Miliary metastases: endometrial carcinoma

Case contributed by Dr Horea Craciun

Presentation

This 39 year old woman presented with 4 weeks history of vaginal pain and painful nodules on palpation in the vaginal canal. She also noticed intermenstrual spotting and around the same time she began to feel more breathless and tired. All these symptoms have progressed rapidly. She became lethargic with a decreased and difficulty passing urine due to discomfort and pain. Speculum examination was difficult due to increased pain and revealed multiple nodular masses spreading into the vaginal cavity.

Patient Data

Age: 39
Gender: Female
Modality: X-ray

The AP erect film demonstrates extensive miliary nodules in keeping with pulmonary metastases. Further imaging recommended to find primary source.

Modality: CT

CT thorax shows bilateral extensive miliary nodules in keeping with secondary deposits. Further investigations to localize primary source have been conducted.

Case Discussion

MRI report for local pelvic staging showed the uterus, adnexa, peritoneum, vagina and periurethral tissues. There was extensive infiltration of the lower uterus and cervix, which extends to the uterine/cervical surface, infiltrating into both adnexa, with a carpet of peritoneal infiltration noted in the pouch of Douglas.

Biopsy was performed and a diagnosis of high-grade stage 4 endometrial adenocarcinoma was formulated.

The patient was informed about diagnosis and prognosis. Options for symptomatic treatment and palliative chemotherapy were addressed as surgery was not an option at this point. The patient asked for a few days to decide about the course of treatment she wanted but unfortunately due to cardio-respiratory complications she passed away only after 5 weeks from the date of admission.

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Case Information

rID: 40384
Case created: 19th Oct 2015
Last edited: 22nd Oct 2015
System: Chest
Inclusion in quiz mode: Included

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