V
%Begin January 2022 Case Cedars-Sinai Skip to content Close
Select your preferred language English عربى 简体中文 繁體中文 فارسي עִברִית 日本語 한국어 Русский Español Tagalog English English عربى 简体中文 繁體中文 فارسي עִברִית 日本語 한국어 Русский Español Tagalog Translation is unavailable for Internet Explorer Cedars-Sinai Home 1-800-CEDARS-1 1-800-CEDARS-1 Close Find a Doctor Locations Programs & Services Health Library Patient & Visitors Community My CS-Link Education clear Go Close Academics Academics Faculty Development Community Engagement Calendar Research Research Areas Research Labs Departments & Institutes Find Clinical Trials Research Cores Research Administration Basic Science Research Clinical & Translational Research Center (CTRC) Technology & Innovations News & Breakthroughs Education Graduate Medical Education Continuing Medical Education Graduate School of Biomedical Sciences Professional Training Programs Medical Students Campus Life Office of the Dean Simulation Center Medical Library Program in the History of Medicine About Us All Education Programs Departments & Institutes Faculty Directory Anatomic and Clinical Pathology Residency Back to Anatomic and Clinical Pathology Residency Application Information Explore the Residency Training Curriculum Autopsy Pathology Rotation Bone and Soft Tissue Head and Neck Pathology Rotation Breast Pathology Rotation Cardiovascular Pathology Rotation Clinical Chemistry Rotation Coagulation Rotation Cytopathology Rotation Dermatopathology Rotation Forensic Pathology Rotation Frozen Section Rotation Gastrointestinal and Liver Pathology Genitourinary Pathology Rotation Genomic Pathology Rotation Gynecologic Pathology Rotation Hematopathology Rotation Laboratory Management Rotation Microbiology Rotation Neuropathology Rotation Pulmonary and Mediastinal Pathology Rotation Renal Pathology Rotation Transfusion Medicine Rotation Surgical Pathology Pathology Physician Scientist Training Program Residents Graduates Case of the Month Archive Publications Leadership Frequently Asked Questions
January 2022 Case
Authors Abebe Teklu (Fellow), Bonnie Balzer, MD, PhD (Faculty)
Gynecologic Pathology
Clinical History A patient in her 50's with a 2-year history of heavy menstrual cycles resulting in anemia. She sought gynecological care during which a pelvic ultrasound, revealed a thickened endometrium and uterine fibroids. She had tried hormonal intrauterine device (IUD) without improvement.
visibility
786 views
thumb_up
13 likes
E
The patient reported pelvic and rectal pressure, but otherwise denied any rectal bleeding or GI symptoms. Patient has no prior history of cancer.
thumb_up
47 likes
E
The patient underwent hysteroscopic endometrial curettage and fibroid resection, and the specimen was sent to pathology. Diagnosis Histopathologic examination showed fragmented specimen containing adenocarcinoma, characterized by relatively well formed glands with cribriform glands in some areas.
thumb_up
38 likes
D
The epithelial cells were relatively uniform with basally oriented nuclei and intracytoplasmic mucin was present in a subset of cells. Some areas contained areas of necrotic cellular debris within the lumens of the neoplastic glands. No areas of non-atypical endometrial hyperplasia or endometrial intraepithelial neoplasia were identified.
thumb_up
36 likes
T
There were fragments of leiomyomas in the background. Immunohistochemical analysis demonstrated the adenocarcinoma cells to be positive for CK20, CDX-2, SATB-2 (patchy), MUC2 (patchy) and CEA.
thumb_up
11 likes
E
They were negative for CK7, PAX-8, GATA-3, ER, PR, Vimentin and hrHPV in-situ. The p16 and MUC6 showed rare positive neoplastic cells, and p53 demonstrated a wild type pattern. Mismatch repair proteins were intact.
thumb_up
4 likes
M
The combined morphologic and immunohistochemical features support and adenocarcinoma with an enteric/gastrointestinal phenotype. The case was finalized as moderately differentiated adenocarcinoma with intestinal/enteric phenotype. In the absence of any notable conventional endometrioid adenocarcinoma or precursor endometrial proliferation, the differential diagnosis included a metastasis (likely from colorectal origin or other sites which may acquire an intestinal phenotype, and an unusual primary endometrial carcinoma with pure intestinal metaplasia/differentiation.
thumb_up
21 likes
T
Additional workup to exclude extrauterine primary sites was recommended. Subsequent imaging was performed which showed a circumferential colonic mass involving the proximal sigmoid and peritoneal carcinomatosis with solid tumor as well as ascites.
thumb_up
32 likes
M
A. 100X B.
thumb_up
22 likes
N
E. F.
thumb_up
41 likes
I
G. H. Fig.
thumb_up
24 likes
D
1 Adenocarcinoma embedded in endometrial stroma (A and B). Adenocarcinoma with dirty necrosis (C) and intracytoplasmic mucin (D).
thumb_up
39 likes
J
The malignant cells are negative for CK-7 (E) and positive for CK-20 (F), CDX-2 (G), SATB-2 (H). Discussion Metastasis to uterine body by extragenital malignancies is extremely rare. In a series of 63 reported cases of metastasis to the uterine body by extragenital primary neoplasms, colorectal carcinoma was the second most common after breast carcinomas.
thumb_up
6 likes
C
Generally, the most common sites of colorectal cancer metastasis include liver, lymph nodes, and lungs. Ovaries are the common female genital tract site of colorectal cancer metastasis (1).
thumb_up
46 likes
N
In this case, the histopathologic, immunoprophile, and imaging findings are essentially those of a colorectal adenocarcinoma. Carcinomas with enteric/intestinal differentiation pose a diagnostic difficulties in the female genital tract for several reasons. First it is possible for non genital sites including ovary, lung, and genitourinary organs to acquire an enteric phenotype morphologically.
thumb_up
45 likes
R
Upon doing so these neoplasms also acquire an enteric immunophenotype essentially rendering organ selective immunohistochemical markers (such as PAX8, WT1, TTF1, GATA3, etc.) uninformative. Intestinal metaplasia/differentiation in primary endometrial carcinoma is uncommon and was first described by Berger in 1984 (2). Nine cases of endometrial carcinoma with intestinal metaplasia/differentiation were reported by Ardighieri, et.
thumb_up
2 likes
N
al. In their series such tumors were described in pure form or in association with endometrioid carcinomas.
thumb_up
47 likes
C
The intestinal metaplastic component was positive for CK7, CK20 and CDX2, and negative for PAX-8, ER and PR expression (3). This immunoprophile is similar to our case; however, the lack of CK7 positivity and presence of CK20 positivity provides further evidence of true enteric differentiation.
thumb_up
17 likes
O
In conclusion, enteric/intestinal type morphology, combined with a lack of a precursor process, and enteric immunophenotype, should alert pathologist to consider the possibility of metastasis. References Kumar NB, Hart WR.
thumb_up
16 likes
E
Metastases to the uterine corpus from extragenital cancers. A clinicopathologic study of 63 cases.
thumb_up
0 likes
V
Berger G, Fetissof F, Vitrey D, Chayvialle JA, Féroldi J. Endometrial carcinoma of the intestinal type.
thumb_up
0 likes
J
A first case report. Appl Pathol. 1984;2(2):63-9.
thumb_up
16 likes
I
Ardighieri L, Palicelli A, Ferrari F, Bugatti M, Drera E, Sartori E, Odicino F. Endometrial Carcinomas with Intestinal-Type Metaplasia/Differentiation: Does Mismatch Repair System Defects Matter? Case Report and Systematic Review of the Literature.
thumb_up
49 likes
T
J Clin Med. 2020 Aug 6;9(8):2552.
thumb_up
36 likes
L
Please ensure Javascript is enabled for purposes of website accessibility
thumb_up
32 likes
Similar Discussions
-
WWE Superstar Tony D Angelo reportedly injured at NXT tapings
-
What We Know About Marcus and Michael Craig of The Amazing Race
-
City Traffic Real Car Racing APK Download for Android
-
Shree Uttar Gujarat Education APK Download for Android
-
Joker Grand Gangster Shooting APK Download for Android
-
Nous n avons pas de temps perdre l activiste qui a jet de la soupe sur un Van Gogh se justifie
-
TPMP Guillaume Genton se confie sur son aventure avec une animatrice amie de Cyril Hanouna Zaptv Voici
-
High Speed Cameras Capture Mosquito Larvae Harpooning Prey With Their Heads
-
Video shows Alhambra police officers pull injured driver from burning vehicle after crash Alhambra Police Rescue
-
Black Friday 2022 de la fecha de inicio a su duraci n y origen Blackfriday 2022 Black
-
Las 8 claves para cuidar la movilidad y la flexibilidad de tus articulaciones
-
This Is How You Are Supposed To Eat Pineapples Correctly
-
Scientists may have just found the secret to hangover free wine
-
5 Things to Do Before You Start Animating
-
Mixed Reality Could Turn Robots Into Extensions of You
-
Why RCS on Android Still Sucks
-
What is RAW Photography?
-
Minimum Requirements for OS X Mountain Lion 10 8
-
Compare Land Rover Range Rover Sport vs Mercedes Benz GLE Class Plug in Hybrid CarBuzz
-
The Retro Inspired Speedback GT Will Debut At Geneva CarBuzz
-
10 things you never knew you could wash in a washing machine Tom s Guide
-
Primary Care in Arizona Sections Mayo Clinic
-
Operatives Controlling auf Basis IT gestützter Kostenrechnung SpringerLink
-
Design Your Own Patch Online
-
Delta Homecraft Table Saw Manual
-
Radio Alarm Clocks At Walmart
-
Deloittle Jobs
-
Chester County Overdrive
-
What Is PCOS Polycystic Ovary Syndrome Symptoms Causes Diagnosis and Treatment Everyday Health
-
CT Brain Neck Angiography Los Angeles CA Cedars Sinai