Primary ovarian carcinosarcoma: Confronting a lethal tumor

Ovarian carcinosarcoma (OCS) is a rare and aggressive malignant mixed Müllerian tumor, accounting for <2% of all ovarian malignancies. Characterized by biphasic histology with epithelial and mesenchymal components, OCS predominantly affects postmenopausal women and carries a poor prognosis. Early diagnosis is challenging due to a nonspecific clinical presentation, often requiring a combination of imaging. A 51-year-old postmenopausal woman presented with lower abdominal pain, postmenopausal spotting, and significant weight loss. Imaging revealed bilateral solid–cystic adnexal masses with metastases to the peritoneum, omentum, and stomach. The initial biopsy suggested high-grade serous carcinoma. Histopathology confirmed a diagnosis of OCS, revealing both carcinomatous and sarcomatous elements. OCS is an uncommon and highly aggressive neoplasm that requires detailed histopathological examination and immunohistochemistry for identifying its biphasic nature. Multimodal management combining surgery and chemotherapy remains the cornerstone of treatment. Awareness and early recognition are critical to improving clinical outcomes in affected patients.