A Case of Malignant Pleural Effusion Secondary to Endometrial Cancer After One Year of Hysterectomy

Abstract

Endometrial cancer is the most common malignant tumor of the female genital tract. It can rarely metastasize to the lung, presenting as a pulmonary nodule and pleural effusion. Here we present a case of a 76-year-old female with a history of endometrial cancer who underwent a total abdominal hysterectomy and came one year later for evaluation of shortness of breath. She was found to have pleural effusion. Diagnostic and therapeutic thoracentesis was positive for malignant cells originating from endometrial cancer. The patient could not tolerate chemotherapy due to poor functional status, and a tunnel pleural catheter was placed for symptomatic relief. In conclusion, it is a rare finding of malignant pleural effusion to have an origin as endometrial cancer. Pleura is the rare distant site of involvement from endometrial cancer.

Malignant Pleural Effusion Due to Uterine Serous Carcinoma: An Unusual Presentation

“…However, arising primarily in post-menopausal women, serous carcinoma of the uterus is very aggressive and has a tendency for early hematogenous and lymphatic spread. It also has a tendency for intraperitoneal spread [ 2 ]. Lung is one of the organs to which endometrial cancer may spread.…”

“…A study conducted in India found the incidence of pleural effusion among endometrial cancers to be between 6-10% [ 7 , 8 ]. There are isolated case reports in the literature whereby uterine serous carcinoma presents with pleural effusion in the recurrent setting or in the already diagnosed patient [ 1 , 2 ]. There has not been, to our knowledge, previous reports of malignant pleural effusion as the diagnostic presentation of serous endometrial carcinoma in a patient with history of breast carcinoma.…”

“…Treatment for metastatic endometrial carcinoma involves cytoreduction with surgery and treatment with chemotherapy [ 2 , 9 ]. Omentectomy is recommended in patients with serous, carcinomasarcoma and undifferentiated endometrial carcinoma.…”

“…Hormone therapy is a viable alternative in patients with estrogen receptor positivity who have progression of disease. Treatment of malignant pleural effusions secondary to endometrial cancer include therapeutic thoracentesis, pleurodesis and in refractory cases pleurectomy [ 2 , 12 , 13 ].…”

“…These can rarely present as malignant pleural effusions in metastatic endometrial carcinoma [ 1 ]. Extrauterine involvement most commonly results in lymph nodal disease of the paraaortic and pelvic lymph nodes [ 2 ]. Other extrauterine sites of spread include peritoneum, brain, bones and liver [ 3 ].…”