Endometrium-Limited Metastasis of Extragenital Malignancies: A Challenge in the Diagnosis of Endometrial Curettage Specimens

Abstract

Malignancies of extragenital origin very rarely metastasize to the uterine body. Endometrium-limited metastases may pose diagnostic challenges in endometrial curettage specimens as they may be misdiagnosed as primary endometrial tumors. We investigated the clinicopathological characteristics of seven cases with endometrial-limited metastases from carcinomas of the nasopharynx (n = 1), breast (n = 2), colon (n = 2), stomach (n = 1), and appendix (n = 1). The patients’ ages ranged from 36 to 71 (mean: 55.4) years. None of the patients had a remarkable gynecological history, and the presenting sign in all cases was abnormal uterine bleeding. Although myometrial involvement was absent, multiple metastases were already present in extrauterine locations such as the lung, liver, bone, abdominopelvic peritoneum, and omentum. All patients underwent ultrasonographic examination prior to endometrial curettage. The histologies of the endometrial metastases identified from the curettage specimens were identical to those of the corresponding primary tumors. Ancillary tests including immunostaining and Epstein–Barr virus-encoded RNA in situ hybridization confirmed the extragenital origin. Endometrium-limited metastases from extragenital malignancies are extremely rare. They present with abnormal vaginal bleeding and mimic endometrial carcinomas of endometrioid or poorly differentiated types. Since their clinical presentations and histological features are similar to those of primary endometrial tumors, pathologists should consider the possibility of metastases while evaluating endometrial curettage specimens obtained from patients with a history of extragenital malignancies.

Clinicopathological Characteristics of Microscopic Tubal Intraepithelial Metastases from Adenocarcinoma and Small Cell Neuroendocrine Carcinoma of the Uterine Cervix

“…Briefly, 4-μm-thick, formalin-fixed, paraffinembedded slices were deparaffinized and rehydrated using a xylene and alcohol solution. Immunostaining was performed using the Bond Polymer Intense Detection System (Vision Biosystems, Mount Waverly, Victoria, Australia) (13)(14)(15)(16)(17)(18)(19). After antigen retrieval, the slices were incubated with primary antibodies including estrogen receptor (ER; 1:150, clone 6F11, Novocastra, Leica Biosystems, Newcastle Upon Tyne, UK), progesterone receptor (PR; 1:100, clone 16, Novocastra), p53 (1:300, clone DO-7, Novocastra), p16 (prediluted, clone E6H4, Ventana Medical Systems, Oro Valley, AZ, USA), neural cell adhesion molecule (CD56, 1:200, clone CD564, Novocastra), chromogranin A (1:800, clone DAK-A3, Dako, Agilent Technologies, Inc., Santa Clara, CA, USA), synaptophysin (1:400, clone DAKO-SYNAP, Dako), and Wilms tumor 1 (WT1, 1:800, clone 6F-H2, Cell Marque, Rocklin, CA, USA).…”

Clinicopathological Characteristics of Pleomorphic High-Grade Squamous Intraepithelial Lesion of the Uterine Cervix: A Single-Institutional Series of 31 Cases

“…The p16 immunostaining pattern was interpreted as block positive when p16 expression was strong and continuous along the basal and parabasal layers, and involved nuclear or nuclear plus cytoplasmic staining. All other p16 immunostaining patterns, described as focal nuclear staining or wispy, blob-like, puddled, or scattered cytoplasmic staining, were interpreted as patchy positive [ 2 , 11 , 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ].…”

Serous Carcinoma of the Endometrium with Mesonephric-Like Differentiation Initially Misdiagnosed as Uterine Mesonephric-Like Adenocarcinoma: A Case Report with Emphasis on the Immunostaining and the Identification of Splice Site TP53 Mutation

“…Immunostaining was performed using a compact polymer method (Bond Polymer Refine Detection kit, Leica Biosystems, Newcastle, United Kingdom) [ 13 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 ]. The tumor cells showed focal nuclear PAX2 immunoreactivity with mild-to-moderate staining intensity ( Figure 2 A).…”