Uterine carcinosarcoma is rare and aggressive tumor with high rates of recurrence and distant metastases. However, brain involvement is exceedingly uncommon and only several cases have been reported so far. Surgery, chemotherapy, and radiotherapy have shown a survival benefit in patients with uterine carcinosarcoma, unfortunately complete remission is extremely rare, and the occurrence of brain metastases represents a very poor prognostic factor. In the case of the single brain metastasis, the removal of the brain lesion is the first oncological goal. 
We present a case of a 74-years old female patient who underwent surgery for brain metastasis 6 years after radical hysterectomy performed due to uterine carcinosarcoma.

Uterine carcinosarcoma (UCS) is also known as malignant mixed Mullerian tumor [1]. It is rare and aggressive tumor with high rates of recurrence and distant metastases. Common sites of metastases are lymph nodes, omentum, ovaries, and fallopian tubes [2]. Similar to other gynecologic malignancies, brain metastases areexceedingly uncommon and only several cases have been reported so far [3]. UCS is considered primarily a disease of women in post-menopausal period with the median age at diagnosis around 70 years. Recurrence-free and overall survival for UCS patients is poor, with five-year survival rates between 30 and 40%. The median interval from presentation to brain involvement and median survival, thereafter, have been reported to be 4.5 months and 3 months, respectively [3, 4]. We present a case of a 74-years old female patient who developed brain metastasis from UCS 6 years after a radical hysterectomy performed due to UCS.

We present a 74-years old female patient who was admitted to our emergency department after she had lost consciousness for several minutes, accompanied by malaise, loss of appetite, and fatigue. 

The patient's history was significant for UCS. This had presented with postmenopausal bleeding 6 years before admission to our neurosurgery department. She was operated in another institution and radical hysterectomy with partial omentectomy, and lymph nodes dissection was performed. Histological examination demonstrated UCS. She proceeded to neoadjuvant chemotherapy and radiotherapy, after which regular check-ups showed complete remission of the disease. The last check-up was about 3 months before she was admitted to our institution, when it was determined that there was no signs of UCS recurrence, and the patient was symptom free at that time. 

Patient’s physical examination at admission was unremarkable. Brain CT demonstrated a cerebral lesion in the right temporal lobe, 42x33mm in diameter, consistent with a partly solitary and partly cystic brain metastasis with a thin wall, showing contrast enhancement and small perifocal edema of the right temporal lobe. Ventricular system was enlarged, but without transependymal periventricular lucency, however this finding was known earlier since patient performed brain CT as part of oncological investigation when a uterine tumor was firstly discovered [Figure 1]. Also, the patient did not have a clinical sign of hydrocephalus, nor fundoscopy revealed signs of papilledema. Due to claustrophobia, the patient refused an MRI. Admission chest x-ray demonstrated two rounded nodules, one in the right lung with a diameter of 32 mm and second in the left lung with 24 mm in diameter corresponding to pulmonary metastases [Figure 2].

Figure 1: Preoperative contrast-enhanced brain CT showing single metastatic lesion in the right temporal lobe.