Clinical history & Virtual slides
J1 【2014-J-1】
Clinical History
A 69-year-old woman (gravida 3, para 3) had lower abdominal pain and vaginal bleeding.
A transvaginal echo showed a uterine tumor, which was hyperechoic compared to the normal myometrium. The endometrial biopsy was negative, but her condition remained highly suspicious. Further testing was necessary. The MRI showed a large mass located on the posterior wall of the uterus, which prolapsed into the endocervical canal and showed a heterogenous hyperintense signal on T2-weighted imaging. The CT scan showed a heterogenous hypodense mass with solid and cystic lesions which invaded the sigmoid and rectum. The CT also revealed metastatic sites (lung and liver) and the possibility that the external iliac lymph node was undergoing metastasis. Hydronephrosis was seen on both sides. The CA-125 level was slightly elevated. Since an advanced uterine malignant tumor was considered, surgical cytoreduction was performed.
Macroscopic Findings
The tumor was a large mass measuring 100 x 110 mm and located on the posterior wall of the uterus. It contained some areas of hemorrhage and necrosis, and filled the endometrial cavity and invaded deeply into the myometrium.
J2 【2014-J-2】
Clinical History
A 33-year-old Japanese woman, gravida 0 para 0, was presented to our department on a suspicion of endometrial carcinoma. In the past, three years ago, a diagnosis of atypical polypoid adenomyoma was made for her at the other hospital. After two more D&C treatments, in vitro fertilization and embryo transfer (IVF-ET) was attempted three times. Subsequently, chest x-ray examination performed during a routine health screening revealed lung cancer, and video assisted thoracic surgery (VATS) was performed in the department of respiratory surgery at our hospital. Pathologic examination of the surgical specimen revealed a metastatic lung cancer positive for both estrogen receptor (ER) and progesterone receptor (PgR).
The patient was thus referred to our department. At that time, her uterus was the size of a hen’s egg, and her uterine adnexa appeared normal. Magnetic resonance imaging showed a thickened endometrium. Her cervical PAP smear was shown to be NILM, but her endometrial PAP smear was suspicious for endometrial carcinoma. A biopsy specimen was obtained, and grade 1 endometrioid adenocarcinoma was diagnosed. Computed tomography (CT) and positron emission tomography-CT showed no other metastases. We performed hysterectomy and bilateral adnectomy.
Macroscopic Findings
Macroscopically, numerous small polypoid masses were apparent throughout the uterine cavity.
J3 【2014-J-3】
The following case is a representative one out of 22 reviewed cases with endometrial polyp-associated carcinoma.
The patient is 62-year-old. The slide is taken from the uterine body containing an endometrial polyp, in which the majorities of preexisting glands are found to be replaced by atypical cells. These cells, displaying high N/C ratio and frequent mitoses, are arranged in micropapillary architecture. The findings are considered to be non-invasive endometrial carcinoma, i.e., serous endometrial intraepithelial carcinoma (SEIC), but minimal stromal invasion cannot be completely ruled out. The carcinoma nests under the polyp may be minimally invading the myometrium around the leiomyoma. In the background, the endometrium is very atrophic with superficial adenomyosis.
K1 【2014-K-1-1 (2009) & 2014-K-1-2 (2013), 2014-K-1-3 (2013)】
A 29 year old female patient was admitted in Ajou University Medical Center due to atypical uterine tumor. According to transvaginalsonographic finding, greater than 18 cm sized lobulated solid mass on left adnexa extending to left lower paracolic gutter, excluding the possibility of intravenous leiomyomatosis. She had an infertility problem and also she had five time of previous operation history (myomectomy and pelvic mass excision) since 2006. Total abdominal hysterectomy and excision of sigmoid colon mass was done. The distributed slides were taken from myomectomy in 2009 year and hysterectomy in 2013 year.
K2 【2014-K-2】
A 49-year-old married woman (P 2-0-0-2) visited the out-patient clinic for further evaluation of a uterine mass, diagnosed as a pedunculatedmyoma at a local clinic. She complained of menorrhagia. A transvaginal ultrasonography showed a pedunculated and elongated submucosal mass at the lower uterine segment, and a hysteroscopic removal of the pedunculated mass was performed, under the impression of a submucosal leiomyoma. The pathologic diagnosis of this specimen prompted a subsequent radical hysterectomy with bilateral salpingo-oophorectomy and pelvic lymph node dissection. On gross examination of the hysterectomy specimen, an 8.8 x 5.8 x 5.2cm-sized solid infiltrative mass was seen involving the uterine wall. The submitted slide is a representative section from the uterine mass.
K3 【2014-K-3-1 & 2014- K-3-2】
A 47-year-old postmenopausal woman (G2P2) presented with abdominal pain for two weeks. She was diagnosed as leiomyoma by ultrasonography, about 2 years ago. On MRI examination, there was a uterine mass with increase in size from 3.2x3.0 cm to 6.5x6.0 cm for 2 years and central necrosis. Laparoscopic vaginal hysterectomy with bilateral salpingo-oophorectomy was performed.
Postoperative PET-CT showed multiple pulmonary, bone and lymph node metastasis. The patient underwent one cycle of chemotherapy and died 2 months after operation.
T1 【2014-T-1】
This 47 year-old female patient presented with heavy menses in May 2011 and a history of having uterine fibroid for 3 years. Preoperative ultrasound examination revealed an anteverted uterus with multiple fibroids measuring 13.4 x 10.5 x 11.5 cm. with the largest intramural nodule measuring 6 x 5.4 x 5.3 cm. and a left-sided nodule measuring 4.9 x 4.6 x 4.5 cm. Endometrial biopsy revealed secretory endometrium and endometrial polyp. The patient underwent laparoscopic supracervical hysterectomy which revealed a 16-week size uterus and normal bilateral ovaries. The uterus was removed piecemeal with a 15-mm. mocellator.
T2 【2014-T-2-1 & 2014-T-2-2】
The 50-year-old female patient had chronic lower abdominal pain for a long time, and the pain condition progressed since 2013/01, In the meantime, she also found bilateral lower limb swelling, so she went to nephrology OPD for help. Elevated serum creatinine was noted and the condition progressed in the following months. She also found persistent vaginal bleeding after amenorrhea of two-month period since 2013/04. As the result, she came to gynecology OPD and was told to have a uterine myoma. After that, in 2013/06, she experienced an episode of sudden onset severe lower abdominal pain, so she underwent subtotal hysterectomy.
T3 【2014-T-3】
This 77-year-old woman has the history of breast cancer, status post mastectomy in 2009, under regular follow-up. Sudden onset of vaginal bleeding was noted in March, 2010. She received endometrial curettage, followed by hysterectomy, and the pathology revealed a stage pT1a "endometrial cancer". During post-operative follow-up, multiple nodules in bilateral lungs were disclosed by imaging studies in August, 2013. She then received surgical resection of some of the lung nodules.