Endometrial adenocarcinoma

Case contributed by Dennis Odhiambo Agolah
Diagnosis certain

Presentation

Post-menopausal bleeding now for two weeks. Bulky, firm uterus on examination per abdomen, to rule out uterine fibroids.

Patient Data

Age: 70 Years
Gender: Female
ultrasound

Complex and aggressive endometrial thickening with mixed parenchymal echopattern that includes foci of expanded anechoic fluid spaces separated by multiple septations, heterogeneous solid areas and chaotic feeder vessels noted. The endometrial/myometrial interface is relatively obliterated and the endometrium measures up to approximately 5 cm thick. The uterine volume of 288 cc is noted. The cervix and the visualized vaginal vault grossly looks normal. No fibroids.

The left ovary is enlarged measuring 23.5 cc in volume with moderately hypoechoic parenchymal reflectivity but with no obvious focal lesions. The right ovary (measuring 1.55 cc in volume) is unremarkable.

Endometrial mass biopsy report

Clinical

70 Years old para 3+0 with post menopausal bleeding due to an endometrial mass. Biopsies of endometrial mass for histopathological evaluation.

Gross

Moderate hemorrhagic curretings all processed in one cassette.

Histopathology

The sections confirm fragments of an invasive endometrial carcinoma infiltrating into the stroma in anastomosing nests eliciting widespread necrosis. The malignant glands are lined by moderately pleomorphic endometrial cells with hyperchromatic nuclei and increased mitotic activity.

Diagnosis

Endometrial mass - Moderately differentiated endometrial adenocarcinoma.

Case Discussion

Serial trans-abdominal and endocavitary ultrasound pictograms with employed color and spectral Doppler analysis of the pelvic viscera yielded worrisome endometrial appearance that prompted a final ultrasound impression of "(i) Complex diffuse endometrial hyperplasia with solid and septated cystic spaces" and "(ii) A likelihood of left ovarian oophoritis/infiltration" concluded.

The uterus is bulky however, no pelvic lymphadenopathy seen. Post processing reports of the endometrial biopsy showed "Moderately differentiated endometrial adenocarcinoma."

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