HPV11 Positive Endometrioid Carcinoma of the Endometrium with Signet-Ring Cells: Diagnostic Criteria and Review of the Literature

Abstract

The presence of signet-ring cells in an endometrial adenocarcinoma is extremely uncommon and it is always necessary to rule out a metastatic neoplasm. We report a FIGO grade 2 endometrial carcinoma with a signet-ring cell component found in the curettage performed to a 53-year-old woman. The neoplastic proliferation was also found in the endometrium of the radical hysterectomy with bilateral salpingo-oophorectomy and pelvic and para-aortic lymphadenectomy. The uterine neoplasm invaded less than one-half of the myometrium (FIGO stage I B). Alcian blue showed the presence of mucin in the signet-ring cells. The patient was alive and without evidence of recurrence 14 months after surgery. Polymerase chain reaction method from paraffin-embedded tissue revealed the presence of human papilloma virus type 11. We have discussed the differential diagnosis of this kind of neoplasm and we have reviewed the literature on signet-ring cell carcinoma of the endometrium.

Primary endometrial carcinoma with signet-ring cells. A case report and review of the literature

“…Moreover, PAX8 is a novel tumor marker whose positivity suggests a tumor origin in the epithelium of the Müllerian ducts rather than a gastroin-testinal or breast carcinoma [8]. In relation to CEA, a tumor marker associated mainly with tumors of the gastrointestinal tract, the cases published to date have not been consistent in their results, since three cases were CEA negative [1,4,6], while three others were CEA positives [3,5]. Therefore, this marker has a limited value both to confirm or to rule out a gastrointestinal origin of the primary tumor.…”

“…On the other hand, it is also important to make a differential diagnosis between an endometrial or cervical origin of the tumor. The presence or absence of certain risk factors, the findings of the physical examination and imaging tests and the determination of the human papillomavirus (HPV) status will help established the diagnosis, as well as the IHC studies since the positivity of the hormonal receptors and vimentin, and the negativity of p16, together with the absence of HPV infection, suggest an endometrial origin of the lesion [1,4,5], while contrary results are associated with a cervical origin, as published by Giordano et al [9]Only the case published by Pusiol et al [6] had negative hormonal receptors and positive p16 as well as infection by HPV genotype 11, despite the endometrium being its primary origin.…”

“…The World Health Organization Classification of tumors considers signet-ring cell carcinoma as a rare histological variant of cervical carcinoma of the uterus, although it does not include it among the histological variants of endometrial carcinoma [2]. To date, only six cases of primary endometrial carcinoma with signet-ring cells have been published in the English literature [1,[3][4][5][6].…”

Primary Endometrial Adenocarcinoma with Signet-Ring Cells: A Rarely Observed Case and Review of the Literature

“…This extremely rare case of an “endometrial adenocarcinoma with signet-ring cells” with an interesting histopathological view is, to our knowledge, the sixth reported case in literature. The identification of a “primary endometrial adenocarcinoma with signet-ring cells” requires ruling out metastatic tumours as well as identifying an endometrial origin with the histopathology and immunohistochemical characteristics [ 1 ]. Both of these steps are essential undertakings because the presence of a metastatic tumour presenting with a signet-ring cell positivity most probably notes a breast or a gastric primary tumour, an advanced stage disease, and a different therapeutical approach.…”

“…Presence of signet-ring cells in primary endometrial adenocarcinoma tumours is a rarely observed entity which has to our knowledge been reported in only 5 cases, previously [ 1 – 4 ] ( Table 1 ).…”