Odgers Harrison, Anderson Lyndal, Kok Peey Sei, Farrell Rhonda
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia.
Int J Surg Case Rep. 2023 Jul;108:108449. doi: 10.1016/j.ijscr.2023.108449. Epub 2023 Jul 1.
Umbilical metastases are uncommon and rarely associated with endometrial cancer. In this report we describe a unique case of a patient with low-grade endometrioid adenocarcinoma (EAC) who developed an umbilical metastasis containing dedifferentiated endometrial carcinoma, in the context of super-morbid obesity with a body mass index (BMI) of 80 kg/m.
A 55-year-old female with atypical endometrial hyperplasia was treated with progestogens whilst attempting weight loss prior to definitive surgery, given the impact of her obesity on surgical risk. She progressed to grade 1 EAC of the uterus and then to metastatic disease in the umbilicus and inguinal lymph nodes. After adequate weight loss, cytoreductive surgery was completed via robotic hysterectomy and bilateral salpingoophorectomy (BSO) and resection of metastatic disease. Differing histological grades were seen across all disease sites with dedifferentiated endometrial carcinoma at the umbilicus. Immunohistochemistry suggested a common uterine origin due to loss of MLH1 and PMS2 proteins.
There are no clear management pathways for the rare umbilical metastases related to endometrial cancer. Our patient's significant obesity complicated their clinical course and highlights the risks of progestogen therapy whilst attempting weight loss prior to definitive surgery for low-grade EAC. Differing grades of disease across metastatic sites in EAC is rare and may reflect the recently recognized intratumoral genetic heterogeneity in endometrial cancers.
Management of umbilical metastases should be individualized to patient factors and local resources. More research is needed into pathways of care for women with low grade EAC with obesity preventing routine surgical management.
脐部转移瘤并不常见，与子宫内膜癌的关联也很少见。在本报告中，我们描述了一例独特的病例，一名患有低级别子宫内膜样腺癌（EAC）的患者在极度肥胖（体重指数BMI为80kg/m²）的情况下发生了脐部转移，转移瘤中含有去分化子宫内膜癌。
一名55岁患有非典型子宫内膜增生的女性，鉴于其肥胖对手术风险的影响，在进行确定性手术前尝试减肥的同时接受了孕激素治疗。她进展为子宫1级EAC，随后出现脐部和腹股沟淋巴结转移。在充分减肥后，通过机器人辅助子宫切除术、双侧输卵管卵巢切除术（BSO）以及转移瘤切除术完成了肿瘤细胞减灭术。在所有疾病部位均观察到不同的组织学分级，脐部为去分化子宫内膜癌。免疫组化显示由于MLH1和PMS2蛋白缺失提示共同的子宫起源。
对于与子宫内膜癌相关的罕见脐部转移瘤，目前尚无明确的管理途径。我们患者的严重肥胖使临床病程复杂化，并凸显了在低级别EAC确定性手术前尝试减肥时进行孕激素治疗的风险。EAC转移部位出现不同分级的疾病很罕见，可能反映了最近在子宫内膜癌中认识到的肿瘤内基因异质性。
脐部转移瘤的管理应根据患者因素和当地资源进行个体化。对于肥胖导致无法进行常规手术管理的低级别EAC女性患者，需要对其护理途径进行更多研究。
