Kawashima Hiroo, Fukuda Takeshi, Sakamoto Kaori, Yamauchi Makoto, Sumi Toshiyuki
Department of Obstetrics and Gynecology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, JPN.
Department of Diagnostic Pathology, Graduate School of Medicine, Osaka Metropolitan University, Osaka, JPN.
Cureus. 2024 Jun 12;16(6):e62274. doi: 10.7759/cureus.62274. eCollection 2024 Jun.
Endometrial carcinoma is the sixth most common cancer among women worldwide. Minimally invasive surgery (MIS) has become the preferred treatment, offering similar survival outcomes to laparotomy with lower complication rates. Corded and hyalinized endometrioid carcinoma (CHEC) is a rare and diagnostically challenging variant of endometrioid carcinoma, first described in 2005, characterized by a biphasic appearance of traditional low-grade endometrioid adenocarcinoma and corded and spindled cells embedded in a hyaline stroma. A 55-year-old nulligravid woman presented with abnormal genital bleeding for 10 days. Initial evaluations, including transvaginal ultrasonography and histological examination, confirmed adenocarcinoma. Imaging studies (magnetic resonance imaging [MRI] and computed tomography [CT]) revealed a thickened endometrium (11 mm) with no myometrial invasion, enlarged pelvic lymph nodes, or distant metastasis. Tumor markers were within normal ranges. She underwent robot-assisted laparoscopic total hysterectomy, bilateral adnexectomy, and pelvic lymph node biopsy using the da Vinci Xi system (Intuitive Surgical, Sunnyvale, CA). Histopathological examination revealed CHEC, with characteristic epithelioid and spindled cells arranged in cords within a hyalinized stroma. Immunohistochemical staining showed focal positivity for cytokeratin AE1/AE3, weak estrogen receptor positivity, and nuclear β-catenin expression, distinguishing it from carcinosarcoma. The diagnosis was confirmed as CHEC, FIGO 2008 stage IA (pT1aN0M0). The patient remained disease-free 18 months post-surgery. CHEC is a rare variant of endometrioid carcinoma with unique histological features. It typically presents in younger patients at an early stage and has a favorable prognosis. Accurate diagnosis is crucial to differentiate it from more aggressive tumors like carcinosarcoma, preventing overtreatment. The immunohistochemical profile, particularly nuclear β-catenin accumulation, is useful in distinguishing CHEC from carcinosarcoma. This is the first documented case of CHEC successfully treated with robot-assisted surgery. Increased awareness among pathologists and clinicians is essential for accurate diagnosis and optimal management of this rare tumor variant.
子宫内膜癌是全球女性中第六大常见癌症。微创手术（MIS）已成为首选治疗方法，其生存结果与剖腹手术相似，但并发症发生率较低。条索状和玻璃样变的子宫内膜样癌（CHEC）是一种罕见且诊断具有挑战性的子宫内膜样癌变体，于2005年首次被描述，其特征是传统低级别子宫内膜样腺癌呈双相外观，以及条索状和梭形细胞嵌入玻璃样间质中。一名55岁未孕女性出现异常生殖器出血10天。包括经阴道超声检查和组织学检查在内的初步评估确诊为腺癌。影像学检查（磁共振成像[MRI]和计算机断层扫描[CT]）显示子宫内膜增厚（11毫米），无肌层浸润、盆腔淋巴结肿大或远处转移。肿瘤标志物在正常范围内。她使用达芬奇Xi系统（直观外科公司，加利福尼亚州森尼韦尔市）接受了机器人辅助腹腔镜全子宫切除术、双侧附件切除术和盆腔淋巴结活检。组织病理学检查显示为CHEC，特征性的上皮样和梭形细胞呈条索状排列于玻璃样间质中。免疫组化染色显示细胞角蛋白AE1/AE3局灶阳性、雌激素受体弱阳性以及核β-连环蛋白表达，可将其与癌肉瘤区分开来。诊断为CHEC，2008年FIGO分期IA期（pT1aN0M0）。患者术后18个月无疾病复发。CHEC是一种具有独特组织学特征的罕见子宫内膜样癌变体。它通常在年轻患者中早期出现，预后良好。准确诊断对于将其与癌肉瘤等更具侵袭性的肿瘤区分开来、避免过度治疗至关重要。免疫组化特征，尤其是核β-连环蛋白积聚，有助于将CHEC与癌肉瘤区分开来。这是首例记录成功通过机器人辅助手术治疗的CHEC病例。提高病理学家和临床医生的认识对于准确诊断和优化管理这种罕见肿瘤变体至关重要。
