Endometrial carcinoma

Case contributed by Dr Michael Burns

Presentation

Presented with anemia, history of rectal bleeding, and a positive FIT test. 75 pound weight loss in a year. Urge incontinence.

Patient Data

Age: 75 years
Gender: Female
CT

The uterus is enlarged, measuring 8.5 cm AP, 13.5 cm transverse, and 20 cm
length.  The myometrium contains multiple large calcified lesions, consistent
with fibroids.  Distended fluid filled endometrial cavity, measuring 9 cm transverse and 5.2 cm AP diameter.  The cervix is bulky, particularly at its posterior aspect, suspicious for a mass lesion.
Bilateral hydronephrosis, mild on the right and minimal on the left.  Mild
dilatation of the ureters bilaterally to the level of the pelvis.  Urinary
bladder is partially compressed by the bulky uterus, otherwise unremarkable.

MRI

There is a 6.1 x 6.2 x 14.7 mass centered within the cervix and extending into
the uterus.  It is predominantly T1 intermediate.  The T2 signal is
heterogeneous.  There is probable parametrial extension at the 6 o'clock
position involving the rectum measuring 0.5 X 1.0 cm.  There is loss of the fat
plane and the rectum and cervix are inseparable from each other.  The fat plane
with the bladder is preserved. 
There is a second pedunculated lesion arising from the uterine fundus measuring
2.6 x 3.3 x 4.5 cm.  It is isointense on both T1 and T2.
Multiple fibroids can be seen within the myometrium.
 

Uterine biopsy pathology report

Uterine curettage:
Final diagnosis - High-grade  p53 mutation adenocarcinoma, consistent with serous carcinoma

   Microscopic           

All of the sections are similar. They show a high-grade adenocarcinoma composed of
irregular nests and cords of malignant cells with marked nuclear pleomorphism, prominent
mitotic activity, and large areas of tumor necrosis. There is some glandular and
micropapillary differentiation.

Immunostain profile:
p53 -strong diffuse positive nuclear staining
ERS- negative
WT1 - negative
p16, Napsin A, p504s - negative

This staining profile supports a diagnosis of serous carcinoma.

Case Discussion

The CT and MR findings suggest an endometrial cancer with spread to the cervix. There is local invasion of the ureters with bilateral hydronephrosis. The biopsy showed uterine serous carcinoma.

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