Han Jiheun, Kim Hyun-Soo
Department of Pathology and Translational Genomics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Case Rep Oncol. 2020 Dec 23;13(3):1537-1544. doi: 10.1159/000511701. eCollection 2020 Sep-Dec.
Minimal uterine serous carcinomas (MUSCs) include serous carcinomas with invasion confined to the endometrium (superficial serous carcinoma) and those without stromal invasion (serous endometrial intraepithelial carcinoma). Although these tumors are confined to the endometrium proper, they have highly metastatic potential for disseminating to extra-uterine sites. We report here a case of MUSC that was initially misdiagnosed as early-stage low-grade endometrioid carcinoma but later metastasized to the abdominopelvic peritoneum. The patient was a 61-year-old woman who was diagnosed with grade 1 endometrioid carcinoma of the endometrium and underwent total hysterectomy. Because the tumor was confined to the endometrium (International Federation of Gynecology and Obstetrics stage IA), no further treatment was performed. However, several metastatic tumor masses were detected in the vaginal stump and abdominopelvic peritoneum 7 years after the surgery. Histologically, the metastatic tumor tissues showed high-grade carcinoma. A review of previous hysterectomy slides showed multiple separate foci of atypical glandular proliferation measuring up to 0.8 cm in the greatest dimension and consisting of markedly atypical cells involving the surface and atrophic glands. The tumor showed a predominantly glandular architecture without evident papillary growth or stromal invasion. However, it had large, pleomorphic nuclei showing a high nuclear-to-cytoplasmic ratio, conspicuous eosinophilic nucleoli, and numerous mitotic figures. Characteristically, the tumor showed marked nuclear atypia immediately appreciated at low magnification in the background of well-formed glandular structures, indicating a significant discordance between nuclear and architectural features. On immunostaining, both the uterine and metastatic tumor tissues exhibited diffuse and strong p16 expression and mutant pattern of p53 expression, confirming the diagnosis of serous carcinoma. In summary, the case findings support that failure to preoperatively recognize high-risk endometrial carcinoma is associated with worse outcomes. Complete surgical staging and accurate pathological diagnosis are critical for patients with serous carcinoma even at the early clinical stage.
微小子宫浆液性癌（MUSCs）包括浸润局限于子宫内膜的浆液性癌（浅表浆液性癌）和无间质浸润的浆液性癌（浆液性子宫内膜上皮内癌）。尽管这些肿瘤局限于子宫内膜本身，但它们具有很高的转移潜能，可扩散至子宫外部位。我们在此报告一例MUSC，最初被误诊为早期低级别子宫内膜样癌，后来转移至腹盆腔腹膜。患者为一名61岁女性，被诊断为子宫内膜1级子宫内膜样癌并接受了全子宫切除术。由于肿瘤局限于子宫内膜（国际妇产科联盟分期IA期），未进行进一步治疗。然而，术后7年在阴道残端和腹盆腔腹膜发现了多个转移瘤肿块。组织学上，转移瘤组织显示为高级别癌。回顾之前子宫切除的切片发现，有多个单独的非典型腺性增生灶，最大直径达0.8 cm，由累及表面和萎缩腺体的明显非典型细胞组成。肿瘤主要呈腺管状结构，无明显乳头样生长或间质浸润。然而，其细胞核大、多形性，核质比高，嗜酸性核仁明显，有许多有丝分裂象。其特征是，在结构良好的腺管结构背景下，低倍镜下即可立即观察到明显的核异型性，表明核特征与结构特征之间存在显著不一致。免疫组化显示，子宫和转移瘤组织均表现为弥漫性强p16表达和p53表达的突变模式，确诊为浆液性癌。总之，该病例结果支持术前未能识别高危子宫内膜癌与较差预后相关。即使在临床早期，对于浆液性癌患者，完整的手术分期和准确的病理诊断也至关重要。
