Cholangiocarcinoma Presenting as Uterine Metastasis

Abstract

Metastases to the female genital tract are rare, with metastatic disease restricted to the uterus being even less frequent. The primary tumor is most often intragenital rather than extragenital. The diagnosis is usually made after occurrence of gynecological symptoms. We describe the case of a 26-year-old female, in whom a curettage for menorrhagia revealed a uterine malignancy, at first thought to be a carcinosarcoma. Biochemistry only showed iron deficiency anemia. Imaging showed discrepant results with liver lesions, suspect of neoplastic or inflammatory disease. She underwent an abdominal hysterectomy and, peroperatively, a frozen section of a mass in the liver hilus demonstrated a cholangiocarcinoma. The diagnosis of a uterine metastasized cholangiocarcinoma was made. We emphasize the fact that uterine metastases have to be excluded in every woman with abnormal uterine bleeding and a personal history of malignancy. However, our case also indicates that gynecological metastatic disease may be the first presentation of an extragenital primary neoplasm.

Metastatic Cholangiocarcinoma to the Uterus Morphologically Imitating Primary Intestinal-type Endometrioid Adenocarcinoma

“…Metastases from extragenital malignancies are uncommon, and typically originate from the breast or gastrointestinal tract primary (5-7). Typically, patients presenting with uterine metastatic disease have a known primary diagnosis, though initial presentation due to gynecologic symptoms without a known primary have been reported (7)(8)(9)(10). In one series, gallbladder primary malignancies constituted only 4.8% of these uncommon lesions (6).…”

“…Metastases to the uterus typically retain the native endometrial glands and stroma 6 , 8 , 11 . This case is unusual for the near-complete replacement of native endometrial glands and stroma (Fig.…”

“…Overall, extragenital metastatic disease to the corpus, endometrium, and cervix is uncommon, with breast cancer being the most common primary tumor (5)(6)(7). Typically, metastases to the uterus retain native endometrial glands (7)(8)(9) with expansion of stroma and only focal effacement of glandular architecture. Cholangiocarcinoma metastatic to the uterus was first reported in 1941 (5).…”

“…Cholangiocarcinoma metastatic to the uterus was first reported in 1941 (5). The bile ducts remain an uncommon primary source for metastases to the uterus, with only a few published case reports (5)(6)(7)(8)(9)(10). The rarity of uterine metastasis may reflect the historical high rates of mortality from hepatic/pulmonary disease before the establishment of distant metastases.…”

Cholangiocarcinoma Presenting as Linitis Plastica with Unusual Metastases to the Psoas Muscle and Urinary Bladder

“…With respect to the genitourinary system, no published cases involve the urinary components of the genitourinary system; the current literature regarding metastatic cholangiocarcinoma include only the penis, uterus, and ovary. 9 - 11 Bladder metastasis along with infiltration of the left psoas muscle may have contributed to hydronephrosis and acute kidney injury.…”