Keywords: Cervical cancer; endometrial serous adenocarcinoma; endometrial polyps
Uterine serous carcinoma (USC) as a rare and aggressive
type, unlike the endometrioid type, is not associated with hyperestrogenism and atypical endometrial
hyperplasia. However, the endometrial intraepithelial
carcinoma is found to be a precursor of it and its associated
with high BMI and hypertension.[
The presentation of patients with USC is often
with extrauterine disease despite minimally invasive
involvement and has a poor prognosis in comparison
with endometrioid type. Polyp- confined USC is
a very rare form of uterine serous carcinoma.[
Due to an abnormal pap test, colposcopy was carried out and it was in favor of cervical adenocarcinoma. As the sonography showed an increase in endometrial thickness, we brought her to the operation room for hysteroscopy.
Macroscopically, there was a 3*2*2cm solid, creambrown
with tip hemorrhage polyp in the uterine cavity
and in microscopic view the uterine cavity mass (Fig.
Histologically, serous adenocarcinoma on polyp was seen, adenomyosis was not involved by carcinoma, and there were no signs of myoinvasion, lymphovascular and omentum involvement.
Immunohistochemically, endometrial mass sample
for P16, P53, vimetin and PAX8 was positive with a high ki67 index (>75%), while ER and WT1 were negative
(Fig.
According to findings and FIGO staging system (2015) and also pTNM staging (AJCC-2017), the tumor was considered as stage 1A and chemotherapy was started for her with convenient results.
In this case, we report a cervical adenocarcinoma and simultaneous detection of endometrial serous carcinoma within the confines of polyp without the involvement of myometrium and other parts of the endometrium, which is unusual and rare.
As the age of a woman advances above its fourth
and fifth decades, endometrial polyps would be a common
finding, and its likelihood with the presence of
hypertension, tamoxifen therapy and obesity rises even
more. Approximately 5.42% of endometrial polyps
contain premalignant or malignant disease, but commonly,
they are considered to be benign lesions.[
Endometrioid adenocarcinoma is the most common
and uterine serous carcinoma (USC) is less common malignant lesions in endometrial polyps. USC, as
an aggressive cancer, has an increasing risk of recurrence
and metastasis. Although estrogen and progesterone
receptor positivity have been reported in the
USC cases in few studies, they are negative in almost
all USC cases. Thus, they are not responsive to hormone
therapy. In contrast, USC cases almost always
have strong reactivity for P53, as our present case has.
[
Concomitant endometrial cancers with cervical cancer
in gynecologic oncology, are very rare conditions,
and to date, few cases have been reported.[
Cervical and endometrial cancers showed up usually
with early symptoms, such as vaginal bleeding.
Thus, they were often diagnosed in stage 1. Cervix and
endometrium should be closely inspected when abnormal vaginal bleeding occurs. To be more accurate,
the postoperative pathological examination should be
carried out and staging before and after the operation
is necessary for determining the type of treatment.[
Treatment strategies in these cases are remaining
controversy. Adjuvant therapy, radiation therapy and
surgery have been debated and everyone reported to
be efficient in specific conditions.[
In our case, as we had a specific condition besides
similarities to a few studies, in tumor board, some recommended
starting radiotherapy because of cervical
involvement. However, we decided to start adjuvant
chemotherapy after surgical management, and fortunately,
now, she is in good condition with well follow
up results.
Informed consent: Written informed consent was obtained from the patient for publishing case report and images.
Peer-review: Externally peer-reviewed.
Conflict of Interest: There is no conflicts of interest.
Financial Disclosure: There is no source of support.
Authorship contributions: Concept - S.A.; Design - M.M, S.R.; Supervision - S.A.; Materials - None; Data collection &/or processing - M.M.; Analysis and/or interpretation - S.A., M.M.; Literature search - S.R.; Writing - S.R.; Critical review - S.A.
