Verrucous Carcinoma of the Endometrium

Abstract

Verrucous carcinoma of the endometrium is an exceedingly rare disease with only a few cases reported in the literature. We describe the case of a 68-year-old postmenopausal patient who presented with vaginal discharge. PAP smears were repeatedly reported negative and an endometrial curettage 2 years prior to the diagnosis only showed fragments of benign squamous epithelium. Because of continuous symptoms a hysterectomy was performed and revealed extensive squamous metaplasia of the endometrium with focal transition to verrucous carcinoma. This case demonstrates that benign appearing squamous epithelium in curettage specimens, especially when abundant, is not necessarily ordinary portio epithelium. In this setting, the clinical presentation becomes paramount for considering a well differentiated squamous carcinoma of the endometrium and avoiding diagnostic delay.

Molecular Analysis of HPV-independent Primary Endometrial Squamous Cell Carcinoma Reveals TP53 and CDKN2A Comutations

“…A total of 28 cases was identified in 14 studies (Table 4). 4,5,[7][8][9][10][11][12][13][14][15][16][17][18] The median age at diagnosis was 62 years, which is slightly younger than the women in our study (mean and median, 78 y). The majority of cases were negative for ER and PR in 19/23 (82.6%) and 19/22 (86.4%) cases, respectively.…”

“…This is similar to the results of this study, where ER and PR were negative in all cases. An aberrant p53 expression pattern was identified in at least 4 of 21 (19%) reported cases 5,7–10,18. Before the recommendations for p53 immunohistochemical reporting in endometrial carcinomas were established,22,23 some reported HPV-independent PESCCs were described as p53 “positive” or “negative.” However, it is challenging to determine if cases reported as “positive” represent an aberrant/mutation-type pattern with diffuse nuclear overexpression, an aberrant cytoplasmic staining pattern, or a normal/wild-type pattern when the specific details of p53 immunostaining interpretation are not provided, as is the situation in 2 of 21 (10%) prior cases.…”

“…An aberrant p53 expression pattern was identified in at least 4 of 21 (19%) reported cases. 5,[7][8][9][10]18 Before the recommendations for p53 immunohistochemical reporting in endometrial carcinomas were established, 22,23 some reported HPVindependent PESCCs were described as p53 "positive" or "negative." However, it is challenging to determine if cases reported as "positive" represent an aberrant/mutation-type pattern with diffuse nuclear overexpression, an aberrant The clinicopathologic and molecular results reported herein are similar to what has been described in SCCs arising in other locations in the lower gynecologic tract.…”

“…The pathogenesis of PESCC is not well understood, and both human papillomavirus (HPV)-associated [4][5][6] and HPV-independent 4,5,[7][8][9][10][11][12][13][14][15][16][17][18] tumors have been described. For HPV-independent tumors, nulliparity, pyometra, and ichthyosis uteri have been implicated as associated conditions.…”

Überraschung in der Abradatdiagnostik

“…Auch diese Sonderfär-bungen zeigten einen weitgehend organoiden plattenepithelialen Aufbau ohne proliferierende oder p53-positive Zellen in den oberen oder mittleren Epithellagen. Da [3]. Zwar sind primä-re Plattenepithelkarzinome des Endometriums, die nicht mit plattenepithelial ausreifenden endometrioiden Adenokarzinomen verwechselt werden dürfen, in der WHO-Klassifikation beschrieben, aber es ist ein sehr seltenes Ereignis.…”