Pathology
Patient underwent TAH/BSO. Pathology revelaed adenocarcinoma, endometrioid type, FIGO grade 2, involving the uterus (with invasion of the outer half of the myometrium), bilateral ovaries, left fallopian tubea, right parametrium and right pelvic sidewall.
The carcinoma involving right ovary, uterus, left fallopian
tube and left ovary appears similar throughout, consisting of an
endometrioid type adenocarcinoma. Immunostains performed on the right
ovarian tumor are positive for CK7 and Pax8, and negative for CK20 and
CDX-2. This excludes a metastatic colon cancer, and is supportive of a
mullerian derived adenocarcinoma. This may represent synchronous
primary adenocarcinomas involving right ovary and endometrium. However,
it may represent metastasis and if metastatic, an endometrial primary
with metastasis to ovary is favored. This is due to the presence of a
precursor lesion in the endometrium, atypical complex hyperplasia.
Also, the deep invasion of myometrium and foci suspicious for
lymphovascular invasion favor metastasis. The staging for endometrial
primary with metastasis to ovaries and parametrial involvement would be:
pT3b, NX. If synchronous primaries, the endometrial cancer staging
would not change. The staging for ovarian primary with extension to
right pelvic side wall (no malignant cells in pelvic washing) would be:
pT2b, NX.