Carcinosarcoma uterino, sus características clínico - patológicas, manejo terapéutico y supervivencia - Samlall, Shivani; Sarria Castro, Madeleine; Parellada Joa, Orlando (Revista Cubana de Obstetricia y Ginecología, 2023)
<span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*394.66px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.0281);" role="presentation">Introducción: <span dir="ltr" style="left: calc(var(--scale-factor)*153.32px); top: calc(var(--scale-factor)*394.66px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.924054);" role="presentation">Los carcinosarcomas uterinos son neoplasias bifásicas, muy agresivas y <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*415.38px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.898213);" role="presentation">poco frecuentes. Representan menos del 5 % de los cánceres endometriales, con elevada <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*436.08px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.923528);" role="presentation">letalidad. <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.01506);" role="presentation">Objetivo: <span dir="ltr" style="left: calc(var(--scale-factor)*135.19px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.943523);" role="presentation">Describir <span dir="ltr" style="left: calc(var(--scale-factor)*189.04px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.869242);" role="presentation">las <span dir="ltr" style="left: calc(var(--scale-factor)*211.53px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.878268);" role="presentation">características <span dir="ltr" style="left: calc(var(--scale-factor)*288.67px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.959294);" role="presentation">clínico <span dir="ltr" style="left: calc(var(--scale-factor)*330.48px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.935451);" role="presentation">patológi<span dir="ltr" style="left: calc(var(--scale-factor)*369.88px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.833526);" role="presentation">cas, <span dir="ltr" style="left: calc(var(--scale-factor)*397.40px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.89598);" role="presentation">manejo <span dir="ltr" style="left: calc(var(--scale-factor)*441.83px); top: calc(var(--scale-factor)*456.78px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.897765);" role="presentation">terapéutico y <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*477.48px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.899644);" role="presentation">supervivencia de carcinosarcoma uterino. <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*498.18px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.972638);" role="presentation">Métodos: <span dir="ltr" style="left: calc(var(--scale-factor)*129.38px); top: calc(var(--scale-factor)*498.18px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.907272);" role="presentation">Se realizó un estudio descriptivo retrospectivo en 40 pacientes con diagnóstico <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.848539);" role="presentation">de <span dir="ltr" style="left: calc(var(--scale-factor)*98.51px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.888606);" role="presentation">carcinosarcoma <span dir="ltr" style="left: calc(var(--scale-factor)*182.96px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.925233);" role="presentation">uterino, <span dir="ltr" style="left: calc(var(--scale-factor)*229.20px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.882536);" role="presentation">atendidos <span dir="ltr" style="left: calc(var(--scale-factor)*284.32px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.848539);" role="presentation">en <span dir="ltr" style="left: calc(var(--scale-factor)*304.82px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.927872);" role="presentation">el <span dir="ltr" style="left: calc(var(--scale-factor)*322.69px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.952293);" role="presentation">Instituto <span dir="ltr" style="left: calc(var(--scale-factor)*371.92px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.927871);" role="presentation">Nacional <span dir="ltr" style="left: calc(var(--scale-factor)*424.45px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.844045);" role="presentation">de <span dir="ltr" style="left: calc(var(--scale-factor)*444.90px); top: calc(var(--scale-factor)*518.88px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.91416);" role="presentation">Oncología y <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*539.58px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.967452);" role="presentation">Radiobiología entre 20<span dir="ltr" style="left: calc(var(--scale-factor)*194.84px); top: calc(var(--scale-factor)*539.58px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.898876);" role="presentation">09 – <span dir="ltr" style="left: calc(var(--scale-factor)*225.68px); top: calc(var(--scale-factor)*539.58px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.975888);" role="presentation">2016. Para el análisis estadístico se utilizaron medidas <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*560.22px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.987228);" role="presentation">cualitativas y cuantitativas, pruebas de hipótesis y análisis de supervivencia con el <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.953869);" role="presentation">método estadístico de <span dir="ltr" style="left: calc(var(--scale-factor)*197.06px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.945868);" role="presentation">Kaplan-<span dir="ltr" style="left: calc(var(--scale-factor)*236.42px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.04203);" role="presentation">Meier y <span dir="ltr" style="left: calc(var(--scale-factor)*284.50px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.999019);" role="presentation">la prueba de <span dir="ltr" style="left: calc(var(--scale-factor)*358.24px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.970336);" role="presentation">Long Rank <span dir="ltr" style="left: calc(var(--scale-factor)*421.62px); top: calc(var(--scale-factor)*580.92px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.97706);" role="presentation">para comparar la <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*601.62px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.894076);" role="presentation">supervivencia por estratos. <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*622.32px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.910709);" role="presentation">Re<span dir="ltr" style="left: calc(var(--scale-factor)*92.00px); top: calc(var(--scale-factor)*622.32px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.958501);" role="presentation">sultados: <span dir="ltr" style="left: calc(var(--scale-factor)*141.62px); top: calc(var(--scale-factor)*622.32px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.913037);" role="presentation">La edad promedio de las pacientes fue 69,7 años. La hipertensión (65,0 %), <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*643.02px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.960667);" role="presentation">diabetes mellitus (37,5 %) y aumento del índice de peso corporal (52,5 %) fueron los <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*663.72px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.905594);" role="presentation">antecedentes más frecuentes. El sangramiento postmenopáusico, el aumento del tamaño <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*684.42px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.932434);" role="presentation">ut<span dir="ltr" style="left: calc(var(--scale-factor)*87.38px); top: calc(var(--scale-factor)*684.42px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.929091);" role="presentation">erino y presencia de pólipo cervical fueron los hallazgos más comunes. 62,5 % de las <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*705.14px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.899379);" role="presentation">pacientes presentó enfermedad avanzada. La terapia multimodal fue la más empleada. La <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*725.84px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.902114);" role="presentation">recurrencia ocurrió en 66,6 % de las pacientes. La tasa de supervivencia global al añ<span dir="ltr" style="left: calc(var(--scale-factor)*485.82px); top: calc(var(--scale-factor)*725.84px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.939712);" role="presentation">o y 3 <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*73.82px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(1.0318);" role="presentation">años fue de 47,5 % y 11,7 % respectivamente. La supervivencia global libre de <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*94.52px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.888257);" role="presentation">enfermedad a los 3 años fue 33,2 %. <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*115.22px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.946468);" role="presentation">Conclusiones: <span dir="ltr" style="left: calc(var(--scale-factor)*156.26px); top: calc(var(--scale-factor)*115.22px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.989799);" role="presentation">El carcinosarcoma uterino es una enfermedad rara y muy agresiva, <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*135.94px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.910652);" role="presentation">diagnosticada en estadios avanzados con un alto índice d<span dir="ltr" style="left: calc(var(--scale-factor)*358.30px); top: calc(var(--scale-factor)*135.94px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.933315);" role="presentation">e recurrencia y mortalidad, por <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.999839);" role="presentation">lo <span dir="ltr" style="left: calc(var(--scale-factor)*96.89px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.865318);" role="presentation">que <span dir="ltr" style="left: calc(var(--scale-factor)*123.76px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.784852);" role="presentation">se <span dir="ltr" style="left: calc(var(--scale-factor)*143.18px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.85578);" role="presentation">hacen <span dir="ltr" style="left: calc(var(--scale-factor)*180.73px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.860754);" role="presentation">necesarios <span dir="ltr" style="left: calc(var(--scale-factor)*240.23px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.922731);" role="presentation">el <span dir="ltr" style="left: calc(var(--scale-factor)*258.34px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.910982);" role="presentation">diagnóstico <span dir="ltr" style="left: calc(var(--scale-factor)*323.17px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.889273);" role="presentation">precoz, <span dir="ltr" style="left: calc(var(--scale-factor)*367.61px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.927872);" role="presentation">el <span dir="ltr" style="left: calc(var(--scale-factor)*385.84px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.891589);" role="presentation">estadiamiento <span dir="ltr" style="left: calc(var(--scale-factor)*461.96px); top: calc(var(--scale-factor)*156.64px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.96);" role="presentation">clínico y <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*177.34px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.962298);" role="presentation">postquirúrgico y el uso de terapias combinadas tanto para estadios tempranos como <span dir="ltr" style="left: calc(var(--scale-factor)*78.00px); top: calc(var(--scale-factor)*197.98px); font-size: calc(var(--scale-factor)*12.00px); font-family: sans-serif; transform: scaleX(0.890465);" role="presentation">tardíos.