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- Title
IMMUNOHISTOCHEMICAL PROFILING IN THE DIFFERENTIAL DIAGNOSIS OF ENDOMETRIAL ADENOCARCINOMA.
- Authors
Iosif, Antonia-Elena; Luchi, Alina-Sabina; Mastan, Adina; Ilie, Vlăduţ Liviu; Oprinca, George Călin
- Abstract
Introduction: Endometrioid-type endometrial adenocarcinoma is a malignant epithelial tumor originating from the single-layered glandular epithelium of the endometrium. Its predominant feature consists of the formation of malignant glands, similar to those found in normal endometrium but with reduced cellular differentiation. The tumor cells typically exhibit pronounced cellular atypia, characterized by significant morphological changes in the nuclei and cytoplasm. The nuclei may be hyperchromatic, pleomorphic, and exhibit an increased nucleo-cytoplasmic ratio. Case Report: A 73-year-old patient presented to the hospital with minimal vaginal bleeding. She returned to the hospital after 2 weeks, and upon paraclinical investigations, a tumoral formation was observed in the myometrium, raising suspicion of uterine sarcoma. After appropriate investigations, surgical intervention was performed, revealing adhesion syndrome between the posterior uterine wall and the large intestine and between the adnexa and the large intestine during abdominal cavity exploration. Total hysterectomy with bilateral salpingoo-ophorectomy and pelvic lymphadenectomy was decided upon and specimens were sent for histopathological examination. Histopathological examination revealed a whitish tumoral formation in the myometrium invading the isthmus and cervix. Microscopically, the uterus exhibited tumor proliferation with mostly solid architecture, focal pseudoglandular areas with central necrosis, and sarcomatoid differentiation infiltrating the endometrial mucosa and over half the thickness of the myometrium. The histopathological analysis diagnosed a poorly differentiated endometrioid-type endometrial adenocarcinoma, necessitating differential diagnosis with uterine leiomyosarcoma and cervical adenocarcinoma. Immunohistochemical tests were positive for CK AE1-AE3, MNF116, CK7, and VIMENTIN markers. Negative CK5/6 marker excluded cervical adenocarcinoma pathology, and negative actin excluded uterine leiomyosarcoma. Discussions : The particularity of this case lies in the importance of immunohistochemical examination in establishing a definitive diagnosis. The patient presented with a tumor invading both the cervix and the myometrium, thus immunohistochemical tests provided certainty in diagnosing poorly differentiated endometrioid-type endometrial adenocarcinoma, eliminating the possibility of uterine leiomyosarcoma and cervical adenocarcinoma. Conclusions: Poorly differentiated endometrioid-type endometrial adenocarcinomas are complex pathologies requiring a comprehensive set of tests for a definitive diagnosis and initiation of appropriate treatment.
- Subjects
ROMANIA; ADENOCARCINOMA; UTERINE tumors; DIFFERENTIAL diagnosis; CANCER invasiveness; CERVIX uteri tumors; MYOMETRIUM; LEIOMYOSARCOMA; CONFERENCES &; conventions; ENDOMETRIAL tumors; IMMUNOHISTOCHEMISTRY; UTERINE hemorrhage
- Publication
Acta Marisiensis. Seria Medica, 2024, Vol 70, p218
- ISSN
2668-7755
- Publication type
Article