and significant ascites was highly suggestive of advanced ovarian carcinoma, demonstrating the diagnostic dilemma these tumors pose. Imaging findings further complicate differentiation, as the 14 cm heterogeneous pelvic mass with peritoneal carcinomatosis seen on CT and the markedly elevated CA-125 (335 U/mL) are indistinguishable from ovarian cancer features. The absence of pathognomonic clinical or radiological characteristics means most cases are only definitively diagnosed postoperatively [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], as exemplified by our patient where frozen section analysis during laparotomy was required to confirm the fallopian tube origin. This diagnostic uncertainty underscores the critical importance of intraoperative histopathological evaluation when encountering suspicious adnexal masses, particularly in postmenopausal women with atypical presentations [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. The tumor\u0026rsquo;s ability to masquerade as more common entities like ovarian cancer or even benign conditions such as hydrosalpinx highlights the need for maintaining a high index of suspicion for this rare but aggressive malignancy [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePathological and Molecular Characteristics\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe histopathological evaluation of our case revealed the defining biphasic pattern characteristic of MMMTs, comprising distinct epithelial and mesenchymal components that underscore both the diagnostic challenges and aggressive nature of this malignancy [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The epithelial component (50\u0026ndash;60%) exhibited features of high-grade serous carcinoma, demonstrating strong immunohistochemical positivity for PAX8 (95%) and WT1 (80%), along with a p53 null mutation pattern\u0026mdash;a hallmark of TP53 dysfunction associated with high-grade serologic tumors. This epithelial element showed marked nuclear atypia, frequent mitotic activity (\u0026gt;\u0026thinsp;20/10 HPF), and geographic necrosis, aligning with its highly malignant potential. In contrast, the sarcomatous component (40\u0026ndash;50%) displayed heterologous chondrosarcomatous differentiation, evidenced by spindle cell morphology arranged in fascicles, extreme nuclear pleomorphism, and diffuse vimentin positivity. Notably, the loss of H3K27me3 expression\u0026mdash;a marker of epigenetic dysregulation\u0026mdash;further highlighted the tumor\u0026rsquo;s genomic instability, which is increasingly recognized as a driver of therapeutic resistance and poor outcomes in MMMTs [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eThe presence of heterologous elements (chondrosarcoma) is of particular prognostic significance, as meta-analyses demonstrate it confers a 2.88-fold increased risk of mortality compared to homologous sarcomas (P\u0026thinsp;=\u0026thinsp;0.0247). This aligns with the tumor\u0026rsquo;s aggressive clinical course in our patient, including its capacity for late recurrence. The p53 null phenotype and H3K27me3 loss further stratify risk, as these alterations are linked to chemo resistance and rapid progression. (Table\u0026nbsp;1)\u003c/p\u003e\u003cp\u003eImportantly, the clonal evolution observed in the recurrent inguinal metastasis\u0026mdash;which lost sarcomatoid features\u0026mdash;suggests selective pressure from platinum-taxane therapy, emphasizing the need for repeat biopsy at recurrence to guide subsequent treatment.\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eSurgical and Therapeutic Implications\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe histopathological findings directly informed management [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. The biphasic morphology mandated maximal cytoreduction [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e], including omentectomy (a 65% reduction in mortality risk, P\u0026thinsp;=\u0026thinsp;0.027) and lymphadenectomy (OR\u0026thinsp;=\u0026thinsp;0.37, P\u0026thinsp;=\u0026thinsp;0.05), as residual sarcomatous components are notoriously chemo resistant [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Despite achieving R0 resection during second-look surgery, the tumor\u0026rsquo;s molecular profile (e.g., H3K27me3 loss) may explain its eventual evasion of adjuvant carboplatin/paclitaxel, culminating in late metastasis [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. This case underscores that while histology confirms diagnosis; integrating molecular markers (e.g., p53, H3K27me3) could refine prognostication and therapeutic selection, particularly for heterologous MMMTs where novel agents targeting sarcomatous pathways (e.g., PARP inhibitors in H3K27me3-deficient tumors) may be warranted. (Table\u0026nbsp;1)\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003ePrognostic Factors and Survival Analysis\u003c/span\u003e\u003c/p\u003e\u003cp\u003eA comprehensive review of 85 documented cases (Table\u0026nbsp;2) identified critical factors influencing survival outcomes in fallopian tube MMMT [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. FIGO staging emerged as the most robust prognostic indicator, with Stage I disease demonstrating markedly superior outcomes (OR\u0026thinsp;=\u0026thinsp;0.13, P\u0026thinsp;=\u0026thinsp;0.0007), while advanced-stage tumors (Stage IIIC: OR\u0026thinsp;=\u0026thinsp;2.57, P\u0026thinsp;=\u0026thinsp;0.05; Stage IV: OR\u0026thinsp;=\u0026thinsp;14.98, P\u0026thinsp;=\u0026thinsp;0.01) were associated with significantly worse survival, reflecting the aggressive biology of disseminated disease [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Histologic subtype further refined risk stratification, as tumors exhibiting heterologous differentiation (e.g., chondrosarcomatous elements) portended a 2.88-fold increased mortality risk compared to homologous variants, likely due to enhanced metastatic potential and therapeutic resistance. Surgical outcomes analysis revealed the life-extending value of complete cytoreduction (R0), with median survival durations diverging dramatically (29 months vs. 8 months for R1/R2 resections), underscoring the necessity of maximal debulking efforts, including omentectomy and lymphadenectomy [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Adjuvant therapy data highlighted the supremacy of platinum-taxane regimens (OR\u0026thinsp;=\u0026thinsp;0.27, P\u0026thinsp;=\u0026thinsp;0.007), which reduced mortality risk by 73% compared to untreated patients (OR\u0026thinsp;=\u0026thinsp;3.73) [12\u0026ndash;75]. Our patient\u0026rsquo;s exceptional 5-year survival despite Stage IIIC disease\u0026mdash;far exceeding the typical 16.1-month median\u0026mdash;may reflect both the achievement of R0 status during second-look surgery and the initial responsiveness to carboplatin/paclitaxel. However, her late inguinal recurrence (5 years post-treatment) exemplifies the propensity for delayed, unpredictable metastases in MMMT, mandating indefinite surveillance even after prolonged remission. These findings collectively emphasize that while aggressive cytoreduction and platinum-based chemotherapy form the therapeutic backbone, the heterologous histology and advanced stage inherent to most cases necessitate novel strategies to address residual micrometastatic disease and clonal evolution [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eQuality of Life Considerations\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe aggressive nature of fallopian tube carcinosarcoma and its intensive treatment regimen impose significant quality of life (QoL) burdens that extend beyond survival outcomes. These challenges manifest across physical, psychological, and socioeconomic domains, necessitating comprehensive supportive care strategies.\u003c/p\u003e\n\u003ch3\u003e1. Physical Impact\u003c/h3\u003e\n\u003cp\u003eThe cumulative effects of treatment leave lasting physical impairments. Platinum-taxane chemotherapy, while effective, frequently causes chronic neuropathy\u0026mdash;as seen in our patient\u0026rsquo;s grade 1 paclitaxel-induced symptoms\u0026mdash;resulting in persistent pain, sensory deficits, and reduced manual dexterity that compromise daily activities [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]. Surgical interventions carry additional risks; inguinal lymphadenectomy predisposes patients to lymphedema, with 15\u0026ndash;30% of gynecologic cancer patients developing this chronic complication according to recent studies [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. In advanced or recurrent cases like ours, ulcerated tumor masses create superimposed challenges, requiring repeated palliative procedures to manage pain, infection risk, and exudate control [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These intersecting physical morbidities underscore the need for proactive rehabilitation and symptom-focused interventions.\u003c/p\u003e\n\u003ch3\u003e2. Psychological Burden\u003c/h3\u003e\n\u003cp\u003eThe unpredictable disease course generates profound emotional distress. Our patient\u0026rsquo;s 5-year disease-free interval\u0026mdash;while clinically favorable\u0026mdash;paradoxically heightened anxiety during surveillance, as each follow-up visit carried the possibility of late recurrence. This phenomenon is particularly acute in rare cancers, where limited patient support networks exacerbate feelings of isolation [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. A 2022 Psycho-Oncology study found that 42% of rare gynecologic cancer patients meet criteria for clinical anxiety, yet fewer than 20% receive specialized mental health support [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. The diagnostic odyssey and treatment complexities inherent to carcinosarcoma further compound this psychological toll.\u003c/p\u003e\n\u003ch3\u003e3. Social and Economic Factors\u003c/h3\u003e\n\u003cp\u003eProlonged illness trajectories strain both patients and caregivers. In resource-limited settings like ours, the financial toxicity of repeated imaging, extended chemotherapy regimens, and unplanned hospitalizations can be catastrophic. Data from low-middle income countries show that 28\u0026ndash;35% of gynecologic cancer patients face treatment non-adherence due to cost barriers [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Concurrently, family caregivers\u0026mdash;who average 32 hours/week of caregiving in advanced cancer\u0026mdash;experience role strain, employment disruptions, and secondary health declines [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. These intersecting vulnerabilities create a cycle where socioeconomic factors directly impact treatment access and outcomes. As highlighted by Barbera et al. (2020) in their work on financial toxicity in gynecologic oncology, these economic burdens can significantly impact patient well-being and treatment adherence [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\n\u003ch3\u003e4. Recommendations for QoL Integration\u003c/h3\u003e\n\u003cp\u003eAddressing these multidimensional challenges requires systematic interventions:\u003c/p\u003e\u003cp\u003eMultidisciplinary Care: Embedding palliative teams at diagnosis (rather than end-stage) improves symptom control and reduces emergency presentations [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. The ESMO guidelines demonstrate 22% fewer hospital readmissions with early palliative integration [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eTargeted Supportive Therapies: Evidence-based interventions\u0026mdash;including graded exercise for neuropathy, compression garments for lymphedema, and cognitive-behavioral therapy for distress\u0026mdash;should be protocolized [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. A 2023 Lancet Oncology meta-analysis showed such approaches improve functional status by 31% in advanced cancer patients [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. The proactive use of Patient-Reported Outcomes (PROs), as discussed by Greimel et al. (2017) in the context of ovarian cancer, can significantly enhance the monitoring of patient well-being and facilitate timely interventions to improve QoL[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003cp\u003eThese measures must be tailored to resource availability, with task-shifting strategies (training nurses in basic distress screening) proving effective in constrained environments. By institutionalizing QoL monitoring alongside traditional oncologic endpoints, we can deliver truly patient-centered care for this challenging malignancy [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cspan type=\"Underline\" class=\"Underline\" name=\"Emphasis\"\u003eTherapeutic Challenges and Future Directions\u003c/span\u003e\u003c/p\u003e\u003cp\u003eThe management of fallopian tube MMMT is evolving with advances in molecular profiling and targeted therapies [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan additionalcitationids=\"CR19\" citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. BRCA testing remains critical in our patient\u0026rsquo;s case, as identification of homologous recombination deficiency (HRD) could expand treatment options to include PARP inhibitors, which have shown efficacy in other HRD-associated gynecologic malignancies. While data specific to MMMT are limited, the potential for synthetic lethality in BRCA-mutated or HRD-positive tumors offers a promising avenue for improving outcomes in this aggressive disease [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e].\u003c/p\u003e\u003cp\u003eIn the realm of immunotherapy, the tumor\u0026rsquo;s PD-L1 negativity (CPS: 5) suggests limited utility for conventional immune checkpoint inhibitors [85]. However, the observed H3K27me3 loss\u0026mdash;a marker of epigenetic dysregulation\u0026mdash;opens doors for investigating novel agents targeting chromatin remodeling pathways, such as EZH2 inhibitors, which are under exploration in sarcomas and other malignancies with similar molecular alterations [2,85]. Additionally, the tumor\u0026rsquo;s high mutational burden or microsatellite instability status, if present, could further guide immunotherapeutic strategies [6, 19, 85].\u003c/p\u003e\u003cp\u003eThe heterologous sarcoma component, particularly the chondrosarcomatous differentiation, presents unique therapeutic challenges. Conventional platinum-taxane chemotherapy, while effective for the epithelial component, often fails to address the sarcomatous elements, which may drive resistance and recurrence [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e]. This underscores the need for sarcoma-directed regimens, such as ifosfamide/doxorubicin, especially in cases with predominant or recurrent sarcomatous features. The integration of such regimens into the treatment paradigm, either sequentially or in combination with platinum-based therapy, warrants clinical investigation to determine optimal sequencing and tolerability.\u003c/p\u003e\u003cp\u003eMoving forward, multidisciplinary collaboration and molecular profiling will be essential to tailor therapy for fallopian tube MMMT [86]. Clinical trials exploring PARP inhibitors, epigenetic modulators, and sarcoma-specific regimens are needed to address the unique biology of this rare and aggressive malignancy [85\u0026ndash;87]. Our patient\u0026rsquo;s case highlights the importance of a personalized approach, leveraging both existing and emerging therapies to improve survival and quality of life.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis case highlights the diagnostic and therapeutic challenges posed by fallopian tube carcinosarcoma, a rare and aggressive malignancy with a propensity for recurrence and progression. Despite initial surgical intervention and adjuvant chemotherapy, the patient experienced disease recurrence in the inguinal region, underscoring the limitations of current treatment modalities. The dual carcinomatous and sarcomatous components of this tumor contribute to its aggressive behavior and poor prognosis, necessitating a multidisciplinary approach to management.\u003c/p\u003e\u003cp\u003eEarly recognition, thorough diagnostic evaluation, and timely intervention are critical in managing this rare malignancy. Furthermore, the development of novel therapeutic strategies, such as targeted therapies and immunotherapy, may offer hope for improved outcomes in the future. This case serves as a reminder of the importance of vigilance in follow-up care and the need for ongoing research to better understand and treat fallopian tube carcinosarcoma.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eNR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNot reported\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eDOD\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eDead of disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eNED\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eNo evidence of disease\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eIHC\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eImmunohistochemistry\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003cdiv class=\"DefinitionListEntry\"\u003e\u003cdiv class=\"Term\"\u003e\u0026bull; \u003cb\u003eMMR\u003c/b\u003e\u003c/div\u003e\u003cdiv class=\"Description\"\u003e\u003cp\u003eMismatch repair\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate:\u003c/strong\u003e\u003cp\u003eThis case report was conducted in accordance with the ethical standards of our institutional research committee and with the 1964 Helsinki declaration and its later amendments. Informed consent was obtained from the patient for inclusion in this study.\u003c/p\u003e\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eConsent for publication:\u003c/strong\u003e\u003cp\u003eWritten informed consent was obtained from the patient for publication of this case report and accompanying images.\u003c/p\u003e\u003c/p\u003e\u003ch2\u003eFunding:\u003c/h2\u003e\u003cp\u003eNo funding was received for this case report.\u003c/p\u003e\u003cp\u003eCompeting interests: The authors declare that they have no competing interests.\u003c/p\u003e\u003cp\u003eAvailability of data and materials: All data generated or analyzed during this study are included in this published article. Additional data are available from the corresponding author on reasonable request.\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eS J: Concepts, Design, Definition of intellectual content, Literature search, Clinical studies, Data analysis, Manuscript preparation and editingM B: Definition of intellectual content, Literature searchS B: Literature searchO J: Clinical studiesA K: Data acquisition, MaterialsH B: MaterialsT BD: Manuscript review, Guarantor/SupervisionAll authors reviewed and approved the submitted manuscript.\u003c/p\u003e\u003ch2\u003eAcknowledgments:\u003c/h2\u003e\u003cp\u003eThe authors would like to thank the pathology and radiology departments for their assistance in diagnosis and management of this case.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eKuboya T, Kato K, Sasaki J. Carcinosarcoma of the fallopian tube: A rare case with rapid metastases and port-site metastasis. Int J Surg Case Rep.\u0026nbsp;2025 Feb 1;127:110889.\u003c/li\u003e\n \u003cli\u003eCozlea AL, Gheorghe M, Kiss SL, Fandi A, Stanca M, Mocan S, et al.\u0026nbsp;Malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: Case report and literature review. Exp Ther Med. 2022 Feb;23(2):177.\u003c/li\u003e\n \u003cli\u003eRaghuvanshi S, Gupta N, Yadav K, Chaudhary S, Mithilesh null, Kumar M, et al.\u0026nbsp;Malignant Mixed Mullerian Tumor (Carcinosarcoma) in the Female Genital Tract: A Retrospective Study From a Single Center in North India. Cureus. 2024 Oct;16(10):e72317.\u003c/li\u003e\n \u003cli\u003eBashour BN, Mancer K, Rance CP. Malignant mixed mullerian tumor of the cervix following cyclophosphamide therapy for nephrotic syndrome. J Pediatr. 1973 Feb;82(2):292-3.\u003c/li\u003e\n \u003cli\u003eTang LS, Zhou YW, Wang JL, Zhang GX, Xu CH, Liu JY, et al.\u0026nbsp;Epidemiology, site-specific characteristics and survival of carcinosarcoma: a retrospective study based on SEER database. BMJ Open. 2023 Dec 14;13(12):e077974.\u003c/li\u003e\n \u003cli\u003eXiao X, Ma R, Shi L, Wang C, Chen J, Lu Y, et al.\u0026nbsp;Case Report: Stage IIIc primary malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: A case of 5-year disease-free survival after cytoreductive surgery combined with peritoneal resection and adjuvant chemotherapy with paclitaxel plus carboplatin. Front Oncol. 2022;12:1054307. Available from: https://www.frontiersin.org/journals/oncology/articles/10.3389/fonc.2022.1054307/full\u003c/li\u003e\n \u003cli\u003eBeijers AJM, Mols F, Vreugdenhil G. A systematic review on chronic oxaliplatin-induced peripheral neuropathy and the relation with oxaliplatin administration. Support Care Cancer Off J Multinatl Assoc Support Care Cancer. 2014 Jul;22(7):1999-2007.\u003c/li\u003e\n \u003cli\u003eStout NL, Weiss R, Feldman JL, Stewart BR, Armer JM, Cormier JN, et al.\u0026nbsp;A systematic review of care delivery models and economic analyses in lymphedema: health policy impact (2004-2011). Lymphology. 2013 Mar;46(1):27-41.\u003c/li\u003e\n \u003cli\u003ePillai RK, Jayasree K. Rare cancers: Challenges \u0026amp; issues. Indian J Med Res. 2017 Jan;145(1):17-27.\u003c/li\u003e\n \u003cli\u003eGoerling U, Hinz A, Koch-Gromus U, Hufeld JM, Esser P, Mehnert-Theuerkauf A. Prevalence and severity of anxiety in cancer patients: results from a multi-center cohort study in Germany. J Cancer Res Clin Oncol. 2023;149(9):6371-9.\u003c/li\u003e\n \u003cli\u003eYabroff KR, Dowling EC, Guy GP, Banegas MP, Davidoff A, Han X, et al.\u0026nbsp;Financial Hardship Associated With Cancer in the United States: Findings From a Population-Based Sample of Adult Cancer Survivors. J Clin Oncol Off J Am Soc Clin Oncol. 2016 Jan 20;34(3):259-67.\u003c/li\u003e\n \u003cli\u003eLambert SD, Harrison JD, Smith E, Bonevski B, Carey M, Lawsin C, et al.\u0026nbsp;The unmet needs of partners and caregivers of adults diagnosed with cancer: a systematic review. BMJ Support Palliat Care. 2012 Sept;2(3):224-30.\u003c/li\u003e\n \u003cli\u003eSmith AJ, Sharma MH, Powell K, Doherty M, Hinkle SN, Ko EM. Financial toxicity in gynecologic oncology: a multi-practice survey. Int J Gynecol Cancer Off J Int Gynecol Cancer Soc. 3 juin 2024;34(6):919‑25.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eFerrell BR, Temel JS, Temin S, Alesi ER, Balboni TA, Basch EM, et al.\u0026nbsp;Integration of Palliative Care Into Standard Oncology Care: American Society of Clinical Oncology Clinical Practice Guideline Update. J Clin Oncol Off J Am Soc Clin Oncol. 2017 Jan;35(1):96-112.\u003c/li\u003e\n \u003cli\u003eSchrijvers D, Cherny NI. ESMO Clinical Practice Guidelines on palliative care: advanced care planning \u0026dagger;. Ann Oncol. 2014 Sept 1;25:iii138-42.\u003c/li\u003e\n \u003cli\u003eExercise interventions on health-related quality of life for cancer survivors (Review). ResearchGate. Available from: https://www.researchgate.net/publication/230678747_Exercise_interventions_on_health-related_quality_of_life_for_cancer_survivors_Review\u003c/li\u003e\n \u003cli\u003eKargo AS, Coulter A, Jensen PT, Steffensen KD. Proactive use of PROMs in ovarian cancer survivors: a systematic review. J Ovarian Res. 15 juill 2019;12:63.\u0026nbsp;\u003c/li\u003e\n \u003cli\u003eGautama MSN, Huang TW, Haryani H, Khalish G, Liu AI, Wibawa YA. Managing Cancer and Living Meaningfully (CALM) Therapy for Improving the Quality of Life of Patients With Cancer: A Meta-Analysis of Randomised Controlled Trials. J Clin Nurs. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/jocn.17754\u003c/li\u003e\n \u003cli\u003eIsmail A, Choi S, Boussios S. Frontiers of Ovarian Carcinosarcoma. Curr Treat Options Oncol. 2023 Dec;24(12):1667-82.\u003c/li\u003e\n \u003cli\u003eBoussios S, Karathanasi A, Zakynthinakis-Kyriakou N, Tsiouris AK, Chatziantoniou AA, Kanellos FS, et al.\u0026nbsp;Ovarian carcinosarcoma: Current developments and future perspectives. Crit Rev Oncol Hematol. 2019 Feb;134:46-55.\u003c/li\u003e\n \u003cli\u003eSohrabi C, Mathew G, Maria N, Kerwan A, Franchi T, Agha RA, et al.\u0026nbsp;The SCARE 2023 guideline: updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg Lond Engl. 2023 May 1;109(5):1136-40.\u003c/li\u003e\n \u003cli\u003eTsai CP, Ho ESC, Ke YM, Hsu ST, Wang RC, Lu CH. Stage III malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: a case of 5-year survival after optimal debulking and adjuvant chemotherapy with paclitaxel plus carboplatin. Taiwan J Obstet Gynecol. 2012 Jun;51(2):294-6.\u003c/li\u003e\n \u003cli\u003eKawaguchi W, Itamochi H, Kigawa J, Kanamori Y, Oishi T, Shimada M, et al.\u0026nbsp;Chemotherapy consisting of paclitaxel and carboplatin benefits a patient with malignant mixed m\u0026uuml;llerian tumor of the fallopian tube. Int J Clin Oncol. 2008 Oct;13(5):461-3.\u003c/li\u003e\n \u003cli\u003eImachi M, Tsukamoto N, Shigematsu T, Watanabe T, Uehira K, Amada S, et al.\u0026nbsp;Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube: Report of two cases and review of literature. Gynecol Oncol. 1992 Oct;47(1):114-24.\u003c/li\u003e\n \u003cli\u003eSur le Carcinome Primaire Dans la Trompe De Fallope: (Avec Expos\u0026eacute; D\u0026rsquo;un Cas): Acta Obstetricia et Gynecologica Scandinavica: Vol 13 , No 3 - Get Access.\u0026nbsp;Available from: https://www.tandfonline.com/doi/pdf/10.3109/00016343309155377\u003c/li\u003e\n \u003cli\u003e\u0026Uuml;ber sechs weitere F\u0026auml;lle von prim\u0026auml;rem Tubencarcinom | Archives of Gynecology and Obstetrics. Available from: https://link.springer.com/article/10.1007/BF01714947\u003c/li\u003e\n \u003cli\u003eBochner K. Primary Uterine Tube Malignancy. Obstet Gynecol. 1961 Dec;18(6):767.\u003c/li\u003e\n \u003cli\u003eObstetrics \u0026amp; Gynecology. Available from: https://journals.lww.com/greenjournal/citation/1964/03000/malignant_mixed_\nm_llerian_tumor_primary_in_uterine.3.aspx\u003c/li\u003e\n \u003cli\u003ePrimary Carcinosarcoma of the Fallopian Tube | Gynecologic and Obstetric Investigation | Karger Publishers. Available from: https://karger.com/goi/article-abstract/156/4/203/386574/Primary-Carcinosarcoma-of-the-Fallopian-Tube\u003c/li\u003e\n \u003cli\u003eMcQUEENEY AJ, Carswell BL, Sheehan WJ. Malignant Mixed M\u0026uuml;llerian Tumor Primary in Uterine Tube: Review of the Literature and Report of an Additional Case. Obstet Gynecol. 1964 Mar;23(3):338.\u003c/li\u003e\n \u003cli\u003eObstetrics \u0026amp; Gynecology. Available from: https://journals.lww.com/greenjournal/abstract/1970/10000/malignant_ mixed_mullerian_tumor_of_the_fallopian.10.aspx\u003c/li\u003e\n \u003cli\u003eObstetrics \u0026amp; Gynecology. Available from: https://journals.lww.com/greenjournal/citation/1973/05000/Malignant_Mixed_ M_llerian_Tumor_of_the_Uterine.13.aspx\u003c/li\u003e\n \u003cli\u003eAcosta AA, Kaplan AL, Kaufman RH. Mixed M\u0026uuml;llerian Tumors of the Oviduct. Obstet Gynecol. 1974 Jul;44(1):84.\u003c/li\u003e\n \u003cli\u003eAggarwal S, Devi PK and Aikat M: Malignant mixed M\u0026uuml;llerian tumour of the fallopian tube. J Obstet Gynaecol India 85: 224-236, 1976\u003c/li\u003e\n \u003cli\u003eCarcinosarcoma and mixed m\u0026ouml;erian tumors of the fallopian tube. Report of four cases - Manes - 1976 - Cancer - Wiley Online Library. Available from: https://acsjournals.onlinelibrary.wiley.com/doi/abs/10.1002/1097-0142(197610)38:4%3C1687::AID-CNCR2820380441%3E3.0.CO;2-H\u003c/li\u003e\n \u003cli\u003eHenderson SR, Harper RC, Salazar OM, Rudolph JH. Primary carcinoma of the fallopian tube: Difficulties of diagnosis and treatment. Gynecol Oncol. 1977 Jun 1;5(2):168-79.\u003c/li\u003e\n \u003cli\u003eMixed mesodermal tumor of the fallopian tube: report of a case and review of literature. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/199800\u003c/li\u003e\n \u003cli\u003eMalignant mixed M\u0026uuml;llerian tumors. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/209372\u003c/li\u003e\n \u003cli\u003eHanjani P, Petersen RO, Bonnell SA. Malignant mixed Mullerian tumor of the fallopian tube: Report of a case and review of literature. Gynecol Oncol. 1980 Jun 1;9(3):381-93.\u003c/li\u003e\n \u003cli\u003eCARCINOSARCOMA OF THE FALLOPIAN TUBE: A CASE REPORT AND REVIEW OF THE LITERATURE - Viniker - 1980 - BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1980.tb04591.x\u003c/li\u003e\n \u003cli\u003eHolst N. Mixed mesodermal tumor of the fallopian tube: a case report. Ann Chir Gynaecol. 1981;70:207. Available from: https://cir.nii.ac.jp/crid/1370004235724097035\u003c/li\u003e\n \u003cli\u003eAbstract - Europe PMC.\u0026nbsp;Available from: https://europepmc.org/article/med/7161756\u003c/li\u003e\n \u003cli\u003e[Heterotopic mesodermal tumor of the fallopian tube]. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/6280648\u003c/li\u003e\n \u003cli\u003eKahanp\u0026auml;\u0026auml; KV, Laine R, Saksela E. Malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: Report of a case with 5-year survival. Gynecol Oncol. 1983 Aug 1;16(1):144-9.\u003c/li\u003e\n \u003cli\u003eDeppe G, Zbella E, Friberg J, Thomas W. Combination chemotherapy for mixed M\u0026uuml;llerian tumor of the fallopian tube. Cancer. 1984;54(8):1517-20.\u003c/li\u003e\n \u003cli\u003eAbstract - Europe PMC. Available from: https://europepmc.org/article/med/3863524\u003c/li\u003e\n \u003cli\u003eMalignant mixed m\u0026uuml;llerian tumor of the fallopian tube. - Abstract - Europe PMC. Available from: https://europepmc.org/article/med/3030230\u003c/li\u003e\n \u003cli\u003eMalignant mixed mesodermal tumour of the fallopian tube - YABUSHITA - 1987 - BJOG: An International Journal of Obstetrics \u0026amp; Gynaecology - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-0528.1987.tb02347.x\u003c/li\u003e\n \u003cli\u003eChen KTK, Wolk RW. Extragenital malignant mixed m\u0026uuml;llerian tumor. Gynecol Oncol. 1988 Jul 1;30(3):422-6.\u003c/li\u003e\n \u003cli\u003eMuntz HG, Rutgers JL, Tarraza HM, Fuller AF. Carcinosarcomas and mixed m\u0026uuml;llerian tumors of the fallopian tube. Gynecol Oncol. 1989 Jul 1;34(1):109-15.\u003c/li\u003e\n \u003cli\u003eAxelrod JH, Herbold DR, Freel JH. Carcinosarcoma of the fallopian tube. Gynecol Oncol. 1989 Mar 1;32(3):398-400.\u003c/li\u003e\n \u003cli\u003eKinoshita M, Asano S, Yamashita M, Matsuda T. Mesodermal mixed tumor primary in the fallopian tube. Gynecol Oncol. 1989 Mar 1;32(3):331-5.\u003c/li\u003e\n \u003cli\u003eMalignant mixed M\u0026uuml;llerian tumour of the fallopian tube - DIJK - 1990 - Histopathology - Wiley Online Library. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1365-2559.1990.tb01120.x\u003c/li\u003e\n \u003cli\u003eSeraj IM, King A, Chase D. Malignant mixed m\u0026uuml;llerian tumor of the oviduct. Gynecol Oncol. 1990 May 1;37(2):296-301.\u003c/li\u003e\n \u003cli\u003eLiang WW, Lin YN, Lee YN. Malignant mixed m\u0026uuml;llerian tumor of fallopian tube. Report of a case and review of literature. Zhonghua Yi Xue Za Zhi Chin Med J Free China Ed. 1990 Apr 1;45(4):272-5.\u003c/li\u003e\n \u003cli\u003eChang HC, Hsueh S, Soong YK. Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube. Case report and review of the literature. Chang Yi Xue Za Zhi. 1991 Dec 1;14(4):259-63.\u003c/li\u003e\n \u003cli\u003eChiou YK, Su IJ, Chen CA, Hsieh CY. Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube. J Formos Med Assoc Taiwan Yi Zhi. 1991 Aug 1;90(8):793-5.\u003c/li\u003e\n \u003cli\u003eMoore DT, Taslimi MM, Kosanovich M. Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube of the heterologous type. J Tenn Med Assoc. 1992 Nov 1;85(11):513-4.\u003c/li\u003e\n \u003cli\u003eCarlson Jr.\u0026nbsp;JA, Ackerman BL, Wheeler JE. Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube. Cancer. 1993;71(1):187-92.\u003c/li\u003e\n \u003cli\u003eWeber AM, Hewett WF, Gajewski WH, Curry SL. Malignant Mixed Mullerian Tumors of the Fallopian Tube. Gynecol Oncol. 1993 Aug 1;50(2):239-43.\u003c/li\u003e\n \u003cli\u003eMalignant mixed miillerian tumor of the fallopian tube - Zorlu - 1994 - Acta Obstetricia et Gynecologica Scandinavica - Wiley Online Library. Available from: https://obgyn.onlinelibrary.wiley.com/doi/abs/10.3109/00016349409015779\u003c/li\u003e\n \u003cli\u003eHorn LC, Werschnik C, Bilek K, Emmert C. Diagnosis and clinical management in malignant M\u0026uuml;llerian tumors of the fallopian tube. Arch Gynecol Obstet. 1996 Mar 1;258(1):47-53.\u003c/li\u003e\n \u003cli\u003eEbert AD, Perez-Canto A, Schaller G, Entezami M, Hopp HS, Weitzel HK. Stage I primary malignant mixed m\u0026uuml;llerian tumor of the fallopian tube. Report of a case with five-year survival after minimal surgery without adjuvant treatment. J Reprod Med. 1998 Jul 1;43(7):598-600.\u003c/li\u003e\n \u003cli\u003eCase Report Malignant mixed mullerian tumour of the fallopian tube occurring in a patient with Peutz\u0026ndash;Jegher\u0026rsquo;s syndrome. | EBSCOhost. Available from: https://openurl.ebsco.com/EPDB%3Agcd%3A11%3A10605611/detailv2?sid=ebsco%3Aplink%3Ascholar\u0026amp;id=ebsco%3Agcd%3A11979082\u0026amp;crl=c\u0026amp;link_origin=scholar.google.com\u003c/li\u003e\n \u003cli\u003eMoustafa M, Beynon DWG, Elmahallawy M. Primary malignant mixed Mullerian tumour of the fallopian tube. J Obstet Gynaecol. 2004 Jan 1. Available from: https://www.tandfonline.com/doi/abs/10.1080/01443610400018825\u003c/li\u003e\n \u003cli\u003eHumble S, Carter E. Pathologic Quiz Case: A Right Adnexal Mass in a Postmenopausal Patient. Arch Pathol Lab Med. 2004 Nov 1;128(11):e161-2.\u003c/li\u003e\n \u003cli\u003eLim BJ, Kim JW, Yang WI and Cho NH: Malignant mixed M\u0026uuml;llerian tumor of fallopian tube with multiple distinct heterologous components. Int J Gynecol Cancer. 14:690-693. 2004.\u003c/li\u003e\n \u003cli\u003eEurope PMC. Available from: https://europepmc.org/article/med/16761749\u003c/li\u003e\n \u003cli\u003eHudelist: Malignant mixed Mullerian tumor with heterologo\u0026hellip; - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20Gynaecol%20Oncol\u0026amp;title=Malignant%20mixed%20M%C3%BCllerian%20tumor%20with%20het erologous%20component%20arising%20in%20the%20fallopian%20tube-a%20case%20report\u0026amp;author=G%20Hudelist\u0026amp;author= K%20Unterrieder\u0026amp;author=O%20Kandolf\u0026amp;author=G%20Alpi\u0026amp;author=S%20Pucher\u0026amp;volume=2 7\u0026amp;publication_year=2006\u0026amp;pages=509-512\u0026amp;pmid=17139989\u0026amp;\u003c/li\u003e\n \u003cli\u003eMalignant m\u0026uuml;llerian mixed tumor (carcinosarcoma) of the fallopian tube: an immunohistochemical study of neoplastic cells - KURODA - 2005 - APMIS - Wiley Online Library. Available from: https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1600-0463.2005.apm_265.x\u003c/li\u003e\n \u003cli\u003eChemotherapy consisting of paclitaxel and carboplatin benefits a patient with malignant mixed m\u0026uuml;llerian tumor of the fallopian tube | International Journal of Clinical Oncology. Available from: https://link.springer.com/article/10.1007/s10147-008-0767-1\u003c/li\u003e\n \u003cli\u003eKourea: Fallopian tube malignant mixed m\u0026uuml;llerian\u0026hellip; - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20 Gynaecol%20Oncol\u0026amp;title=Fallopian%20tube% 20malignant%20mixed %20M%C3%BCllerian%20 tumor%20(carcinosarcoma):\n %20A%20case%20report%20with%20 immunohistochemical%20p rofiling\u0026amp;author=HP%20Kourea\u0026amp;author=G%20Adonakis\u0026amp;author=G%20 \nAndroutsopoulos\u0026amp;author=P%20Zyli\u0026amp;author=G%20Kourounis\u0026amp;volume=29\u0026amp;publication_year=2008\u0026amp;pages=538-542\u0026amp;pmid=19051831\u0026amp;\u003c/li\u003e\n \u003cli\u003eCarcinosarcoma of the fallopian tube with metastasis of its epithelial component to the ovary, appendix and omentum: Journal of Obstetrics and Gynaecology: Vol 29 , No 6 - Get Access. Available from: https://www.tandfonline.com/doi/full/10.1080/01443610902780815\u003c/li\u003e\n \u003cli\u003eShen YM, Xie YP, Xu L, Yang KX, Yu N, Yu Y, et al.\u0026nbsp;Malignant mixed m\u0026uuml;llerian tumor of the fallopian tube: report of two cases and review of literature. Arch Gynecol Obstet. 2010 Jun 1;281(6):1023-8.\u003c/li\u003e\n \u003cli\u003eHeterologous Malignant Mixed M\u0026uuml;llerian Tumor of the Uterus and Fallopian Tube: A Case Report | Journal of Gynecologic Surgery. Available from: https://www.liebertpub.com/doi/abs/10.1089/gyn.2010.0094\u003c/li\u003e\n \u003cli\u003eWatanabe: Malignant mixed M\u0026uuml;llerian tumor of the\u0026hellip; - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20Gynaecol%20Oncol\u0026amp;title=Malignant%20mixed% 20M%C3%BCllerian%20tumor%20of%20the% 20fallopian%20tube:%20A%20case%20report\u0026 \namp;author=T%20Watanabe\u0026amp;author=T%20Sugino\u0026amp;author= S%20Furukawa\u0026amp;author=S%20Soeda\u0026amp;author=H%20Nishiyama \u0026amp;volume=33\u0026a mp;publication_year=2012\u0026amp;pages=223-226\u0026amp;pmid=22611970\u0026amp;\u003c/li\u003e\n \u003cli\u003eTsai CP, Ho ESC, Ke YM, Hsu ST, Wang RC, Lu CH. Stage III malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: a case of 5-year survival after optimal debulking and adjuvant chemotherapy with paclitaxel plus carboplatin. Taiwan J Obstet Gynecol. 2012 Jun;51(2):294-6.\u003c/li\u003e\n \u003cli\u003eGupta R, Jenison EL. A rare case of carcinosarcoma of the fallopian tube presenting with torsion, rupture and hemoperitoneum. Gynecol Oncol Case Rep.\u0026nbsp;2011 Nov 11;2(1):4-5.\u003c/li\u003e\n \u003cli\u003eTakemoto Y, Ota T, Aoki Y, Ogura K, Ogishima D, Matsumoto T. Carcinosarcoma of the fallopian tube with disappearance of carcinoma cells by neoadjuvant chemotherapy: case study. Eur J Gynaecol Oncol. 2015;36(5):618-22.\u003c/li\u003e\n \u003cli\u003eNarin: Primary fallopian tube carcinosarcoma: Report\u0026hellip; - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Yeditepe%20Med%20J\u0026amp;title=Primary%20fallopian%20tube% 20carcinosarcoma:%20Report%20of%20two%20cases\u0026amp;author=MA% 20Narin\u0026amp;author=D%20Basaran\u0026amp;author=A%20Karalok\u0026amp;author=T%20Turan\u0026amp;author=G%20Tulunay \u0026amp;volume=11\u0026amp;publication_year=2015\u0026amp;pages=945-948\u0026amp;\u003c/li\u003e\n \u003cli\u003eVale-Fernandes E, Rodrigues F, Serrano P, Silva AI.\u0026nbsp;Primary malignant mixed M\u0026uuml;llerian tumour of the fallopian tube: a rare and difficult but possible diagnosis. Case Rep.\u0026nbsp;2015 Mar 16;2015:bcr2014209268.\u003c/li\u003e\n \u003cli\u003ePrimary malignant mixed M\u0026uuml;llerian tumor of the fallopian tube after subtotal hysterectomy: A case report and literature review | Archives of Gynecology and Obstetrics. Available from: https://link.springer.com/article/10.1007/s00404-014-3611-z\u003c/li\u003e\n \u003cli\u003eMonsalve N, Santos M, Petrosino P, Arenas A, S\u0026aacute;nchez Z. http://ve.scielo.org/scielo.php?script=sci_abstract\u0026amp;pid=S0048-77322015000300009\u0026amp;lng=es\u0026amp;nrm=iso\u0026amp;tlng=es.\u0026nbsp;Rev Obstet Ginecol Venezuela. 2015 Sept;75(3):212-6.\u003c/li\u003e\n \u003cli\u003eZhang Q, Liu A, Wu JJ, Niu M, Zhao Y, Tian SF, et al.\u0026nbsp;Primary malignant mixed M\u0026uuml;llerian tumors of the fallopian tube with cervix metastasis: A rare case report and literature review. Medicine (Baltimore). 2018 Jul;97(28):e11311.\u003c/li\u003e\n \u003cli\u003eB\u0026eacute;csi: Malignant mixed M\u0026uuml;llerian tumor of fallopian\u0026hellip; - Google Scholar. Available from: https://scholar.google.com/scholar_lookup?journal=Eur%20J%20 Gynaecol%20Oncol\u0026amp;title=Malignant%20mixed%20M%C3%BCllerian%20tumor%20of%20fallopian% 20tube:%20Report% 20of%20a%20case%20and%20review%20of%20the%20literature\u0026amp;author=J%20B%C3%A9csi\u0026 amp;author=B%20Szab %C3%B3\u0026amp;author=T%20Szab%C3%B3\u0026amp;author=M%20Onu%C8%99\u0026amp;author=S% 20Mocan\u0026amp;volume=11\u0026amp;publication_year=2019\u0026amp;pages=143-147\u0026amp;\u003c/li\u003e\n \u003cli\u003eXiao X, Ma R, Shi L, Wang C, Chen J, Lu Y, et al.\u0026nbsp;Case Report: Stage IIIc primary malignant mixed M\u0026uuml;llerian tumor of the fallopian tube: A case of 5-year disease-free survival after cytoreductive surgery combined with peritoneal resection and adjuvant chemotherapy with paclitaxel plus carboplatin. Front Oncol. 2022;12:1054307.\u003c/li\u003e\n \u003cli\u003eDaniyal M, Polani AS, Canary M. Ovarian Carcinosarcoma and Response to Immunotherapy. Cureus. 2023 Apr;15(4):e37149.\u003c/li\u003e\n \u003cli\u003eHacking S, Chavarria H, Jin C, Perry A, Nasim M. Landscape of Immune Checkpoint Inhibition in Carcinosarcoma (MMMT): Analysis of IDO-1, PD-L1 and PD-1. Pathol Res Pract. 2020 Apr;216(4):152847.\u003c/li\u003e\n \u003cli\u003ePinto A, Mackrides N, Nadji M. PD-L1 Expression in Carcinosarcomas of the Gynecologic Tract: A Potentially Actionable Biomarker. Appl Immunohistochem Mol Morphol AIMM. 2018 Jul;26(6):393-7.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTable 1 and 2 are available in the Supplementary Files section.\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Fallopian tube carcinosarcoma, Malignant mixed Müllerian tumor (MMMT), Heterologous differentiation, Platinum-taxane chemotherapy, Late recurrence, Targeted therapy, Gynecologic malignancy, Sarcomatous component","lastPublishedDoi":"10.21203/rs.3.rs-7102999/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-7102999/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cu\u003eBackground:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003ePrimary fallopian tube malignant mixed Müllerian tumors (MMMTs), or carcinosarcomas, are exceptionally rare (\u0026lt;0.5% of gynecologic malignancies) and highly aggressive biphasic neoplasms. Their nonspecific presentation often mimics ovarian cancer, posing significant diagnostic challenges and typically conferring a poor prognosis. This report details an exceptional case of recurrent mixed papillary carcinosarcoma originating in the fallopian tube, which presented as a bilateral inguinal relapse five years after the patient achieved remission. This prolonged remission followed by such a late and unusual pattern of recurrence, particularly in the inguinal region, makes this case particularly unique and clinically insightful.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eCase Report:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eA 68-year-old female presented in 2019 with abdominal pain and ascites. Imaging and elevated CA-125 suggested ovarian cancer, but exploratory laparotomy revealed a FIGO stage IIIC primary fallopian tube carcinosarcoma with extensive local invasion, necessitating initial palliative R2 cytoreduction. Histopathology confirmed a biphasic tumor with high-grade serous carcinoma (PAX8+, WT1+, p53 null) and heterologous chondrosarcomatous components (vimentin+, H3K27me3 loss). Following 6 cycles of carboplatin/paclitaxel, a second-look surgery achieved complete R0 resection of residual sarcomatoid peritoneal deposits, followed by 3 consolidation chemotherapy cycles. Remarkably, the patient remained disease-free for 5 years. In 2024, she presented with bilateral inguinal masses. This late recurrence, particularly in the inguinal region, brought with it significant physical discomfort and, crucially, a profound psychological burden, impacting her previously stable quality of life. The patient underwent bilateral therapeutic inguinal lymphadenectomy. This intervention, while serving for palliative tumor debulking, was primarily aimed at alleviating the distressing symptoms and improving her overall quality of life, which had been severely deteriorated by the physical and psychological impacts of the relapse. Palliative lymphadenectomy confirmed late recurrence of carcinosarcoma (pure carcinoma in nodes, mixed in ulcerated mass). BRCA1 analysis is pending; she is currently receiving carboplatin/paclitaxel/bevacizumab.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eDiscussion:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003eThis case highlights the extreme rarity of tubal carcinosarcoma and exceptional 5-year survival despite advanced stage (IIIC) and unfavorable heterologous histology. Prolonged survival likely resulted from achieving R0 resection and initial chemosensitivity. The recurrence after 5 years underscores the potential for very late relapse, necessitating long-term surveillance. Clonal evolution in the recurrence was noted.\u003c/p\u003e\n\u003cp\u003eA dedicated QoL analysis emphasizes the physical, emotional, and social burdens of prolonged treatment and recurrence, advocating for integrated palliative care and patient-centered follow-up.\u003c/p\u003e\n\u003cp\u003e\u003cu\u003eConclusion:\u003c/u\u003e\u003c/p\u003e\n\u003cp\u003ePrimary fallopian tube carcinosarcoma is rare and aggressive. This case shows prolonged survival is possible with aggressive multimodal treatment (optimal R0 cytoreduction, platinum-based chemotherapy), even with adverse factors. However, the risk of very late recurrence mandates indefinite follow-up. Molecular profiling may aid prognostication and targeted therapy selection.\u003c/p\u003e\n\u003cp\u003eEqually critical are the profound quality of life implications of this disease and its treatment. Our patient faced cumulative physical burdens, including chemotherapy-induced neuropathy, surgical complications, and functional limitations from inguinal lymphadenectomy, alongside the psychological toll of prolonged surveillance and disease recurrence. These challenges underscore the need for early and ongoing integration of supportive care measures—such as pain management, physical therapy, and psychosocial support—into treatment paradigms.\u003c/p\u003e\n\u003cp\u003eThis dual emphasis on oncologic control and quality of life aligns with modern patient-centered care models and is particularly relevant for aggressive malignancies where treatment intensity must be balanced against survivorship considerations.\u003c/p\u003e","manuscriptTitle":"Recurrent Fallopian Tube Carcinosarcoma, Clinical Insights into a Rare and Lethal Gynecologic Tumor: A Case Report and Review of Therapeutic Challenges","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-07-23 08:34:35","doi":"10.21203/rs.3.rs-7102999/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8072a43b-f2a9-4ca5-a93d-5d3f63f6c1df","owner":[],"postedDate":"July 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-09-04T07:53:32+00:00","versionOfRecord":[],"versionCreatedAt":"2025-07-23 08:34:35","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-7102999","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-7102999","identity":"rs-7102999","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}