Serous carcinoma arising from uterine adenomyosis/adenomyotic cyst of the cervical stump: a report of 3 cases

Abstract

BackgroundSerous carcinoma arising in adenomyosis and adenomyotic cyst is very rare. Only 3 serous carcinomas and 5 serous endometrial intraepithelial carcinomas (EIC) have been reported to date.MethodsWe reviewed the clinicopathological features of 2 serous carcinoma in uterine adenomyosis and 1 serous EIC in adenomyotic cyst of the cervical stump.ResultsCase 1 had an endometrial serous carcinoma in the uterine myometrium and the left ovary. A minor component of benign endometrial glands with minimal endometrial stroma was found in the uterine mass and the surrounding myometrium. Case 2 showed 3 small foci of serous carcinoma, serous EIC and endometrial glandular dysplasia (EmGD) in the adenomyosis. Scanty serous carcinoma was present in the endometrium without evidence of myometrial invasion. The eutopic endometrium in both case 1 and 2 had no evidence of neoplastic changes after complete examination. Case 3 had 3 microscopic serous EICs in the adenomyotic cysts of the cervical stump. One EIC lesion coexisted with EmGD. No cancer was found in the endocervical tube although the preoperative endocervical biopsy showed a poorly differentiated endometrioid carcinoma. Immunohistochemistry demonstrated that serous carcinoma in case 1 and EIC in all 3 cases showed a characteristic pattern of p53 and p16 over expression, high Ki67 index, and lack of WT1, ER and PR staining. EmGD in case 1 and 3 had a similar staining pattern except a lower Ki67 index and the presence of ER expression.ConclusionsWe believe that this case series may expand our recognition on serous carcinoma arising in uterine adenomyosis/adenomyotic cyst including extra-uterine spread and the potential synchronous growth of carcinomas in eutopic endometrium.

The clinicopathological characteristics and survival outcomes of endometrial carcinoma coexisting with or arising in adenomyosis: A pilot study

“…Little is known about the pathogenesis of EEC-AIA. The malignant transformation of adenomyosis is thought to be due to the transition of the endometrial epithelium into monolayer tumor cells 19 , which can produce many histological types, including EEC, papillary serous carcinoma 20 , serous carcinoma 21,22 , primary uterine müllerian mucinous borderline tumor (MMBT) 23 , and clear cell carcinoma 24 . The predominant histological types are EEC and clear cell carcinoma 7,25,26 .…”

Adenomyosis and Endometrial Cancer: Literature Review

“…Hernandez and Woodruff [39], for example, reported that they identified adenomyosis in 21 (10%) out of the 204 hysterectomies carried out for endometrial cancer between 1955 and 1974 and that 2 out of the 21 cases had atypical hyperplasia and 6 had adenocarcinoma in adenomyosis. Lu et al [67] argued that these criteria are too strict. Indeed, they would not apply to any of their 3 cases.…”

Diagnostic and Prognostic Role of WT1 Immunohistochemical Expression in Uterine Carcinoma: A Systematic Review and Meta-Analysis across All Endometrial Carcinoma Histotypes

“…Therefore, to better clarify this issue, we conducted a systematic review and meta-analysis, including all published papers on the WT1 immunohistochemical expression across all histotypes of endometrial carcinoma. The present paper included a total of 35 eligible studies with 52 datasets and 1616 patients for qualitative analysis [ 10 , 11 , 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 ].…”